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Article ; Online: How to prevent atrial oesophageal fistula following ablation of atrial fibrillation: are there actually any effective methods?-Authors' reply.

Scanavacca, Mauricio / De Vasconcelos, José Tarcísio Medeiros / Galvão Filho, Silas Dos Santos / Atié, Jacob / Maciel, Washington / De Souza, Olga Ferreira / Saad, Eduardo Benchimol / Kalil, Carlos Antonio / De Castro Mendonça, Rodrigo / Araujo, Nilson / Pisani, Cristiano F

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology

2017 Volume 20, Issue 3, Page(s) 562–563

MeSH term(s)	Atrial Fibrillation ; Catheter Ablation ; Esophageal Fistula/surgery ; Heart Atria ; Humans
Language	English
Publishing date	2017-11-01
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	1449879-0
ISSN	1532-2092 ; 1099-5129
ISSN (online)	1532-2092
ISSN	1099-5129
DOI	10.1093/europace/eux224
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Article ; Online: Atrial-oesophageal fistula following percutaneous radiofrequency catheter ablation of atrial fibrillation: the risk still persists.

Medeiros De Vasconcelos, José Tarcisio / Filho, Silas Dos Santos Galvão / Atié, Jacob / Maciel, Washington / De Souza, Olga Ferreira / Saad, Eduardo Benchimol / Kalil, Carlos Antonio / De Castro Mendonça, Rodrigo / Araujo, Nilson / Pisani, Cristiano F / Scanavacca, Mauricio Ibrahim

2017 Volume 19, Issue 2, Page(s) 250–258

Abstract: Aims: Atrial-oesophageal fistula is a serious complication related to ablation of atrial fibrillation. As its occurrence is rare, there is a great lack of information about their mechanisms, incidence, presentations, and treatment. The objective of this ...

Abstract	Aims: Atrial-oesophageal fistula is a serious complication related to ablation of atrial fibrillation. As its occurrence is rare, there is a great lack of information about their mechanisms, incidence, presentations, and treatment. The objective of this manuscript is to present a series of cases of atrial-oesophageal fistula in Brazil, focusing on incidence, clinical presentation, and follow-up. Methods and results: This is a retrospective multicentre registry of atrial-oesophageal fistula cases that occurred in eight Brazilian centres from 2003 to 2015. Ten cases (0.113%) of atrial-oesophageal fistula were reported in 8863 ablation procedures in the period. Most of the subjects were male (70%) with age 59.6 ± 9.3 years. Eight centres were reference units in atrial fibrillation ablation with an experience over than 200 procedures at the time of fistula occurrence. Oesophageal temperature monitoring was performed in eight cases using coated sensors in six. The first atrial-oesophageal fistula clinical manifestation was typically fever (in six patients), with a median onset time of 16.5 (12–43) days after ablation. There was a delay of 7.8 ± 3.3 days between the first manifestation and the diagnosis in five patients. The treatment was surgical in six cases, clinical in three and stenting in one. Seven patients died (70%) and two developed permanent neurological sequelae. Conclusion: Atrial-oesophageal fistula remains a serious complication following AF ablation despite the incorporation of protective measures and increased technical experience of the groups. The high morbidity and mortality despite the treatment indicates the need to develop adequate preventive strategies.
MeSH term(s)	Adult ; Aged ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/mortality ; Atrial Fibrillation/physiopathology ; Atrial Fibrillation/surgery ; Brazil/epidemiology ; Catheter Ablation/adverse effects ; Catheter Ablation/mortality ; Esophageal Fistula/diagnosis ; Esophageal Fistula/epidemiology ; Esophageal Fistula/mortality ; Esophageal Fistula/therapy ; Esophagoscopy ; Female ; Fever/epidemiology ; Heart Atria/injuries ; Heart Injuries/diagnosis ; Heart Injuries/epidemiology ; Heart Injuries/mortality ; Heart Injuries/therapy ; Humans ; Incidence ; Male ; Middle Aged ; Registries ; Retrospective Studies ; Risk Factors ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome
Language	English
Publishing date	2017-01-30
Publishing country	England
Document type	Journal Article ; Multicenter Study
ZDB-ID	1449879-0
ISSN	1532-2092 ; 1099-5129
ISSN (online)	1532-2092
ISSN	1099-5129
DOI	10.1093/europace/euw284
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Book: O eletrocardiograma e a clínica

Andréa, Eduardo / Atié, Jacob / Maciel, Washington

2004

Author's details	Eduardo Andréa (org), Jacob Atié, Washington Maciel
MeSH term(s)	Heart Diseases/pathology ; Electrocardiography
Language	Portuguese
Size	730 p. :, ill. ;, 29 cm.
Publisher	Diagraphic Editora
Publishing place	Rio de Janeiro, RJ, Brasil
Document type	Book
ISBN	9788589718059 ; 8589718050
Database	Catalogue of the US National Library of Medicine (NLM)

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Article ; Online: Critérios prognósticos de sucesso e recorrência na ablação circunferencial para tratamento da fibrilação atrial Prognostic criteria of success and recurrence in circumferential ablation for the treatment of atrial fibrillation

Maciel Washington / Eduardo Andréa / Nilson Araújo / Hecio Carvalho / Luiz Gustavo Belo / Leonardo Siqueira / Claudio Munhoz / Rodrigo Cosenza / Fabiana Mitidieri / Jacob Atié

Arquivos Brasileiros de Cardiologia, Vol 88, Iss 2, Pp 134-

2007 Volume 143

Abstract: OBJETIVOS: Analisar o sucesso da ablação circunferencial da fibrilação atrial e investigar possíveis preditores, clínicos e eletroanatômicos, de recorrência da arritmia. MÉTODOS: Foram analisados 104 pacientes consecutivos, submetidos à ablação ... ...

Abstract	OBJETIVOS: Analisar o sucesso da ablação circunferencial da fibrilação atrial e investigar possíveis preditores, clínicos e eletroanatômicos, de recorrência da arritmia. MÉTODOS: Foram analisados 104 pacientes consecutivos, submetidos à ablação circunferencial para tratamento de fibrilação atrial paroxística/persistente, sem cardiopatia estrutural e refratários a pelo menos duas drogas antiarrítmicas. Eram do sexo masculino 72 pacientes e a idade média do grupo foi de 58,6 + 10,9 anos. O procedimento consistiu em punção transeptal única e mapeamento tridimensional, com o sistema CARTO® para a aquisição de pontos no átrio esquerdo e veias pulmonares. As aplicações de radiofreqüência foram realizadas ao redor dos óstios das veias pulmonares, até a redução > 80% da amplitude dos potenciais atriais. Uma linha adicional foi criada no istmo mitral e outra no istmo cavotricuspídeo. Foram analisadas: volume total do átrio esquerdo, área ablacionada ao redor das veias pulmonares e a presença ou não de falhas na linha de ablação (linha completa ou incompleta). Foi considerada linha completa quando a distância entre dois pontos contíguos de aplicação de radiofreqüência foi inferior a 10 mm. RESULTADOS: Em acompanhamento médio de 18 meses, 87 pacientes estavam em ritmo sinusal (84%) e 17 pacientes apresentaram recidiva (16%). Na análise multivariada, somente o volume atrial esquerdo (p < 0,0001) e a ablação completa (p <0 ,05) foram preditores independentes de recorrência. CONCLUSÃO: Os resultados sugerem que o volume atrial esquerdo e a presença de ablação completa são preditores de recorrência da fibrilação atrial. OBJECTIVES: To analyze the success of circumferential ablation on atrial fibrillation and investigate possible clinical and electro-anatomical predictors of the recurrence of cardiac arrhythmia. METHODS: Analysis was done of 104 consecutive patients, free of structural heart disease and refractory to at least 2 antiarrhythmic drugs, submitted to circumferential ablation for treatment of paroxysmal/persistent atrial fibrillation. Were males 72 of the patients and the average age of the group was 58.6 + 10.9. The procedure consisted in a single transeptal puncture and three-dimensional mapping using the CARTO® system. Images of the left atrium and pulmonary veins were reconstructed. Radiofrequency applications were performed around the pulmonary vein ostia, up to a > 80% reduction in atrial potential amplitude. An additional mitral isthmus line was created, as well as one in the cavo-tricuspid isthmus. Total left-atrial volume, area ablated around the pulmonary veins, and the presence or absence of flaws in the ablation line (complete or incomplete line) were analyzed. A line was considered complete when the distance between two contiguous radiofrequency application points was less than 10 mm. RESULTS: After an average follow-up period of 18 months, 87 patients were in sinus rhythm (84%), while 17 patients presented recidivism (16%). In the multivariate analysis only left-atrial volume (p < 0.0001) and complete ablation (p < 0.05) were independent predictors of success. CONCLUSION: These data suggest that the left-atrial volume and the presence of complete ablation are predictors of recurrence.
Keywords	Fibrilação atrial ; mapeamento eletroanatômico ; ablação por cateter ; Atrial fibrillation ; electroanatomical mapping ; catheter ablation ; Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Cardiovascular ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	English
Publishing date	2007-02-01T00:00:00Z
Publisher	Sociedade Brasileira de Cardiologia - SBC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Clinical follow-up of patients with implantable cardioverter-defibrillator.

da Fonseca, Silvia Martelo Souza / Belo, Luiz Gustavo / Carvalho, Hécio / Araújo, Nilson / Munhoz, Cláudio / Siqueira, Leonardo / Maciel, Washington / Andréa, Eduardo / Atié, Jacob

Arquivos brasileiros de cardiologia

2007 Volume 88, Issue 1, Page(s) 8–16

Abstract: Objective: To report appropriate (AT) and inappropriate (IT) ICD therapies in patients with ischemic and nonischemic heart disease, as well as early and late procedure-related complications.: Methods: One hundred and fifty-five patients (119 male and ...

Abstract	Objective: To report appropriate (AT) and inappropriate (IT) ICD therapies in patients with ischemic and nonischemic heart disease, as well as early and late procedure-related complications. Methods: One hundred and fifty-five patients (119 male and 36 female), mean age 47 years (21-88), who underwent ICD implantation between 1994 and March 2003 were analyzed. Patients were divided into the following groups: Group I--Post-AMI patients (n = 80); Group II--Patients with nonischemic heart disease and LV ejection fraction < 40% (n = 45), Chagas disease (n = 18), idiopathic dilated cardiomyopathy (n= 12), hypertensive disease (n = 8), hypertrophic cardiomyopathy (n = 4) and valvular heart disease (n = 3); Group III--Patients with arrhythmogenic right ventricular dysplasia (n = 13); and Group IV--Patients with channelopathies: Brugada Syndrome (n = 8) and idiopathic ventricular arrhythmias (n = 9). All patients underwent electrophysiological study (EPS) with induction of sustained ventricular arrhythmia ICD implantation. Results: During the 26-month mean follow up, a high rate of appropriate ICD therapies (antitachycardia pacing and/or shock) was observed (46%) in the four groups, with no statistically significant difference. The four groups did not differ in either overall (8.4%) or arrhythmic mortality (1.3%). There was no correlation between appropriate ICD therapies and initial clinical presentation or inducible ventricular arrhythmia at EPS, and a 4% incidence of early and late procedure-related complications was found. Conclusion: The high incidence of appropriate ICD therapy and low rate of sudden death in the patients studied suggest that ICD is a valuable strategy in the management of ischemic and nonischemic patients previously selected by means of EPS.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Death, Sudden, Cardiac/prevention & control ; Defibrillators, Implantable/adverse effects ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tachycardia, Ventricular/complications ; Tachycardia, Ventricular/therapy ; Time Factors ; Treatment Outcome ; Ventricular Dysfunction, Left/etiology
Language	Portuguese
Publishing date	2007-03-15
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	730261-7
ISSN	1678-4170 ; 0066-782X
ISSN (online)	1678-4170
ISSN	0066-782X
DOI	10.1590/s0066-782x2007000100002
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Article ; Online: Prognostic criteria of success and recurrence in circumferential ablation for the treatment of atrial fibrillation.

Maciel, Washington / Andréa, Eduardo / Araújo, Nilson / Carvalho, Hecio / Belo, Luiz Gustavo / Siqueira, Leonardo / Munhoz, Claudio / Cosenza, Rodrigo / Mitidieri, Fabiana / Atié, Jacob

Arquivos brasileiros de cardiologia

2007 Volume 88, Issue 2, Page(s) 134–143

Abstract: Objectives: To analyze the success of circumferential ablation of atrial fibrillation and to investigate possible clinical and electroanatomic predictors of recurrence of cardiac arrhythmia.: Methods: 104 consecutive patients free of structural heart ...

Abstract	Objectives: To analyze the success of circumferential ablation of atrial fibrillation and to investigate possible clinical and electroanatomic predictors of recurrence of cardiac arrhythmia. Methods: 104 consecutive patients free of structural heart disease and refractory to at least two antiarrhythmic drugs, and undergoing circumferential ablation for the treatment of paroxysmal/persistent atrial fibrillation were analyzed. Seventy two patients were males and the mean age of the group was 58.6 + 10.9 years. The procedure consisted of a single transseptal puncture and three-dimension mapping using the CARTO system to acquire points in the left atrium and pulmonary veins. Radiofrequency applications were performed encircling the pulmonary vein ostea, up to a > or = 80% reduction of the atrial potential amplitude. One additional line was created in the mitral isthmus and another in the cavotricuspid isthmus. Total left atrium volume, area ablated around the pulmonary veins, and completeness of the ablation line (complete or incomplete line) were analyzed. A line was considered complete when the distance between two contiguous radiofrequency application points was lower than 10mm. Results: In a mean 18-month follow-up, 87 patients were in sinus rhythm (84%), and 17 patients presented recurrence (16%). In the multivariate analysis, only the left atrial volume (p<0.0001) and complete ablation (p<0.05) were independent predictors of recurrence. Conclusion: The results suggest that the left atrial volume and the presence of complete ablation are predictive of recurrence of atrial fibrillation.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Atrial Fibrillation/surgery ; Catheter Ablation/adverse effects ; Catheter Ablation/methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; Recurrence ; Treatment Outcome
Language	Portuguese
Publishing date	2007-03-15
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	730261-7
ISSN	1678-4170 ; 0066-782X
ISSN (online)	1678-4170
ISSN	0066-782X
DOI	10.1590/s0066-782x2007000200002
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Article ; Online: Intra-His bundle block

Andréa Eduardo M. / Atié Jacob / Maciel Washington A. / Oliveira Jr Nilson A. de / Camanho Luiz Eduardo / Belo Luís Gustavo / Carvalho Hecio Affonso de / Siqueira Leonardo / Saad Eduardo / Venancio Ana Claudia

Arquivos Brasileiros de Cardiologia, Vol 79, Iss 5, Pp 532-

clinical, electrocardiographic, and electrophysiologic characteristics

2002 Volume 537

Abstract: OBJECTIVE: To assess the clinical, electrocardiographic, and electrophysiologic characteristics of patients (pt) with intra-His bundle block undergoing an electrophysiologic study (EPS). METHODS: We analyzed the characteristics of 16 pt with second- ... ...

Abstract	OBJECTIVE: To assess the clinical, electrocardiographic, and electrophysiologic characteristics of patients (pt) with intra-His bundle block undergoing an electrophysiologic study (EPS). METHODS: We analyzed the characteristics of 16 pt with second-degree atrioventricular block and symptoms of syncope or dyspnea, or both, undergoing conventional EPS. RESULTS: Intra-His bundle block was documented in 16 pt during an EPS. In 15 (94%) pt, the atrioventricular block was recorded in sinus rhythm; 4 (25%) pt had intra-His Wenckebach phenomenon, which correlated with Mobitz I (MI) atrioventricular block on the electrocardiogram. Seven (44%) pt had 2:1 atrioventricular block, 2 of whom were asymptomatic (12.5%). One (6%) pt had intra- and infra-His bundle block. Clinically, 11 (68%) pt had syncope or presyncope, 3 (18%) had dyspnea on exertion, and 2 (12.5%) were asymptomatic. Eight (50%) pt had bundle-branch block as follows: 4 (25%) pt had left bundle-branch block, and 4 (25%) had right bundle-branch block. Left anterosuperior divisional block was observed in 3 pt (19%), 2 of whom with associated right bundle-branch block. CONCLUSION: Intra-His bundle block was observed in 11% of the pt with second-degree atrioventricular block, syncope or presyncope, or both, it being the most frequent clinical presentation. Intra-His bundle block was more common in the elderly (> 60 years) and among females. The most frequent electrocardiographic presentations were second-degree Mobitz I or type 2:1 atrioventricular block.
Keywords	intra-His ; atrioventricular block ; syncope ; Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Cardiovascular ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	616
Language	English
Publishing date	2002-01-01T00:00:00Z
Publisher	Sociedade Brasileira de Cardiologia - SBC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Intra-His bundle block. Clinical, electrocardiographic, and electrophysiologic characteristics.

Andrea, Eduardo M / Atie, Jacob / Maciel, Washington A / de Oliveira, Nilson A / Camanho, Luiz Eduardo / Belo, Luís Gustavo / de Carvalho, Hecio Affonso / Siqueira, Leonardo / Saad, Eduardo / Venancio, Ana Claudia

Arquivos brasileiros de cardiologia

2002 Volume 79, Issue 5, Page(s) 526–537

Abstract: Objective: To assess the clinical, electrocardiographic, and electrophysiologic characteristics of patients (pt) with intra-His bundle block undergoing an electrophysiologic study (EPS).: Methods: We analyzed the characteristics of 16 pt with second- ... ...

Abstract	Objective: To assess the clinical, electrocardiographic, and electrophysiologic characteristics of patients (pt) with intra-His bundle block undergoing an electrophysiologic study (EPS). Methods: We analyzed the characteristics of 16 pt with second-degree atrioventricular block and symptoms of syncope or dyspnea, or both, undergoing conventional EPS. Results: Intra-His bundle block was documented in 16 pt during an EPS. In 15 (94%) pt, the atrioventricular block was recorded in sinus rhythm; 4 (25%) pt had intra-His Wenckebach phenomenon, which correlated with Mobitz I (MI) atrioventricular block on the electrocardiogram. Seven (44%) pt had 2:1 atrioventricular block, 2 of whom were asymptomatic (12.5%). One (6%) pt had intra- and infra-His bundle block. Clinically, 11 (68%) pt had syncope or presyncope, 3 (18%) had dyspnea on exertion, and 2 (12.5%) were asymptomatic. Eight (50%) pt had bundle-branch block as follows: 4 (25%) pt had left bundle-branch block, and 4 (25%) had right bundle-branch block. Left anterosuperior divisional block was observed in 3 pt (19%), 2 of whom with associated right bundle-branch block. Conclusion: Intra-His bundle block was observed in 11% of the pt with second-degree atrioventricular block, syncope or presyncope, or both, it being the most frequent clinical presentation. Intra-His bundle block was more common in the elderly (> 60 years) and among females. The most frequent electrocardiographic presentations were second-degree Mobitz I or type 2:1 atrioventricular block.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Bundle-Branch Block/complications ; Bundle-Branch Block/physiopathology ; Electrocardiography ; Electrophysiologic Techniques, Cardiac ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Syncope/etiology ; Syncope/physiopathology
Language	Portuguese
Publishing date	2002-11
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	730261-7
ISSN	0066-782X
ISSN	0066-782X
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Article ; Online: Diretrizes para Avaliação e Tratamento de Pacientes com Arritmias Cardíacas

Feitosa Gilson Soares / Nicolau José Carlos / Lorga Adalberto / Lorga Filho Adalberto / D'Ávila André / Rassi Jr Anis / Paola Angelo A. V. de / Pedrosa Anísio / Costa Álvaro Barros da / Peres Ayrton / Grupi César / Cirenza Cláudio / Moreira Dalmo / Sobral Dário / Hachul Denise / D'Andréa Eduardo / Sosa Eduardo / God Epotamênides M. Good / Brito Fábio Sândoli de /

Cruz Fernando / Fenelon Guilherme / Lima Gustavo Glotz / Brito Hélio / Maia Ivan G. / Atié Jacob / Jorge José Carlos Moura / Andrade José Carlos de / Mateos José Carlos Pachón / Ribeiro José Carlos / Pimenta João / Vasconcelos José Tarcísio de / Gizzi Júlio / Zimerman Leandro / Castilho Luiz Antonio Teno / Fagundes Márcio / Figueiredo Márcio / Martinelli Filho Martino / Scanavacca Maurício I. / Valente Ney / Medeiros Paulo / Brofman Paulo / Miranda Reynaldo Castro / Costa Roberto / Kunyioshi Ricardo / Sá Roberto / Rassi Sérgio G. / Siqueira Sérgio / Galvão Silas / Nishioka Silvana / Grillo Tereza / Rodrigues Thiago da Rocha / Maciel Washington

Arquivos Brasileiros de Cardiologia, Vol 79, Iss suppl.5, Pp 1-

2002 Volume 50

Keywords	Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Cardiovascular ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	English
Publishing date	2002-01-01T00:00:00Z
Publisher	Sociedade Brasileira de Cardiologia - SBC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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