Papers by Mariana Gnoatto
Devido a que o pensamento de Karl Marx constitui uma obra aberta, o marxismo integra diversas tra... more Devido a que o pensamento de Karl Marx constitui uma obra aberta, o marxismo integra diversas tradições ideológicas, filosóficas e políticas. Não existem definições únicas e taxativas, como erroneamente afirmavam os antigos manuais soviéticos de divulgação (ou outros similares inspirados neles). Cada tradição marxista reinterpreta o legado de Marx e suas categorias de diverso modo. Há muitas maneiras possíveis de compreender este pensamento. Obviamente, não somos exceção. Expressamos, apenas, uma aproximação possível ao marxismo. Existem outras.
Revista Espanola De Cardiologia, 2007
:441-4 441 Typically, sustained monomorphic ventricular tachycardia (SMVT) in patients with a pre... more :441-4 441 Typically, sustained monomorphic ventricular tachycardia (SMVT) in patients with a previous myocardial infarction (MI) is characterized by a wide QRS complex. However, occasionally patients present with SMVT and a narrow QRS complex (N-SMVT). We studied retrospectively the incidence of N-SMVT (i.e., QRS interval <140 ms) in patients with a previous MI and inducible SMVT who underwent electrophysiological evaluation. Of the 135 consecutive patients with inducible SMVT, 8 (5.9%) presented with inducible N-SMVT. The mean QRS complex duration in patients with N-SMVT was 126 (8) ms. Radiofrequency ablation was successful in 5 out of 6 patients (83%). One of the remaining two received an implantable defibrillator, while the other was given amiodarone. Findings during radiofrequency ablation showed that the reentry circuit was located in the left septum in 4 out of the 5 patients (80%). N-SMVT is relatively uncommon, but the success rate of radiofrequency ablation is high. The reentry circuit is most often located in the septum. Palabras clave: Ablación con catéter. Electrofisiología. Taquicardia. Infarto de miocardio.
Europace, 2005
The mechanism by which atrial fibrillation is initiated in patients with accessory pathways is no... more The mechanism by which atrial fibrillation is initiated in patients with accessory pathways is not fully understood. Retrograde conduction of ventricular premature beats to the atrium, causing the arrhythmia, is a very rare cause. We report a patient with WolffeParkinsoneWhite syndrome (WPW), without previous tachycardias, who presented multiple episodes of paroxysmal atrial fibrillation after having a myocardial infarction. During the electrophysiological (EP) study the patient presented two spontaneous episodes of atrial fibrillation initiated by ventricular premature beats conducted to the atria through the accessory pathway. After successful catheter ablation of the accessory pathway the patient did not present arrhythmia recurrences.
Pace-pacing and Clinical Electrophysiology, 2003
Journal of Cardiovascular Electrophysiology, 2005
Introduction: Reentry within a major thoracic vein has been suggested as a cause of atrial arrhyt... more Introduction: Reentry within a major thoracic vein has been suggested as a cause of atrial arrhythmias. However, little is known about these potential reentrant circuits.Methods and Results: Atypical atrial flutter was induced and mapped in 67 out of 225 atrial flutter ablation procedures. Reentry around the superior vena cava (SVC) was suspected in three patients. The suspected SVC flutter was induced and terminated by pacing in all patients. Fusion was demonstrated during flutter entrainment by subeustachian isthmus pacing in all of them. The postpacing interval following entrainment by pacing from different sites of the right atrium (RA) or coronary sinus was longer than the flutter cycle length. Macroreentry within the SVC was demonstrated both by sequential activation and a postpacing interval matching the flutter cycle length when pacing from different sites around the SVC in all patients. Atrial–venous–atrial electrogram sequence was demonstrated following flutter entrainment by atrial pacing. Flutter was terminated by an electrical stimulus delivered to the SVC, which was not propagated to the trabeculated RA, in one patient, and linear radiofrequency application from the distal SVC to the posterior wall of the RA, or to the superoseptal portion of the crista terminalis, in the other two.Conclusion: Macroreentry within the SVC is a distinctive mechanism responsible for rapid atrial activation, which is different from other reported flutter mechanisms, such as upper loop reentry. SVC longitudinal radiofrequency application can eliminate the arrhythmia without the need for complete electrical disconnection of the vein.
Pace-pacing and Clinical Electrophysiology, 2008
Background:Catheterization of the coronary sinus (CS) plays a preponderant role in device implant... more Background:Catheterization of the coronary sinus (CS) plays a preponderant role in device implantation and electrophysiology. Nevertheless, catheterization of this structure can be time-consuming and is related to operator experience. An inferior radiolucent area of the cardiac right anterior oblique (RAO) view has been suggested as a landmark to guide CS catheterization. However, the true relationship of this area with the CS ostium (CSO) has not been studied.Methods:Thirty-five consecutive patients who underwent right coronary angiography were prospectively enrolled in the study. Fluoroscopic images of the heart in the right anterior oblique, both immediately before and during the venous phase of right coronary angiography, were recorded and digitally stored. Postprocedure measurements of the inferior radiolucent area within the cardiac silhouette and, subsequently, the distance of this area to the CSO, were performed by two independent observers.Results:A radiolucent area of 9.5 ± 3.0 × 11.0 ± 3.4 mm was identified in the inferior annulus by the two evaluators in all patients. No significant differences in the dimensions of this area were found between the two observers. The CSO was 9.6 ± 7.2 mm superior and 0.1 ± 9.0 mm posterior to the radiolucent area and no statistically significant differences were found between the two observers.Conclusion:An inferior radiolucent area can be identified within the cardiac silhouette in most patients in the RAO view. This area is slightly anterior and inferior to the CSO and can be used for catheterization guidance of this latter structure.
Europace, 2007
An increased incidence of Wolff-Parkinson-White (WPW) syndrome with tricuspid atresia has been re... more An increased incidence of Wolff-Parkinson-White (WPW) syndrome with tricuspid atresia has been reported. Although atrioventricular accessory pathways may develop across suture lines after the Fontan-Björk procedure, the presence of multiple acquired accessory pathways has only been described rarely. We report on a case of a female with tricuspid atresia who underwent the Fontan operation at 5 years of age. One year later, she developed a WPW pattern. Narrow complex tachycardias started at the age of 18. An electrophysiological study revealed the presence of three accessory pathway connections at the surgical anastomosis level. All of them were successfully ablated and there were no recurrences.
Revista Espanola De Cardiologia, 2004
Una paciente de 26 años, diagnosticada de atresia tricuspídea, corregida con operación de Fontan ... more Una paciente de 26 años, diagnosticada de atresia tricuspídea, corregida con operación de Fontan (anastomosis auriculopulmonar y cierre proximal de la arteria pulmonar), fue enviada por presentar episodios documentados de flúter auricular paroxístico. Durante el estudio electrofisiológico se indujo reproduciblemente un flúter auricular común con giro antihorario a través del istmo subeustaquiano. Se realizó la reconstrucción anatómica de la aurícula derecha (AD) mediante el sistema de navegación no fluoroscópico NavX ® (Endocardial Solutions, Minnesota, Estados Unidos) ( , izquierda, oblicua anterior derecha; derecha, oblicua anterior izquierda), que mostraba, al mismo tiempo, un catéter tetrapolar en la orejuela derecha (rojo), uno duodecapolar alrededor del anillo tricuspídeo (amarillo) y uno de ablación en el istmo subeustaquiano (blanco). Este sistema representa, en un modelo tridimensional, la superficie endocárdica mediante el marcado y la unión de los puntos adquiridos con los catéteres. La reconstrucción anatómica de la AD, de las
Aims We sought to determine the incidence, mechanisms, and time to syncope recurrence in patients... more Aims We sought to determine the incidence, mechanisms, and time to syncope recurrence in patients with spontaneous syncopal monomorphic ventricular tachycardia (SyMVT) treated with an implantable cardiac defibrillator (ICD). Methods and results Incidence and causes of syncope following ICD implantation in consecutive patients (n ¼ 26) with spontaneous SyMVT were compared with those found in consecutive patients (n ¼ 50) with spontaneous non-syncopal monomorphic ventricular tachycardia (NSyMVT). Patients with SyMVT had a higher incidence of syncope (46% patients) than those with NSyMVT (2% patients) at 31 + 21 and 34 + 23 months follow-up, respectively (hazard ratio, 0.19; 95% confidence interval, 0.04-0.42; P ¼ 0.0001). Among the former, four patients (15%) had non-arrhythmic syncope and eight patients had arrhythmic syncope (31%), which was associated with either ICD proarrhythmia (seven episodes of VT acceleration or VF degeneration by ATP or low/high-energy shocks in three patients) or spontaneous VT and VF (five episodes in five patients). Median time to the first arrhythmic syncope was 376 days. Arrhythmic syncope presented after a first non-syncopal VT recurrence in six patients (75%). Conclusion Syncope following ICD implantation is common in patients with SyMVT in contrast to patients with NSyMVT. Late syncope presentation supports reassessment of driving restrictions in this setting.
Revista Espanola De Cardiologia, 2007
Rev Esp Cardiol. 2007;60(4):441-4 441
Revista Espanola De Cardiologia, 2004
Revista Espanola De Cardiologia, 2004
Introduction. The ablation of ventricular tachycardia is limited by a number of factors that redu... more Introduction. The ablation of ventricular tachycardia is limited by a number of factors that reduce the effectiveness of this intervention in patients with structural heart disease compared to other types of arrhythmia. Recent years have seen the development of several nonfluoroscopic navigation techniques that facilitate the mapping of complex arrhythmogenic substrates. One such technique, the LocaLisa system, has not previously been tested for the ablation of ventricular tachycardia.
Class I antiarrhythmic drug infusion has been established as the standard test to unmask Brugada ... more Class I antiarrhythmic drug infusion has been established as the standard test to unmask Brugada syndrome. This report presents two patients with Brugada syndrome with positive flecainide response which was not reproducible in a subsequent test.
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Papers by Mariana Gnoatto