Papers by Francisco Madeira
European journal of echocardiography, Dec 1, 1999
Revista portuguesa de cardiologia, Oct 1, 2020
A patient with a dual chamber pacemaker was admitted to the emergency room after out-of-hospital ... more A patient with a dual chamber pacemaker was admitted to the emergency room after out-of-hospital cardioversion for syncopal sustained monomorphic ventricular tachycardia. Device interrogation revealed an abnormally timed ventricular spike after a ventricular premature beat at the beginning of the event, caused by a pacemaker algorithm designed to avoid atrial fibrillation, non-competitive atrial pacing. Despite the absence of significant coronary lesions, in the setting of a vulnerable substrate-a hypokinetic and hyperechogenic region of ventricular myocardium-a n upgrade to a dual-chamber implantable cardioverter-defibrillator was performed, and substrate ablation was planned.
Research Square (Research Square), Aug 5, 2021
Background Permanent pacemaker (PPM) implantation remain a common nding after Transcatheter aorti... more Background Permanent pacemaker (PPM) implantation remain a common nding after Transcatheter aortic valve replacement (TAVR). Overall rate of PPM implantation after TAVR varies and is related to various factors and is highly variable. The purpose of this review is to evaluate the incidence of new permanent pacemaker implant at 1 year irrespective of valve brand manufacturer, vascular access used, deployment technique/mechanism. Secondary outcomes included all-cause mortality, 30-day, 1-year mortality, and cardiovascular mortality. Methods We performed a systematic search for studies that reported the incidence of PPM implantation after TAVR. Data on study, patient, and procedural characteristics were abstracted. Risk ratios (RRs); odds ratio (OR) and 95% con dence intervals were calculated by use of random effects models. Results 14 studies were included, totalling 25,967 TAVR patients, mean age 80.15 ± 6.91years, 52.9% being male, 26.3% of which required PPM implantation 1-year after intervention (p = 0.00001; RR 115.16). Conclusions Various factors impact the risk for pacemaker implantation after TAVR and one quoter of the patients undergo new permanent pacemaker implant at 1-year post undergoing TAVR. * Plus-minus values are means ±SD. Percentages may not total 100 because of rounding. TAVR transcatheter aortic-valve replacement. † The Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) provides an estimate of the risk of death at 30 days among patients undergoing surgical aortic-valve replacement on the basis of several demographic and procedural variables. ¶ Logistic EuroSCORE range from 0 to 100%, with higher scores indicating greater surgical risk and a score of 20% indicating very high risk; ‡ The Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is a measure of the severity and extent of coronary artery disease. Low SYNTAX scores (<18) are associated with a higher success rate with PCI, scores between 18 and 27 with an intermediate success rate, and scores higher than 27 with a low success rate. § These data were reported by the studies.
Research Square (Research Square), Aug 9, 2021
Background: Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) are increasingly used in clinica... more Background: Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) are increasingly used in clinical practice for patients with atrial fibrillation (AF) undergoing catheter ablation. Catheter ablation is an established treatment option for patients with AF, however, it is associated with significant complications such as ischemic stroke and bleeding. We aimed to compare by meta-analytical techniques, the safety and efficacy of NOACs vs. warfarin. Methods: PUBMED, EMBASE, CENTRAL and Scopus were searched for randomized trials comparing uninterrupted NOACs and warfarin in patients undergoing AF catheter ablation. Ischemic and hemorrhagic stroke, major and minor bleeding, cardiac tamponade and access related complications were compared between the two groups. Results: A total of 4 trials with 1173 patients were included in the meta-analysis. NOACs and warfarin, resulted in similar risk of ischemic stroke [Odds ratio (OR); 0.50; 95% confidence interval (CI): (0.12-2.08); P=0.34), major bleeding [0.33(0.09-1.13); P=0.08] including cardiac tamponade [0.54(0.03-9.05); P=0.67] and minor bleeding [1.13(0.80-1.59); P=0.48], and lower risk of access-related complications [0.56(0.31-1.00); P=0.05)]. Conclusion: The findings of this meta-analysis showed that compared to warfarin, periprocedural anticoagulation with NOACs, result in reduced access-related complications and the incidence of ischemic stroke and bleeding was similar in the two groups.
Europace, May 1, 2021
Funding Acknowledgements: Type of funding sources: None. Introduction: Artificial intelligence (A... more Funding Acknowledgements: Type of funding sources: None. Introduction: Artificial intelligence (AI) through machine learning (ML) refers to the simulation of human intelligence with the capacity for achieving goals within computers. In electrophysiology, ML has many applications in electrocardiography, intracardiac mapping and cardiac implantable electronic devices (CIEDs). Remote monitoring (RM) of patients equipped with CIEDs associates the analysis of event reports and calendar-based remote follow-ups (FU). ML applications have allowed for risk stratification, improved arrhythmia localisation and streamlined remote monitoring which may significantly reduce the workload faced by electrophysiologists. Aim To develop a system that automates cardiac implantable electronic devices remote follow-up. Methods and Results We created a Java software application, that uses the latest optical character recognition techniques combined with artificial intelligence and natural language processing to extract information from PDF reports of RM of CIEDs from different manufacturers. The current version is HIPAA (Health Insurance Portability and Accountability Act) complaint and runs on local computers only. Using the current system, we were able to run and extract data from 30 remote follow-up PDF reports of Cardiac Implantable Defibrillators (ICDs) and Cardiac Resynchronization Therapy with Defibrillator (CRT-Ds). Time taken from data extraction to conversion of all 30 device PDFs was under 5 minutes. Process and data extracted are presented in the figure below. (Figure 1) Conclusion: This machine learning algorithm proved that it is possible to facilitate and automate remote follow-up of cardiac implantable electronic devices. In a near future this will allow to us to efficiently increase productivity, by speeding and facilitating interpretation of remote device follow-ups, leading to improvements in patientcare and precision cardiovascular medicine. Furthermore, in the current and future pandemics it may help prevent unnecessary in-person medical visits, avoiding additional, unnecessary strain on an already overburdened and overwhelmed healthcare system, and saving costs.
Europace, Jun 1, 2017
Among warfarin groups, continued warfarin group were 157 patients and discontinued warfarin group... more Among warfarin groups, continued warfarin group were 157 patients and discontinued warfarin group were 410 patients including 173 patients treated with heparin-bridging.Among DOACs groups, continued DOACs group were 21 patients and discontinued DOACs group were 84 patients.There was no significant difference of major bleeding complication between continued warfarin and DOACs groups (9.6 % vs. 9.5 %, p ¼ 0.98, respectively). In discontinued anticoagulation groups, compared with discontinued warfarin group, discontinued DOACs group had significantly lower rate of major bleeding complication (7.6 % vs. 1.2 %, p ¼ 0.03, respectively). Conclusions: Major bleeding complication in both continued warfarin and DOACs groups is relatively high in operation of CIEDs. Considering discontinued anticoagulation, using DOACs with lower bleeding complication is better choice than warfarin.
Europace, Jun 1, 2017
adenosine analog 2-chloro-N6-cyclopentyladenosine (50 nM CCPA) and the A1-R antagonist 1-butyl-3-... more adenosine analog 2-chloro-N6-cyclopentyladenosine (50 nM CCPA) and the A1-R antagonist 1-butyl-3-(3-hydroxypropyl)-8-(3-noradamantyl)xanthine (40 nM PSB36) were applied in this study. CCPA shortened both the AP duration at 90% repolarization (APD90) and the atrial effective refractory period (ERP). In addition, the adenosine analog strongly affected the membrane excitability by reducing the rheobase. Application of PSB36 prolonged APD90 and ERP, and in addition increased the rheobase. Rapid electrical stimulation (burst pacing) was applied to induce AF. Hearts treated with CCPA revealed a profound increase in AF inducibility (control 52% 6 14.75 vs. CCPA 80% 6 9.60). In contrast, PSB36 strongly prevented AF events (16% 6 5.54) and reduced AF duration (control 24.54 s 6 8.15; CCPA 27.14 s 6 9.04; PSB36 13.59 s 6 7.72). In addition, acute administration of PSB36 reverted hearts back to sinus rhythm following more than five minutes in AF. In conclusion, in isolated rat heart preparations A1 receptor activity, probably due to local release of adenosine, has a profound effect on atrial electrophysiology, promoting AF vulnerability.
Europace, Dec 1, 2003
Significant variations exist in the distribution pattern of atriovenhicular block, sick sinus syn... more Significant variations exist in the distribution pattern of atriovenhicular block, sick sinus syndrome and slow atria1 fibrillation. Also for the more uncmmmn indications, some relevant differences between countries occur
Journal of Cardiovascular Echography, 2019
We report a case of a 43-year-old man with situs inversus and dextrocardia who was admitted with ... more We report a case of a 43-year-old man with situs inversus and dextrocardia who was admitted with syncope in the setting of complete atrioventricular block. The complex anatomy poses a considerable challenge to transvenous permanent pacemaker implantation. We employed a novel technique using vascular ultrasound and agitated saline solution to assist with lead positioning. This technique could be useful in pediatric populations or younger patients, in whom the use of ionizing radiation is an important issue.
American Journal of Cardiology, Dec 1, 2019
LivaNova had no role in the study beyond funding. Conflicts of Interest J.B.A. reports grant supp... more LivaNova had no role in the study beyond funding. Conflicts of Interest J.B.A. reports grant supports by LivaNova. The other authors have no conflicts of interest to declare.
Revista portuguesa de cardiologia, Oct 1, 2014
Based on a survey sent to Portuguese centers that perform diagnostic and interventional electroph... more Based on a survey sent to Portuguese centers that perform diagnostic and interventional electrophysiology and/or implantable cardioverter-defibrillator (ICD) implantations, the authors analyze the number and type of procedures performed during 2012 and compare these data with previous years. In 2012, a total of 2561 diagnostic electrophysiologic studies were performed, which were followed by ablation in 2017 cases, representing a steady situation compared with the previous year. There was a 12% increase in the number of ablation procedures for atrial fibrillation, making it for the first time the most frequent indication for ablation, overtaking atrioventricular nodal reentrant tachycardia. The total number of first ICD implantations was 1048 (around 100 per million population), of which 375 were cardiac resynchronization devices (BiV ICDs). This represents a slight decrease (3.3%) in the total number of new implants, with a relative increase of 10% in the number of BiV ICDs compared to the previous year. However, there was a considerable increase in the number of ICD generator replacements, resulting in an overall increase of 3.5% in implantations performed in 2012. Some comments are made regarding developments in this activity and its current status, and on some factors that may influence the dynamics of this area of interventional cardiology.
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2001
To evaluate the association between patterns of pulmonary transvalvular and venous flows in patie... more To evaluate the association between patterns of pulmonary transvalvular and venous flows in patients with ischemic heart disease, assessed by Doppler echocardiography, and invasive measurements of left ventricular (LV) diastolic pressures. Thirty-seven patients with clinical diagnosis or suspicion of coronary heart disease and referred for coronary angiography; all were in sinus rhythm, and had no known valvular heart or chronic pulmonary disease. The following were recorded during transthoracic Doppler echocardiography: acceleration time (AT) and total ejection time (ET) of right ventricular outflow; duration of the flow at atrial contraction (a duration) and duration of the "A" wave of mitral inflow (A duration). These data were correlated with the values of LV filling pressures previously obtained by cardiac catheterization. We found a significant correlation of LV end-diastolic pressures with the difference a-A duration (r = 0.75; p < 0.001) and also with the ratio ...
Diabetes/Metabolism Research and Reviews, 2017
Background: Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) are increasingly used in clinica... more Background: Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) are increasingly used in clinical practice for patients with atrial fibrillation (AF) undergoing catheter ablation. Catheter ablation is an established treatment option for patients with AF, however, it is associated with significant complications such as ischemic stroke and bleeding. We aimed to compare by meta-analytical techniques, the safety and efficacy of NOACs vs. warfarin. Methods: PUBMED, EMBASE, CENTRAL and Scopus were searched for randomized trials comparing uninterrupted NOACs and warfarin in patients undergoing AF catheter ablation. Ischemic and hemorrhagic stroke, major and minor bleeding, cardiac tamponade and access related complications were compared between the two groups. Results: A total of 4 trials with 1173 patients were included in the meta-analysis. NOACs and warfarin, resulted in similar risk of ischemic stroke [Odds ratio (OR); 0.50; 95% confidence interval (CI): (0.12-2.08); P=0.34), major bleeding [0.33(0.09-1.13); P=0.08] including cardiac tamponade [0.54(0.03-9.05); P=0.67] and minor bleeding [1.13(0.80-1.59); P=0.48], and lower risk of access-related complications [0.56(0.31-1.00); P=0.05)]. Conclusion: The findings of this meta-analysis showed that compared to warfarin, periprocedural anticoagulation with NOACs, result in reduced access-related complications and the incidence of ischemic stroke and bleeding was similar in the two groups.
Revista Portuguesa de Cardiologia, 2020
A patient with a dual chamber pacemaker was admitted to the emergency room after out-of-hospital ... more A patient with a dual chamber pacemaker was admitted to the emergency room after out-of-hospital cardioversion for syncopal sustained monomorphic ventricular tachycardia. Device interrogation revealed an abnormally timed ventricular spike after a ventricular premature beat at the beginning of the event, caused by a pacemaker algorithm designed to avoid atrial fibrillation, non-competitive atrial pacing. Despite the absence of significant coronary lesions, in the setting of a vulnerable substrate-a hypokinetic and hyperechogenic region of ventricular myocardium-a n upgrade to a dual-chamber implantable cardioverter-defibrillator was performed, and substrate ablation was planned.
Journal of Cardiovascular Echography, 2019
We report a case of a 43-year-old man with situs inversus and dextrocardia who was admitted with ... more We report a case of a 43-year-old man with situs inversus and dextrocardia who was admitted with syncope in the setting of complete atrioventricular block. The complex anatomy poses a considerable challenge to transvenous permanent pacemaker implantation. We employed a novel technique using vascular ultrasound and agitated saline solution to assist with lead positioning. This technique could be useful in pediatric populations or younger patients, in whom the use of ionizing radiation is an important issue.
The American Journal of Cardiology, 2019
LivaNova had no role in the study beyond funding. Conflicts of Interest J.B.A. reports grant supp... more LivaNova had no role in the study beyond funding. Conflicts of Interest J.B.A. reports grant supports by LivaNova. The other authors have no conflicts of interest to declare.
EP Europace, 2017
long-stand PAA before, during and after the procedure whereas for 3 (0.3%) pts no PAA was adopted... more long-stand PAA before, during and after the procedure whereas for 3 (0.3%) pts no PAA was adopted. Local application of antibiotics in the pocket was used in 320 (33%) pts, mainly Rifampicin and Cephalosporins. The most commonly used antibiotics were Cephalosporins (712, 72.4%), followed by Penicillin (171, 17.4%), Vancomycin (43, 4.4%), Fluorochinolons (30, 3.1%), Macrolides (22, 2.2%) and Tetracycline (2, 0.2%). Different suture strategy were used: intradermal absorbable suture in 800 (81.4%) pts, discontinued suture in 292 (29.7%) pts, Sticker in 71 (7.2%) and Stapler in 9 (0.9%) pts. The coagulation strategy during and at the end of the procedure included Electrosurgery (568, 57.8%), Diatermalcoagulation (376, 38.3%), Haemostatic in the pocket (76, 7.7%) and pro-coagulant in the pocket (84, 8.5%). Conclusion: We performed the first systematic investigation of preventive strategies for the prevention of ICD replacement-related infections in current Italian practice. This exploratory analysis of the peri-procedural factors potentially influencing outcomes may improve future practice by providing hints on avoidable risks.
Revista Portuguesa de Cardiologia, 2014
Resumo Os autores analisam o número e tipo de procedimentos efetuados durante o ano de 2012 com b... more Resumo Os autores analisam o número e tipo de procedimentos efetuados durante o ano de 2012 com base em inquéritos enviado aos centros nacionais que durante este ano praticaram eletrofisiologia diagnóstica e de intervenção e/ou implantaram cardioversores-desfibrilhadores (CDI), e comparam estes dados com os de anos anteriores. Em 2012 foram efetuados 2561 estudos eletrofisiológicos diagnósticos, seguidos de ablação em 2017 dos casos, o que representa uma estabilização comparativamente ao ano anterior. Registou-se um aumento de 12% no número de ablações de fibrilhação auricular, que passou a representar a indicação mais frequente para ablação, ultrapassando a taquicardia por reentrada nodal auriculoventricular. O número total de primeiras implantações de CDI foi de 1048 (cerca de 100/milhão de habitantes), sendo que, destes, 375 eram CDI com ressincronização ventricular (CDI BIV). Estes dados traduzem um ligeiro decréscimo (3,3%) do número de primeiras implantações, com um aumento relativo de 10% no número de CDI BIV face ao ano anterior. No entanto, verificou-se um crescimento muito significativo no número de substituições de geradores de CDI, de que resultou um acréscimo de 3,5% no total de implantações efetuadas em 2012. São feitas algumas considerações acerca da evolução e estado atual desta atividade hospitalar e sobre alguns fatores que poderão influenciar a dinâmica verificada nesta área da cardiologia de intervenção.
BackgroundPermanent pacemaker (PPM) implantation remain a common finding after Transcatheter aort... more BackgroundPermanent pacemaker (PPM) implantation remain a common finding after Transcatheter aortic valve replacement (TAVR). Overall rate of PPM implantation after TAVR varies and is related to various factors and is highly variable. The purpose of this review is to evaluate the incidence of new permanent pacemaker implant at 1 year irrespective of valve brand manufacturer, vascular access used, deployment technique/mechanism. Secondary outcomes included all-cause mortality, 30-day, 1-year mortality, and cardiovascular mortality.MethodsWe performed a systematic search for studies that reported the incidence of PPM implantation after TAVR. Data on study, patient, and procedural characteristics were abstracted. Risk ratios (RRs); odds ratio (OR) and 95% confidence intervals were calculated by use of random effects models.Results14 studies were included, totalling 25,967 TAVR patients, mean age 80.15 ± 6.91years, 52.9% being male, 26.3% of which required PPM implantation 1-year after ...
Objectives: Patients (pts) operated for type A aortic dissection remain at high risk of late morb... more Objectives: Patients (pts) operated for type A aortic dissection remain at high risk of late morbidity and mortality. The aim of this study was the detection of postsurgical complications and prognostic indexes during a long-term follow-up with magnetic resonance imaging (MRI). Methods: Thirty-seven pts were studied (19 men, 18 women), 3173 years old (54.4 ? 12.2). submitted to surgery for type A aortic dissection, with replacement of ascending aorta. All pts were followed with MRI yearly, since the surgery time until 39.3 -+ 2.9 months to identify postsurgical complications in three aortic segments (arch, thoracic descending, abdominal)-aneurysm, false aneurysm, redissection. rupture, and death. Prognostic indexes analyzed were presence of residual aortic flap, false lumen patency, false lumen dimensions, initial aortic dimensions, and increase rate of aortic dimensions. Results: One hundred eleven aortic segments were analyzed. Complications detected were that aneurysm occurred in...
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Papers by Francisco Madeira