Cardiology and Cardiovascular Medicine, Critical Care and Intensive Care Medicine
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Scopus Publications
Scopus Publications
Author's Reply—Left bundle branch pacing as cause for takotsubo cardiomyopathy? Frederico Scuotto, Caio Marcos de Moraes Albertini, Stefano Garzón Dias Lemos, Rodolfo Staico, Renato Samy Assad, Claudio Cirenza Heartrhythm Case Reports, 2021 We thank Dr Ronan Walsh and his team for showing interest in our paper, as well as allowing us the opportunity to further discuss it. Several factors have been reported to trigger takotsubo cardiomyopathy (TCM). In the setting of surgical procedures, the very anesthetic act has been described as a trigger for TCM.1Agarwal S. Sanghvi C. Odo N. Castresana M.R. Perioperative takotsubo cardiomyopathy: implications for anesthesiologist.Ann Card Anaesth. 2019; 22: 309-315Crossref PubMed Scopus (7) Google Scholar,2Meng L. Wells C. Takotsubo cardiomyopathy during emergence from general anaesthesia.Anaesth Intensive Care. 2009; 37: 836-839Crossref PubMed Google Scholar A recognizable number of other triggers are thought to be implicated in TCM onset in this scenario.1Agarwal S. Sanghvi C. Odo N. Castresana M.R. Perioperative takotsubo cardiomyopathy: implications for anesthesiologist.Ann Card Anaesth. 2019; 22: 309-315Crossref PubMed Scopus (7) Google Scholar,2Meng L. Wells C. Takotsubo cardiomyopathy during emergence from general anaesthesia.Anaesth Intensive Care. 2009; 37: 836-839Crossref PubMed Google Scholar However, lead extractions as possible triggers for TCM are not yet published. We recognize that aggressive lead extractions rather than simple lead placement might be a trigger for TCM; however, we hypothesized that this was not the case in our procedure, based on 3 elements. (1) The first approach of the surgical team was not to extract the ventricular lead. The team noticed that it was untied from its venous path and also from the right ventricular apex; hence, if left unextracted, it might still contribute to lead dysfunction and pacemaker malfunctioning. (2) There was no need for mechanical or laser extraction material to remove the electrode. (3) The patient experienced hypertension during the procedure at the time of the new lead placement in the deep septal position, possibly owing to pain at that point of time. In conclusion, we recognized that TCM might have several triggers involving surgical procedures, including right ventricular lead extraction as one of them in our case. However, in light of the above-mentioned explanation, we strongly realized that the new lead placement was the trigger for TCM in this particular case. To the Editor—Left bundle branch pacing as cause for takotsubo cardiomyopathy?HeartRhythm Case ReportsVol. 7Issue 8PreviewScuotto and colleagues1 recently published a case report on takotsubo cardiomyopathy (TCM) after left bundle branch pacing in a 93-year-old man. The insertion of a left bundle branch pacing lead took place after extraction of a failing pacing lead implanted 14 years prior. The authors describe this induction of TCM as a consequence of the insertion of the left bundle pacing lead. The authors do not describe the details of the extraction procedure or the type of lead removed. Full-Text PDF Open Access
Takotsubo cardiomyopathy after left bundle branch pacing: A case report Frederico Scuotto, Caio Marcos de Moraes Albertini, Stefano Garzón Dias Lemos, Rodolfo Staico, Renato Samy Assad, Claudio Cirenza Heartrhythm Case Reports, 2021 Takotsubo cardiomyopathy (TCM) was first reported in Japan in the early 1990s.1 Initial reports had described it mostly as a consequence of emotional or physical stress.1,2 However, over the past 30 years, a variety of conditions have been reported to elicit TCM.2 Atypical situations, such as a lightning strike, hypoglycemic attack, and SARS-CoV-2 infection, have been reported to induce TCM.3–5 Occasionally, pacemaker implantation has also been described as a potential trigger of TCM.6
Upper extremity deep venous thrombosis and pulmonary embolism after transvenous lead replacement or upgrade procedures Caio Marcos de Moraes Albertini, Katia Regina da Silva, Marta Fernandes Lima, Joaquim Maurício da Motta Leal Filho, Martino Martinelli Filho, Roberto Costa PACE Pacing and Clinical Electrophysiology, 2020 BackgroundVenous obstructions are frequent in patients with transvenous leads, although related clinical findings are rarely reported. After lead replacement or upgrade procedures, these lesions are even more frequent, but there is still no evidence to support this observation.AimTo investigate the incidence and possible risk factors for upper extremity deep venous thrombosis (UEDVT) and pulmonary embolism (PE) after lead replacement or upgrade procedures.MethodsProspective cohort carried out between April 2013 and July 2016. Preoperative evaluation included venous ultrasound and pulmonary angiotomography. Diagnostic exams were repeated postoperatively to detect the study outcomes. Multivariate logistic regression models were used to identify prognostic factors.ResultsAmong the 84 patients included, 44 (52.4%) were female and mean age was 59.3 ± 15.2 years. Lead malfunctioning (75.0%) was the main surgical procedure indication. Lead removal was performed in 44 (52.4%) cases. The rate of postoperative combined events was 32.6%, with 24 (28.6%) cases of UEDVT and six (7.1%) cases of PE. Clinical manifestations of deep venous thrombosis occurred in 10 (11.9%) patients. Independent prognostic factors for UEDVT were severe collateral circulation in the preoperative venography (odds ratio [OR] 4.7; 95% confidence interval [CI] 1.1–19.8; P = .037) and transvenous lead extraction (OR 27.4; 95% CI 5.8–128.8; P < .0001).ConclusionReoperations involving previously implanted transvenous leads present high rates of thromboembolic complications. Transvenous lead extraction had a significant impact on the development of UEDVT. These results show the need of further studies to evaluate the role of preventive strategies for this subgroup of patients.
Electrical storm treated successfully in a patient with TANGO2 gene mutation and long QT syndrome: A case report Frederico Scuotto, Maria Fernanda Silva Jardim, Flávia Balbo Piazzon, Caio Marcos de Moraes Albertini, Renato Samy Assad, Guilherme Fenelon, Claudio Cirenza Heartrhythm Case Reports, 2020 Key Teaching Points•Recently, investigators linked a hereditary form of pediatric metabolic myopathy to biallelic truncating mutations in the transport and Golgi organization 2 (TANGO2) gene. This condition is characterized by a syndrome including encephalopathy, hypoglycemia, and rhabdomyolysis and cardiac arrhythmias.•TANGO2 mutation syndrome–related cardiac arrhythmias are associated with long QT interval, which may result in torsades de pointes, ventricular fibrillation, and sudden cardiac death.•Patients with TANGO2-related electrical storm may be successfully treated conventionally, with transvenous pacing and intravenous beta-blockers. Moreover, isoproterenol may also play an important role, serving as a bridge until successful pacing is achieved. •Recently, investigators linked a hereditary form of pediatric metabolic myopathy to biallelic truncating mutations in the transport and Golgi organization 2 (TANGO2) gene. This condition is characterized by a syndrome including encephalopathy, hypoglycemia, and rhabdomyolysis and cardiac arrhythmias.•TANGO2 mutation syndrome–related cardiac arrhythmias are associated with long QT interval, which may result in torsades de pointes, ventricular fibrillation, and sudden cardiac death.•Patients with TANGO2-related electrical storm may be successfully treated conventionally, with transvenous pacing and intravenous beta-blockers. Moreover, isoproterenol may also play an important role, serving as a bridge until successful pacing is achieved.
Efficacy, safety, and performance of isolated left vs. Right ventricular pacing in patients with bradyarrhythmias: A randomized controlled trial Elizabeth Sartori Crevelari, Katia Regina da Silva, Caio Marcos de Moraes Albertini, Marcelo Luiz Campos Vieira, Martino Martinelli Filho, Roberto Costa Arquivos Brasileiros De Cardiologia, 2019 Background Considering the potential deleterious effects of right ventricular (RV) pacing, the hypothesis of this study is that isolated left ventricular (LV) pacing through the coronary sinus is safe and may provide better clinical and echocardiographic benefits to patients with bradyarrhythmias and normal ventricular function requiring heart rate correction alone. Objective To assess the safety, efficacy, and effects of LV pacing using an active-fixation coronary sinus lead in comparison with RV pacing, in patients eligible for conventional pacemaker (PM) implantation. Methods Randomized, controlled, and single-blinded clinical trial in adult patients submitted to PM implantation due to bradyarrhythmias and systolic ventricular function ≥ 0.40. Randomization (RV vs. LV) occurred before PM implantation. The main results of the study were procedural success, safety, and efficacy. Secondary results were clinical and echocardiographic changes. Chi-squared test, Fisher's exact test and Student's t-test were used, considering a significance level of 5%. Results From June 2012 to January 2014, 91 patients were included, 36 in the RV Group and 55 in the LV Group. Baseline characteristics of patients in both groups were similar. PM implantation was performed successfully and without any complications in all patients in the RV group. Of the 55 patients initially allocated into the LV group, active-fixation coronary sinus lead implantation was not possible in 20 (36.4%) patients. The most frequent complication was phrenic nerve stimulation, detected in 9 (25.7%) patients in the LV group. During the follow-up period, there were no hospitalizations due to heart failure. Reductions of more than 10% in left ventricular ejection fraction were observed in 23.5% of patients in the RV group and 20.6% of those in the LV group (p = 0.767). Tissue Doppler analysis showed that 91.2% of subjects in the RV group and 68.8% of those in the LV group had interventricular dyssynchrony (p = 0.022). Conclusion The procedural success rate of LV implant was low, and the safety of the procedure was influenced mainly by the high rate of phrenic nerve stimulation in the postoperative period.
Usefulness of preoperative venography in patients with cardiac implantable electronic devices submitted to lead replacement or device upgrade procedures Caio Marcos de Moraes Albertini, Katia Regina da Silva, Joaquim Maurício da Motta Leal Filho, Elizabeth Sartori Crevelari, Martino Martinelli Filho, Francisco Cesar Carnevale, Roberto Costa Arquivos Brasileiros De Cardiologia, 2018 Background Venous obstructions are common in patients with transvenous cardiac implantable electronic devices, but they rarely cause immediate clinical problems. The main consequence of these lesions is the difficulty in obtaining venous access for additional leads implantation. Objectives We aimed to assess the prevalence and predictor factors of venous lesions in patients referred to lead reoperations, and to define the role of preoperative venography in the planning of these procedures. Methods From April 2013 to July 2016, contrast venography was performed in 100 patients referred to device upgrade, revision and lead extraction. Venous lesions were classified as non-significant (< 50%), moderate stenosis (51-70%), severe stenosis (71-99%) or occlusion (100%). Collateral circulation was classified as absent, discrete, moderate or accentuated. The surgical strategy was defined according to the result of the preoperative venography. Univariate analysis was used to investigate predictor factors related to the occurrence of these lesions, with 5% of significance level. Results Moderate venous stenosis was observed in 23%, severe in 13% and occlusions in 11%. There were no significant differences in relation to the device side or the venous segment. The usefulness of the preoperative venography to define the operative tactic was proven, and in 99% of the cases, the established surgical strategy could be performed according to plan. Conclusions The prevalence of venous obstruction is high in CIED recipients referred to reoperations. Venography is highly indicated as a preoperative examination for allowing the adequate surgical planning of procedures involving previous transvenous leads.
Prognosis determinants after cardioverter-defibrillators implantation in Brazil Arn Migowski, Regina Maria de Aquino Xavier Arquivos Brasileiros De Cardiologia, 2017 Mailing Address: Arn Migowski • Rua das Laranjeiras 374, Instituto Nacional de Cardiologia, 5o andar. Postal Code 22240-006, Laranjeiras, RJ – Brazil E-mail: arnmigowski@yahoo.com.br, arn.santos@inca.gov.br Manuscript received November 30, 2016, revised manuscript January 26, 2017, accepted January 26, 2017
Complications after surgical procedures in patients with cardiac implantable electronic devices: Results of a prospective registry Katia Regina da Silva, Caio Marcos de Moraes Albertini, Elizabeth Sartori Crevelari, Eduardo Infante Januzzi de Carvalho, Alfredo Inácio Fiorelli, Martino Martinelli Filho, Roberto Costa Arquivos Brasileiros De Cardiologia, 2016 Background: Complications after surgical procedures in patients with cardiac implantable electronic devices (CIED) are an emerging problem due to an increasing number of such procedures and aging of the population, which consequently increases the frequency of comorbidities. Objective: To identify the rates of postoperative complications, mortality, and hospital readmissions, and evaluate the risk factors for the occurrence of these events. Methods: Prospective and unicentric study that included all individuals undergoing CIED surgical procedures from February to August 2011. The patients were distributed by type of procedure into the following groups: initial implantations (cohort 1), generator exchange (cohort 2), and lead-related procedures (cohort 3). The outcomes were evaluated by an independent committee. Univariate and multivariate analyses assessed the risk factors, and the Kaplan-Meier method was used for survival analysis. Results: A total of 713 patients were included in the study and distributed as follows: 333 in cohort 1, 304 in cohort 2, and 76 in cohort 3. Postoperative complications were detected in 7.5%, 1.6%, and 11.8% of the patients in cohorts 1, 2, and 3, respectively (p = 0.014). During a 6-month follow-up, there were 58 (8.1%) deaths and 75 (10.5%) hospital readmissions. Predictors of hospital readmission included the use of implantable cardioverter-defibrillators (odds ratio [OR] = 4.2), functional class III-IV (OR = 1.8), and warfarin administration (OR = 1.9). Predictors of mortality included age over 80 years (OR = 2.4), ventricular dysfunction (OR = 2.2), functional class III-IV (OR = 3.3), and warfarin administration (OR = 2.3). Conclusions: Postoperative complications, hospital readmissions, and deaths occurred frequently and were strongly related to the type of procedure performed, type of CIED, and severity of the patient's underlying heart disease.
Glocal Clinical Registries: Pacemaker Registry Design and Implementation for Global and Local Integration - Methodology and Case Study Kátia Regina da Silva, Roberto Costa, Elizabeth Sartori Crevelari, Marianna Sobral Lacerda, Caio Marcos de Moraes Albertini, Martino Martinelli Filho, José Eduardo Santana, João Ricardo Nickenig Vissoci, Ricardo Pietrobon, Jacson V. Barros Plos One, 2013 Background The ability to apply standard and interoperable solutions for implementing and managing medical registries as well as aggregate, reproduce, and access data sets from legacy formats and platforms to advanced standard formats and operating systems are crucial for both clinical healthcare and biomedical research settings. Purpose Our study describes a reproducible, highly scalable, standard framework for a device registry implementation addressing both local data quality components and global linking problems. Methods and Results We developed a device registry framework involving the following steps: (1) Data standards definition and representation of the research workflow, (2) Development of electronic case report forms using REDCap (Research Electronic Data Capture), (3) Data collection according to the clinical research workflow and, (4) Data augmentation by enriching the registry database with local electronic health records, governmental database and linked open data collections, (5) Data quality control and (6) Data dissemination through the registry Web site. Our registry adopted all applicable standardized data elements proposed by American College Cardiology / American Heart Association Clinical Data Standards, as well as variables derived from cardiac devices randomized trials and Clinical Data Interchange Standards Consortium. Local interoperability was performed between REDCap and data derived from Electronic Health Record system. The original data set was also augmented by incorporating the reimbursed values paid by the Brazilian government during a hospitalization for pacemaker implantation. By linking our registry to the open data collection repository Linked Clinical Trials (LinkedCT) we found 130 clinical trials which are potentially correlated with our pacemaker registry. Conclusion This study demonstrates how standard and reproducible solutions can be applied in the implementation of medical registries to constitute a re-usable framework. Such approach has the potential to facilitate data integration between healthcare and research settings, also being a useful framework to be used in other biomedical registries.
