Introdução: As extrassístoles ventriculares e supraventriculares (EV e ESSV) são frequentes e muitas vezes sintomáticas. O íon magnésio (Mg) desempenha um papel importante na fisiologia do potencial de ação transmembrana celular e do ritmo cardíaco. Objetivo: Avaliar se a administração do Pidolato de Magnésio (PMg) em pacientes com EV e ESSV é superior ao placebo (P) na melhora dos sintomas e densidade das extrassístoles(DES). Métodos: Estudo duplo-cego, randomizado, com 90 pacientes sintomáticos consecutivos, com mais de 240/EV ou ESSV ao Holter de 24 horas e selecionados para receber P ou PMg. Para avaliar a melhora da sintomatologia, foi feito um questionário categórico e específico de sintomas relacionado às extrassístoles. Foi considerada significante uma redução de mais de 70% na DES por hora após o tratamento. A dose do PMg foi de 3,0g/dia por 30 dias, equivalente a 260mg do elemento Mg. Nenhum paciente tinha cardiopatia estrutural ou insuficiência renal. Resultados: Dos 90 pacientes estudados, 49 eram do sexo feminino (54,4%). A faixa etária variou de 16 a 70 anos. No grupo PMg, 77,8% dos pacientes tiveram redução maior que 70%, 6,7% deles entre 50% a 70% e, somente 13,3% dos pacientes com redução menor que 50% na DES . No grupo P, 44,4% dos pacientes tiveram melhora de apenas 30% na frequência de extrassístoles (p<0,001). A melhora dos sintomas foi alcançada em 91,1% dos pacientes do grupo PMg, comparada com somente 15,6% do grupo P(p<0,001). Conclusão: A suplementação de Mg por via oral reduziu a DES, resultando em melhora dos sintomas. Estudos clínicos e moleculares são necessários para avaliar o Mg intracelular e orientar quanto às necessidades diárias deste íon, evidenciar as prováveis deficiências e esclarecer melhor como prevenir e tratar pacientes com extrassístoles sintomáticas e sem cardiopatia estrutural. / Introduction: Premature ventricular and supraventricular complexes (PVC and PsVC) are frequent and often symptomatic. The magnesium (Mg) ion plays a role in the physiology of cell membranes and cardiac rhythm. Objective: We evaluated whether the administration of Mg Pidolate (MgP) in patients with PVC and PsVC is superior to placebo (P) in improving symptoms and arrhythmia frequency. Methods: Randomized double-blind study with 90 consecutive symptomatic patients with more than 240 PVC or PsVC on 24-hour Holter monitoring who were selected to receive placebo or MgP. To evaluate symptom improvement, a categorical and a specific questionnaire for symptoms related to PVC and PsVC was made. Improvement in premature complex density (PCD) per hour was considered significant if percentage reduction was >=70% after treatment. The dose of MgP was 3.0 g/day for 30 days, equivalent to 260mg of Mg element. None of the patients had structural heart disease or renal failure. Results: Of the 90 patients, 49 were female (54,4%). Ages ranged from 16 to 70 years old. In the MgP group, 77.8% of patients had a PCD reduction >70%, 6,7% of them from 50% to 70%, and only 13.3% <50%. In the P group, 44,4% showed slight improvement, <30%, in the premature complexes frequency (p<0.001). Symptom improvement was achieved in 91.1% of patients in the MgP group, compared with only 15.6% in the P group (p<0.001). Conclusions: Oral Mg supplementation decreases PCD, resulting in symptom improvement. Clinical and molecular studies are needed to evaluate intracellular Mg and develop better targets for the daily needs of this ion, show probable deficiencies, and explain how to prevent and better treat patients with symptomatic premature ventricular, and supraventricular complexes and no apparent heart disease.

La fibrose cardiaque fait le lit des arythmies cardiaques, qu’elles soient atriales ou ventriculaires. L’IRM est devenue un outil non invasif indispensable pour diagnostiquer la présence de fibrose au niveau cardiaque, mais offre également des informations pronostiques, ainsi que pour le suivi des patients atteints de fibrillation auriculaire (FA), notamment persistante. La technique de référence reste le rehaussement tardif après injection de gadolinium, permettant de révéler des régions localisées de fibrose. Notre travail a consisté en la mise au point d’une technique non invasive (par la mesure du T2 avec IRM à haut champ à 11,75 T) afin de quantifier la fibrose myocardique interstitielle diffuse dans un modèle de souris diabétiques. La fibrose a été significativement corrélée à une survenue plus importante des arythmies ventriculaires en comparaison avec un groupe de souris contrôles. L’étape suivante a été de transposer cette technique de mesure de T2 en IRM clinique chez des patients devant bénéficier d’une procédure d’ablation de FA. La deuxième technique, cette fois-ci invasive pour évaluer la fibrose (notamment atriale) pour les patients atteints de FA est la cartographie de voltage au niveau de l’oreillette gauche. Nous avons utilisé un nouveau système de cartographie à ultra-haute définition afin de quantifier la fibrose (zones cicatricielles denses) correspondant aux régions dont les signaux enregistrés avaient une amplitude bipolaire inférieure à 0,015 mV, soit très en deçà des seuils précédemment rapportés concernant la fibrose. / Fibrosis represents the main substrate for cardiac arrhythmias, either atrial or ventricular. MRI has become a critical tool to not only diagnose the presence of cardiac fibrosis, but also provides important informations on the prognosis and the follow-up of patients with atrial fibrillation (AF), especially in its persistent type. The gold standard is the Late Gadolinium Enhancement, allowing to reveal localized regions of fibrosis. Our study reported a technique for non invasive quantification of interstitial diffuse ventricular fibrosis in diabetic mice (T2 measurement high field MRI at 11,75 T). This fibrosis was significantly correlated to the occurrence of ventricular arrhythmias in comparison with the control group. The next step was the transposition of this T2 measurement with MRI in the clinical setup of patients who undergo an AF ablation procedure. The second technique for atrial fibrosis assessment for patients suffering from AF is the invasive realization of left atrial voltage mapping. A new ultra-high definition system was used to quantify the fibrosis (dense scar) in regions with bipolar amplitude electrograms of less than 0,015 mV. This cutoff was far lower than the previously published definition of the dense scar in the literature (< 0,1 mV).

Introdução: As extrassístoles ventriculares e supraventriculares (EV e ESSV) são frequentes e muitas vezes sintomáticas. O íon magnésio (Mg) desempenha um papel importante na fisiologia do potencial de ação transmembrana celular e do ritmo cardíaco. Objetivo: Avaliar se a administração do Pidolato de Magnésio (PMg) em pacientes com EV e ESSV é superior ao placebo (P) na melhora dos sintomas e densidade das extrassístoles(DES). Métodos: Estudo duplo-cego, randomizado, com 90 pacientes sintomáticos consecutivos, com mais de 240/EV ou ESSV ao Holter de 24 horas e selecionados para receber P ou PMg. Para avaliar a melhora da sintomatologia, foi feito um questionário categórico e específico de sintomas relacionado às extrassístoles. Foi considerada significante uma redução de mais de 70% na DES por hora após o tratamento. A dose do PMg foi de 3,0g/dia por 30 dias, equivalente a 260mg do elemento Mg. Nenhum paciente tinha cardiopatia estrutural ou insuficiência renal. Resultados: Dos 90 pacientes estudados, 49 eram do sexo feminino (54,4%). A faixa etária variou de 16 a 70 anos. No grupo PMg, 77,8% dos pacientes tiveram redução maior que 70%, 6,7% deles entre 50% a 70% e, somente 13,3% dos pacientes com redução menor que 50% na DES . No grupo P, 44,4% dos pacientes tiveram melhora de apenas 30% na frequência de extrassístoles (p<0,001). A melhora dos sintomas foi alcançada em 91,1% dos pacientes do grupo PMg, comparada com somente 15,6% do grupo P(p<0,001). Conclusão: A suplementação de Mg por via oral reduziu a DES, resultando em melhora dos sintomas. Estudos clínicos e moleculares são necessários para avaliar o Mg intracelular e orientar quanto às necessidades diárias deste íon, evidenciar as prováveis deficiências e esclarecer melhor como prevenir e tratar pacientes com extrassístoles sintomáticas e sem cardiopatia estrutural. / Introduction: Premature ventricular and supraventricular complexes (PVC and PsVC) are frequent and often symptomatic. The magnesium (Mg) ion plays a role in the physiology of cell membranes and cardiac rhythm. Objective: We evaluated whether the administration of Mg Pidolate (MgP) in patients with PVC and PsVC is superior to placebo (P) in improving symptoms and arrhythmia frequency. Methods: Randomized double-blind study with 90 consecutive symptomatic patients with more than 240 PVC or PsVC on 24-hour Holter monitoring who were selected to receive placebo or MgP. To evaluate symptom improvement, a categorical and a specific questionnaire for symptoms related to PVC and PsVC was made. Improvement in premature complex density (PCD) per hour was considered significant if percentage reduction was >=70% after treatment. The dose of MgP was 3.0 g/day for 30 days, equivalent to 260mg of Mg element. None of the patients had structural heart disease or renal failure. Results: Of the 90 patients, 49 were female (54,4%). Ages ranged from 16 to 70 years old. In the MgP group, 77.8% of patients had a PCD reduction >70%, 6,7% of them from 50% to 70%, and only 13.3% <50%. In the P group, 44,4% showed slight improvement, <30%, in the premature complexes frequency (p<0.001). Symptom improvement was achieved in 91.1% of patients in the MgP group, compared with only 15.6% in the P group (p<0.001). Conclusions: Oral Mg supplementation decreases PCD, resulting in symptom improvement. Clinical and molecular studies are needed to evaluate intracellular Mg and develop better targets for the daily needs of this ion, show probable deficiencies, and explain how to prevent and better treat patients with symptomatic premature ventricular, and supraventricular complexes and no apparent heart disease.

Background: Rhythmia is a novel mapping system of cardiac arrhythmias, it utilizes a multielectrode catheter, Orion. Together these two instruments generate high accurate maps of the cardiac chamber which facilitate the identification of arrythmia focus and its ablation. Objective: our aim of this study was to evaluate the safety and feasibility of the Rhythmia system, mid-term recurrence rate and the predictors of recurrence from intervention and patients related factors. Methods: this was a retrospective cohort analysis on patients who underwent cardiac ablation with Rhythmia system at Örebro University Hospital between October 2017 and March 2020. The patients were followed-up to evaluate the recurrence. Results: 62 ablation procedures were included, premature ventricular contraction 20, atrial fibrillation 19, ectopic atrial tachycardia 10, ventricular tachycardia 6, atrial flutter 5 and accessory pathways 2. Rhythmia was feasible with 100% technically successful procedures. It had also low complications risk, with an overall 6.5% complications rate. Over a mean follow up of 5.1 months (Range 1-12), 59% of patients got recurrence. The highest recurrence rate of 75% was observed in the premature ventricular complex group. None of all studied variables showed any statistically significance association with the recurrence of the most three encountered arrhythmias. Conclusion: the use of Rhythmia was feasible and relatively safe. The recurrence rate of arrhythmias after using Rhythmia was high, and no reliable predictors could be found. However, there was a trend that atrial fibrillation which required long total procedure time and long fluoroscopy time had higher risk to recur.

No description available.

La modélisation de l’électrophysiologie in silico a été un sujet de recherche important ces dernières décennies. Afin de pouvoir utiliser ces progrès importants dans les applications cliniques, il faut mettre en place des modèles macroscopiques qui peuvent être utilisés pour la planification et le guidage des procédures cliniques.L’objectif de cette thèse est de construire de tels modèles macroscopiques spécifiques à chaque patient pour le diagnostic et la prévision, dans le but d’améliorer la planification et le guidage de l’ablation par radio-fréquence (ARF) des patients souffrant de tachycardie ventriculaire (TV) après infarctus. Dans ce travail, nous avons proposé un cadre pour la personnalisation d’un modèle cardiaque 3D, le modèle de Mitchell-Schaeffer (MS), et nous avons évalué sa puissance prédictive dans plusieurs configurations de stimulation. Ceci a été réalisé sur des données ex vivo de cœurs porcins à l’aide d’images médicales et de données cartographiques optiques de l’épicarde. Ce cadre a ensuite été appliqué à un ensemble de données cliniques provenant d’imagerie hybride XMR et d’une procédure de cartographie électrophysiologique sur un patient souffrant d’insuffisance cardiaque.Ensuite, le modèle 3D MS a également été adapté pour simuler le comportement macroscopique structural de la fibrose près des cicatrices. La simulation d’une étude in silico de stimulation de TV en utilisant le modèle adapté personnalisé MS a été réalisée pour quantifier le risque de TV en termes de cartes d’inductibilité, de réentrées des modèles et de cartes de points de sortie. Une approche de modélisation pour l’ablation par RF fondée sur l’état de l’art a été proposée. Enfin, l’étude in silico de stimulation de TV a été appliquée aux données in vivo personnalisées des patients, qui ont suivi ce protocole. Ceci a permis une validation de la prévision in silico de TV post-infarctus par comparaison avec la TV clinique induite. Ler ôle de l’hétérogénéité spatiale des propriétés des tissus cardiaques estimés dans la genèse de TV ischémique a été évalué, ainsi que les caractéristiques des points de sortie, qui sont les candidats potentiels à l’ablation par RF. / Modelling cardiac electrophysiology for arrhythmias in silico has been an important research topic for the last decades. In order to translate this important progress into clinical applications, there is a requirement to make macroscopic models that can be used for the planning and guidance of clinical procedures. The objective of this thesis was to construct such macroscopic EP models specifict o each patient for study and prediction, in order to improve the planning and guidance of radio frequency ablation (RFA) the rapieson patients suffering from post infarction Ventricular Tachycardia (VT). In this work, we proposed a framework for the personalisation of a 3D cardiac EP model, the Mitchell-Schaeffer (MS) model, an devaluated its volumetric predictive power under various pacing scenarios.This was performed on ex vivo large porcine healthy heart susing Diffusion Tensor MRI (DT-MRI) and dense optical mapping data of the epicardium. This framework was then also applied to a clinical dataset derived from a hybrid XMR imaging and sparse electroanatomical mapping on a patient with heart failure. Next, the 3DMS model was also adapted to simulate the macroscopic structural behaviour of fibrosis near the scars. The simulation of an in silico VT stimulation study using the personalised adapted MS model was then performed, to quantify VT risk in terms of inducibility maps, re-entry patterns and exit point maps. A rule-based modelling approach for RF ablation lesions based on state of the art studies was proposed. Lastly, the in silico VT stimulation study was applied to in vivo personalised data of patients who underwent a clinical VT stimulation study. A validation of the in silico post-infarct VT prediction was performed against the clinically induced VT. Therole of spatial heterogeneity of the estimated patient’s cardiac tissue properties in the genesis of ischemic VT was learnt, along with their characteristics for entry/exit points, which are the potential candidates for RF ablation.

INTRODUÇÃO: pacientes com doença renal crônica em diálise apresentam elevada mortalidade anual, principalmente decorrente de eventos cardiovasculares, com destaque para morte súbita cardíaca (MSC). Os eventos arrítmicos (EA) são considerados os principais responsáveis pela MSC, tornando relevante a sua avaliação. Dispositivos cardíacos modernos como o looper implantável, que tem capacidade de monitorar o ritmo cardíaco por longo período de tempo e diagnosticar EA, podem contribuir na estratificação de risco desta população. OBJETIVOS: avaliar a taxa de ocorrência dos EA em candidatos a transplante renal com looper implantável e identificar fatores associados; determinar a significância prognóstica dos EA na MSC e mortalidade total; avaliar eficiência diagnóstica do looper e o papel da diálise. MÉTODOS: estudo clínico observacional, prospectivo e aberto que incluiu cem candidatos a transplante renal, em hemodiálise e com alto risco para transplante (idade >=50 anos, DM ou doença cardiovascular). Entre junho/2009 e janeiro/2010, os pacientes foram submetidos ao implante do looper para detecção dos EA e seguimento clínico de um ano. A idade média do grupo foi 59 anos; 65% homens; 97% hipertensos, 70% diabéticos, 34% com infarto prévio e tempo médio de 53,8 meses em hemodiálise. O diagnóstico dos EA seguiu protocolo específico e foram descritos todos os eventos clínicos fatais e não fatais. A estatística incluiu: análise descritiva dos EA, associação destes com variáveis exploratórias pelos testes de qui-quadrado, exato de Fischer, t-Student, Mann-Whitney e regressão logística stepwise selection para análise multivariada (p<0,05). RESULTADOS: foram diagnosticados 5075 EA em 98 pacientes em seguimento médio de 425 dias. A taxa de ocorrência dos EA na casuística foi: bradiarritmias (25%), arritmias supraventriculares (94%) e arritmias ventriculares (79%). Os EA mais comuns foram: taquicardia sinusal (39%) e atrial não sustentada (27%), extrassístoles ventriculares e atriais isoladas (16% e 5,4%) e taquicardia ventricular não sustentada (TVNS - 5,3%). Foram preditores para ocorrência dos EA: duração intervalo PR (p=0,0008; OR=1,05; IC-95%=1,02-1,08) e QT longo (p=0,002; OR=7,28; IC- 95%=2,01-26,35) para bradiarritmias; duração intervalo QTc (p=0,022; OR=1,02; IC-95%=1,01-1,04) e presença de insuficiência cardíaca (p=0,034; OR=9,87; IC- 95%=1,17-82,79) para arritmias ventriculares e dilatação ventricular esquerda (p=0,041; OR=2,83; IC-95%=1,01-7,96) para TVNS. Ocorreram 35 eventos clínicos não fatais, 14 transplantes renais e 18 óbitos. Dentre os óbitos, 38,9% foram cardiovasculares súbitos: quatro arritmogênicos, um IAM e dois indeterminados. Não houve associação entre EA e eventos fatais; fibrilação atrial e bradiarritmias tiveram associação significativa com eventos não fatais. O mecanismo de morte (arritmogênico) foi elucidado pelo looper em quatro pacientes com MSC; um paciente apresentou bloqueio atrioventricular e necessitou de marca-passo. A taxa de EA foi superior no período intradiálise em comparação ao interdiálise (p<0,001). CONCLUSÕES: neste estudo, que avaliou a monitorização cardíaca prolongada com looper implantável em candidatos a transplante renal, a taxa de ocorrência de EA foi elevada; foram preditores dos EA: a duração intervalo PR e presença de QT longo para bradiarritmias, duração intervalo QTc e insuficiência cardíaca para arritmias ventriculares e dilatação ventricular para TVNS; a taxa de mortalidade foi elevada, com importante contribuição da MSC; não houve associação entre EA e mortalidade total ou súbita; houve associação entre as bradiarritmias e a fibrilação atrial com a ocorrência de eventos não fatais; os EA foram mais frequentes no período intradiálise; o looper implantável foi eficiente na elucidação diagnóstica, com poucas complicações. / INTRODUCTION: chronic kidney disease patients undergoing dialysis have a high annual mortality rate, mainly due to cardiovascular disease. Sudden cardiac death (SCD), attributed to arrhythmic mechanisms, is considered the major cause of these high death rates. The implantable loop recorder (ILR), a modern cardiac device has the ability for long-term cardiac rhythm monitoring and diagnosing arrhythmic events (AE), which in fact may contribute to the risk stratification of this population. OBJECTIVES: this study was designed to evaluate the incidence and predictors of AE in renal transplant candidates with ILR; to determine the prognostic significance of AE in SCD and all-cause mortality, evaluate the diagnostic effectiveness of ILR and the role of dialysis. METHODS: a prospective, open, observational clinical study was conducted, including one hundred renal transplant candidates undergoing hemodialysis, at high risk for transplantation (age >=50 years, diabetes or cardiovascular disease). Between June/2009 and January/2010, patients received an ILR for detection of AE with a one-year follow-up. Mean age of the group was 59 years; 65% were men; 97% hypertensive, 70% diabetic, 34% had previous myocardial infarction and mean hemodialysis time was 53.8 months. The diagnosis of AE followed specific protocol and all fatal and non-fatal clinical events were described. The statistical analysis included: descriptive analysis of AE, an association between these events and exploratory variables by chi-square tests, Fisher exact test, Student\'s t test, Mann-Whitney test and logistic regression using stepwise selection for multivariate analysis (p<0.05). RESULTS: during mean follow-up of 425 days, 5075 AE were diagnosed by ILR in 98 patients. The rate of occurrence of EA in this patients was: bradyarrhythmias (25%), supraventricular arrhythmias (94%) and ventricular arrhythmias (79%). The most common AE were: sinus tachycardia (39%), nonsustained atrial tachycardia (27%), isolated premature ventricular beats (16%), isolated premature atrial beats (5.4%) and nonsustained ventricular tachycardia (NSVT - 5.3%). Predictors for the occurrence of AE were: duration of PR interval (p=0.0008; OR=1.05; 95%CI=1.02-1.08) and long QT (p=0.002; OR=7.28; 95%CI=2.01-26.35) for bradyarrhythmia; duration of QTc interval (p=0.022; OR=1.02; 95%CI=1.01-1.04) and presence of heart failure (p=0.034; OR=9.87; 95%CI=1.17-82.79) for ventricular arrhythmia and left ventricular dilatation (p=0.041; OR=2.83; 95%CI=1.01-7.96) for NSVT. There were 35 non-fatal clinical events, 14 renal transplantations and 18 deaths during follow-up. Regarding causes of death, 38.9% were due to sudden cardiovascular event: four were arrhythmogenic, one resulted from acute myocardial infarction and two were indeterminate. There was no association between AE and all cause or sudden mortality; bradyarrhythmias and atrial fibrillation were associated with the occurrence of non-fatal clinical events. The mechanism of death (arrhythmogenic) was elucidated by ILR in four patients with SCD; one patient had atrioventricular block and required pacemaker insertion. The rate of AE was higher in the intradyalitic period compared to interdialytic (p <0.001). CONCLUSIONS: in this study, which evaluate long-term cardiac rhythm monitoring with ILR in renal transplant candidates, the incidence of AE was high; predictors for the occurrence of AE were: duration of PR interval and presence of long QT for bradyarrhythmia, duration of QTc interval and heart failure for ventricular arrhythmia and left ventricular dilatation for NSVT; mortality rate was high and SCD made an important contribution. There was no association between AE and all-cause mortality and SCD; bradyarrhythmias and atrial fibrillation were associated with non-fatal events; the EA rate was higher at intradialytic period; the ILR was efficient in elucidating diagnoses and had few complications.

Inúmeros problemas cotidianos estão mal esclarecidos para portadores de marcapasso cardíaco definitivo (MCD). Dentre eles, destaca-se sua relação com atividades físicas e programas de treinamento. Este estudo, PRACTICING - Physical Training Effect In Pacemaker Patients, tem o objetivo de avaliar o impacto do treinamento físico sobre o consumo de oxigênio (VO2 pico) e a qualidade de vida em portadores de MCD. Métodos - estudo prospectivo, unicêntrico e randomizado que incluiu portadores de MCD atrioventricular com funções sinusal e ventricular normais, sedentários, com idade entre 18 e 80 anos. Os pacientes foram distribuídos em três grupos: GTFS - grupo treinamento físico supervisionado; GTFNS - treinamento físico não supervisionado e GC - controle. Foram analisadas as variáveis obtidas por teste ergoespirométrico (TEE) e questionários de qualidade de vida (SF36 e Aquarel), no inicio do estudo e após 4 meses de seguimento. Resultados - Foram incluídos 18 pacientes no GTFS; 20 no GTFNS e 20 no GC. A idade média foi 55,4 ± 10 anos, 69,0% era do sexo feminino e a FEVE média foi 63,41 ± 5,0%. Hipertensão arterial, diabetes mellitus e doença de Chagas estiveram presentes em 56,9%, 25,8% e 25,9%, respectivamente. O tempo médio de uso de MCD foi de 59,4 ± 62,6 meses. O VO2máx médio inicial da população foi de 24,0 ± 5,8ml/kg/min e não houve diferença entre os três grupos (P=0,279). Apenas no GTFS ocorreu melhora significativa no VO2máx após treinamento físico: 23,86±4,38 versus 26,74 ± 4,18 ml/kg/min, (P=0,001). A avaliação da qualidade de vida demonstrou apenas diferença no domínio desconforto no peito no GTFNS e dispneia no GC (Aquarell). Conclusão - Em portadores de MCD sem disfunção ventricular, o treinamento físico supervisionado proporcionou melhora expressiva do consumo de oxigênio e de suas repercussões funcionais, embora com baixo impacto na qualidade de vida / Many everyday problems are poorly cleared for permanent cardiac pacemaker (MCD). Among these, there is its relation to physical activities and training programs. This study, PRACTICING- Physical Training Effect In Pacemaker Patients - aimed to assess the impact of physical training on the oxygen uptake (VO2 peak) and the quality of life in patients with MCD. Methods - prospective, singlecenter, randomized trial that included patients with atrioventricular MCD with sinus function and ventricular normal, sedentary, aged between 18 and 80 years. Patients were divided into three groups: GTFS - group supervised physical training; GTFNS - physical training unsupervised and GC - control. We analyzed the variables obtained by cardiopulmonary exercise test form (TEE) and quality of life questionnaires (SF36 and Aquarel) at study start and after four months of follow-up. Results - We included 18 patients in GTFS; 20 in GTFNS and 20 in the control group. The mean age was 55.4 ± 10 years, 69.0% were female and the mean LVEF was 63.41 ± 5.0%. hypertension, diabetes mellitus and Chagas disease were present in 56.9%, 25.8% and 25.9%, respectively. The average time of use of MCD was 59.4 ± 62.6 months. The initial average VO2max of the population was 24.0 ± 5,8 ml/kg/min and there was no difference among the three groups (P = 0.279). Only in GTFS was significant improvement in VO2max after physical training: 23.86 ± 4.38 versus 26.74 ± 4,18 ml/kg/min (P = 0.001). The evaluation of quality of life, demonstrated only difference in discomfort in the chest area in GTFNS and dyspnoea in CG (Aquarell). Conclusion - In patients with MCD without ventricular dysfunction, physical training protocol supervised provided significant improvement in oxygen uptake and its functional repercussions, albeit with low impact on quality of life

Inúmeros problemas cotidianos estão mal esclarecidos para portadores de marcapasso cardíaco definitivo (MCD). Dentre eles, destaca-se sua relação com atividades físicas e programas de treinamento. Este estudo, PRACTICING - Physical Training Effect In Pacemaker Patients, tem o objetivo de avaliar o impacto do treinamento físico sobre o consumo de oxigênio (VO2 pico) e a qualidade de vida em portadores de MCD. Métodos - estudo prospectivo, unicêntrico e randomizado que incluiu portadores de MCD atrioventricular com funções sinusal e ventricular normais, sedentários, com idade entre 18 e 80 anos. Os pacientes foram distribuídos em três grupos: GTFS - grupo treinamento físico supervisionado; GTFNS - treinamento físico não supervisionado e GC - controle. Foram analisadas as variáveis obtidas por teste ergoespirométrico (TEE) e questionários de qualidade de vida (SF36 e Aquarel), no inicio do estudo e após 4 meses de seguimento. Resultados - Foram incluídos 18 pacientes no GTFS; 20 no GTFNS e 20 no GC. A idade média foi 55,4 ± 10 anos, 69,0% era do sexo feminino e a FEVE média foi 63,41 ± 5,0%. Hipertensão arterial, diabetes mellitus e doença de Chagas estiveram presentes em 56,9%, 25,8% e 25,9%, respectivamente. O tempo médio de uso de MCD foi de 59,4 ± 62,6 meses. O VO2máx médio inicial da população foi de 24,0 ± 5,8ml/kg/min e não houve diferença entre os três grupos (P=0,279). Apenas no GTFS ocorreu melhora significativa no VO2máx após treinamento físico: 23,86±4,38 versus 26,74 ± 4,18 ml/kg/min, (P=0,001). A avaliação da qualidade de vida demonstrou apenas diferença no domínio desconforto no peito no GTFNS e dispneia no GC (Aquarell). Conclusão - Em portadores de MCD sem disfunção ventricular, o treinamento físico supervisionado proporcionou melhora expressiva do consumo de oxigênio e de suas repercussões funcionais, embora com baixo impacto na qualidade de vida / Many everyday problems are poorly cleared for permanent cardiac pacemaker (MCD). Among these, there is its relation to physical activities and training programs. This study, PRACTICING- Physical Training Effect In Pacemaker Patients - aimed to assess the impact of physical training on the oxygen uptake (VO2 peak) and the quality of life in patients with MCD. Methods - prospective, singlecenter, randomized trial that included patients with atrioventricular MCD with sinus function and ventricular normal, sedentary, aged between 18 and 80 years. Patients were divided into three groups: GTFS - group supervised physical training; GTFNS - physical training unsupervised and GC - control. We analyzed the variables obtained by cardiopulmonary exercise test form (TEE) and quality of life questionnaires (SF36 and Aquarel) at study start and after four months of follow-up. Results - We included 18 patients in GTFS; 20 in GTFNS and 20 in the control group. The mean age was 55.4 ± 10 years, 69.0% were female and the mean LVEF was 63.41 ± 5.0%. hypertension, diabetes mellitus and Chagas disease were present in 56.9%, 25.8% and 25.9%, respectively. The average time of use of MCD was 59.4 ± 62.6 months. The initial average VO2max of the population was 24.0 ± 5,8 ml/kg/min and there was no difference among the three groups (P = 0.279). Only in GTFS was significant improvement in VO2max after physical training: 23.86 ± 4.38 versus 26.74 ± 4,18 ml/kg/min (P = 0.001). The evaluation of quality of life, demonstrated only difference in discomfort in the chest area in GTFNS and dyspnoea in CG (Aquarell). Conclusion - In patients with MCD without ventricular dysfunction, physical training protocol supervised provided significant improvement in oxygen uptake and its functional repercussions, albeit with low impact on quality of life

Radiofrequency catheter ablation (RFA) is a rapidly developing, minimally invasive method of treatment for heart arrhythmias. Its employment is however limited due to complications, including thromboembolic ones. The basic of seven objectives of this dissertation were to: 1. by using different agonists of aggregation, to evaluate alteration of platelet aggregation in the venous blood and platelet-rich plasma, fibrinogen and D-dimer levels before RFA, immediately after, 24 hours and 72 hours after RFA under the influence of RFA in patients suffering from heart arrhythmia; 2. to establish the influence of the total RFA energy, structural heart disease, antithrombotic medicines know in the alteration of platelet aggregation induced by different agonists and in the alteration before RFA, immediately after and 24 hours after RFA. The obtained data show that changes in PA after RFA depended on whether PA proceeded in the venous blood or plasma and on the agonist used to induce aggregation. According to the results, PA is suppressed immediately after RFA and increases in 24 hours. The level of the applied total energy had an effect on changes in platelet aggregation after RFA. The dynamics of PA in patients with and without a structural heart disease were similar. The obtained pre-RFA values of PA were lower in blood and even lower in plasma in the group of patients who used aspirin, as compared to those who used low molecular mass heparin or no antithrombotic medicines. Despite the... [to full text]