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Victor Sanfins,
Assunção Alves,
Bernardete Rodrigues,
J Carlos Chaves,
Hipólito Reis,
Vitor Lagarto,
Sandra Santos,
José António Nobre,
Vitor Martins,
Isabel Santos,
Cristina Viscenju, Francisco Madeira,
Carlos Morais,
Nuno Morujo,
José Conceição,
Paula Pedrosa,
António Drummond Freitas,
Graça Caires,
Louís Moura Duarte,
Gracieta Ruivo
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ABSTRACT: The aim of this prospective registry is to evaluate a new algorithm designed to reduce the percentage of unnecessary ventricular pacing (%VP) in patients implanted with a dual-chamber pacemaker, through a dedicated pacing mode (called AAISafeR2) operating in AAI mode with back-up ventricular pacing in DDD mode, and to describe the incidence and distribution of atrioventricular (AV) block in this population. Investigators were free to assign patients to AAISafeR2 mode or to standard DDD (if AAISafeR was contraindicated, mainly due to permanent high-degree AV block). Patients underwent routine follow-up visits at 3, 6, 12, 18 and 24 months after implantation. At each follow-up visit, data were retrieved from pacemaker memories and analyzed to extract %VP and incidence of AV block. Up to December 2006, 158 patients (94 men, mean age 69 +/- 14 years) from nine Portuguese centers had been consecutively included. We also determined the distribution of AV block (according to the criteria used by the pacemaker to classify AV block and switch to DDD mode). AAISafeR was shown to be effective in reducing unnecessary VP in our patient population. The analysis also reveals a high incidence of paroxysmal AV block, often unknown at the time of implantation. There were no complications associated with AAISafeR programming.
Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 04/2010; 29(4):581-9.
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ABSTRACT: An implantable cardioverter defibrillator (ICD) is designed to sense life-threatening ventricular arrhythmias and terminate them, either by rapid pacing or by delivering an electrical shock. Nowadays it is a proven therapy for both primary and secondary prevention of sudden cardiac death. The typical configuration of an ICD consists of a right ventricular sensing/defibrillator lead with two coils (one distal, located in the right ventricle, and one proximal, located at the superior vena cava-right atrium junction) and an active can, the so-called "ventricular triad". Although effective in the vast majority of patients, it could be argued that this is not the most rational arrangement in electrical terms, since the main shock vector is anteriorly displaced in relation to the greater portion of the left ventricular mass. We describe a case of an ICD defibrillation failure that was solved by placing an additional defibrillator lead in a tributary of the coronary sinus.
Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 04/2010; 29(4):703-9.
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ABSTRACT: The problem of waiting lists has been widely debated in the Portuguese society. In this paper, the authors report the first results of a prioritization approach, started in March 2000. In this program cardiologists and general practitioners work in close proximity, coordinating efforts in order to improve the establishment of clinical priorities, and consequently optimize hospital referral. Working as cardiology consultants, the authors were able to reduce the number of first consultation requests by 77.9% (December 2002). For the first time it was possible to match the number of requests with the available consultation times, halting the growth of the waiting list.
Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 12/2003; 22(11):1335-42.
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ABSTRACT: To evaluate the role of contrast Doppler echocardiography in the assessment of aortic stenosis severity, in comparison with the conventional method and using the catheterization study as the gold standard.
Prospective comparative study.
Echocardiography Laboratory of Cardiology Department.
We included 36 consecutive patients, 20 male, aged 67 +/- 11 years, referred for catheterization study to evaluate aortic stenosis severity.
All patients underwent conventional and contrast Doppler echocardiography and catheterization study. For contrast Doppler, we used Levovist (300 mg/ml infusion). We analyzed the following echocardiographic parameters: a) left ventricle dimensions, wall thickness and function; b) aortic valve morphology; c) post-stenotic aortic valve flow--peak velocity, velocity-time integral, peak gradient, mean gradient; d) left ventricle outflow tract flow--peak velocity, velocity-time integral; e) aortic valve functional area; f) acquisition time and Doppler signal intensity for post-stenotic aortic valve flow. Catheterization parameters analyzed: a) peak aortic valve gradient; b) mean aortic valve gradient.
Contrast Doppler yielded higher peak gradients than conventional Doppler (85.6 +/- 30.2 vs 72.6 +/- 26.1 mmHg, p < 0.001), as well as higher mean gradients (51.4 +/- 19.0 vs 44.2 +/- 15.9 mmHg, p < 0.001). Peak gradients obtained with contrast Doppler correlated with those obtained invasively (r = 0.88, p < 0.001), although the values were higher (85.6 +/- 30.2 vs 73.6 +/- 32.0 mmHg, p < 0.001). There was no difference between mean contrast Doppler gradients and mean catheterization gradients, which showed a high correlation (r = 0.89, p < 0.001). There was no difference between peak and mean gradients obtained by conventional Doppler and invasively, which yielded correlations of 0.73 and 0.75, respectively (p < 0.001). The sensitivity of contrast Doppler for detection of severe aortic stenosis was 100% for peak gradient and 84% for mean gradient, while for conventional Doppler it was 68% and 58%. The specificity of contrast Doppler was 65% for peak gradient and 88% for mean gradient, while for conventional Doppler it was, respectively, 58% and 88%. Acquisition time for aortic flow visualization was lower (p < 0.001) and flow intensity higher for contrast Doppler, in comparison with conventional Doppler.
In this study, contrast Doppler yielded high correlations with invasive data and higher sensitivity and specificity for detection of severe aortic stenosis than conventional Doppler. It is a useful method for evaluation of aortic stenosis severity.
Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 05/2002; 21(5):555-72.
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22:1335-42.
