Myocardial Infarction with ST Elevation and Reperfusion Therapy in Brazil: Data from the ACCEPT Registry.

Background: There is a lack of information from Brazil regarding therapies used and outcomes in patients with acute coronary syndrome with ST elevation (STEMI).

Objectives: To evaluate evidence-based therapies, occurrence of outcomes, reperfusion use, and predictors of not receiving reperfusion in patients with STEMI in a national multicenter registry.

Methods: Patients with STEMI from the ACCEPT registry, with up to 12 hours of symptoms, were followed for 1 year for the occurrence of major adverse cardiovascular events.

Twelve-lead ambulatory ECG recording using a seven-electrode recorder: An alternative method for electrophysiological evaluation.

Introduction: Conventional three-lead ambulatory electrocardiogram recording (3L-AECG) is used for the quantitative diagnosis of arrhythmias. However, the lack of crucial information, such as QRS morphology and orientation, renders the 3L-AECG incomplete for planning electrophysiological interventions. The 12-lead AECG (12L-AECG) merges the temporal resolution 3L-AECG with the spatial resolution of the standard electrocardiogram (S-ECG).

Amiodarone or Implantable Cardioverter-Defibrillator in Chagas Cardiomyopathy: The CHAGASICS Randomized Clinical Trial.

Importance: Over 10 000 people with Chagas disease experience sudden cardiac death (SCD) annually, mostly caused by ventricular fibrillation. Amiodarone hydrochloride and the implantable cardioverter-defibrillator (ICD) have been empirically used to prevent SCD in patients with chronic Chagas cardiomyopathy.

Objective: To test the hypothesis that ICD is more effective than amiodarone therapy for primary prevention of all-cause mortality in patients with chronic Chagas cardiomyopathy and moderate to high mortality risk, assessed by the Rassi score.

Refining ECG interpretation: From false assumptions to evidence-based precision.

Introduction: Electrocardiography (ECG) remains a fundamental tool in cardiovascular diagnostics, frequently relying on System 1 thinking-rapid, intuitive pattern recognition (PR). However, this approach can be insufficient when dealing with complex cases where diagnostic precision is essential. This article emphasizes the importance of integrating System 2 thinking-a more deliberate, evidence-based approach-into ECG interpretation to enhance diagnostic accuracy and avoid clinical errors.

EPM algorithm: A stepwise approach to accessory pathway localization in ventricular pre-excitation.

Background: Accurate estimation of accessory pathway (AP) localization in patients with ventricular pre-excitation or Wolff-Parkinson-White (WPW) syndrome remains a diagnostic challenge. Existing algorithms have contributed significantly to this area, but alternative algorithms can offer additional perspectives and approaches to AP localization.

Objective: This study introduces and evaluates the diagnostic accuracy of the EPM algorithm in AP localization, comparing it with established algorithms Arruda and EASY.

Epicardial mapping complicated by multi-vessel coronary spasm and electrical storm.

The case report describes a severe multi-vessel coronary spasm complicating the epicardial mapping in a patient with chronic Chagas cardiomyopathy.

Pacemaker lead-related macroreentrant atrial tachycardia.

Macroreentrant atrial circuits are frequently associated with scarring. Previous reports have shown the possible development of scar tissue that is adjacent to pacemaker (PM) leads. However, reports of PM lead-related reentrant tachycardia are scarce.

Long-term clinical outcomes of patients with nonsignificant transplanted renal artery stenosis.

Background: Transplant renal artery stenosis (TRAS) is the main vascular complication of kidney transplantation. For research and treatment purposes, several authors consider critical renal artery stenosis to be greater than 50%, and percutaneous intervention is indicated in this scenario. However, there are no reports in the current literature on the evolution of patients with less than 50% stenosis.

Epicardial and Endocardial Ablation Based on Channel Mapping in Patients With Ventricular Tachycardia and Chronic Chagasic Cardiomyopathy: Importance of Late Potential Mapping During Sinus Rhythm to Recognize the Critical Substrate.

Background Ventricular tachycardia (VT) in patients with chronic chagasic cardiomyopathy (CCC) is associated with considerable morbidity and mortality. Catheter ablation of VT in patients with CCC is very complex and challenging. The main goal of this work was to assess the efficacy of VT catheter ablation guided by late potentials (LPs) in patients with CCC.

Ventricular arrhythmias in the Chagas disease are not random phenomena: Long-term monitoring in Chagas arrhythmias.

Background: Variability of ventricular arrhythmias among days in patients with Chagas disease is not detected by 24 hours of Holter monitoring.

Objective: To analyze whether ventricular arrhythmias are a random phenomenon or have a reproducible behavior in patients with Chagas cardiomyopathy.

Method: Holter monitoring was recorded in 16 subjects with a mean age of 52 ± 8 years.

Catheter entrapment in Chiari network: Extraction with radiofrequency.

We report a challenging case of a duodecapolar mapping catheter entrapment in Chiari network and its release by radiofrequency energy application with an ablation catheter.

Clinical value of myocardial performance index in patients with isolated diastolic dysfunction.

Aims: The Doppler-derived myocardial performance index (MPI) has been considered as a diagnostic and prognostic Doppler marker for many different clinical conditions. The purpose of this study was to determine the diagnostic accuracy of traditional Pulsed-wave Doppler (PWD-MPI) and Pulsed-wave tissue Doppler imaging (TDI-MPI) and the degree of agreement between these methods in patients with grade-I diastolic dysfunction (DDI) and a normal ejection fraction.

Methods: Forty-seven consecutive ambulatory patients with DDI were compared to 51 healthy subjects with normal echocardiograms.

Prevalence of atrial fibrillation and stroke risk assessment based on telemedicine screening tools in a primary healthcare setting.

Background: Worldwide atrial fibrillation (AF) prevalence varies between 0.1% and 4.0%, and has been increasing.

Radiofrequency ablation of a middle cardiac vein inserted accessory pathway resulting in posterolateral coronary artery occlusion: A case report.

Introduction: Posteroseptal accessory pathways account for 34.5% of the total. Of these, 36% are located within the coronary sinus (CS).

'Choosing Wisely' culture among Brazilian cardiologists.

Objective: (i) To describe how aligned the 'Choosing Wisely' concept is with the medical culture among Brazilian cardiologists and (ii) to identify predictors for physicians' preference for avoiding wasteful care.

Design: Cross-sectional study.

Setting: Brazilian Society of Cardiology.

Objective Evaluation of Gastroesophageal Reflux Disease in Patients with Paroxysmal Atrial Fibrillation.

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Some evidence shows that gastroesophageal reflux disease (GERD) may be a trigger for paroxysmal AF (PAF). Most of the previous studies that correlated GERD and AF used questionnaires to diagnose GERD, not an objective evaluation.

Prognostic value of real-time three-dimensional echocardiography compared to two-dimensional echocardiography in patients with systolic heart failure.

Heart failure (HF) is associated with morbidity and mortality. Real-time three-dimensional echocardiography (RT3DE) may offer additional prognostic data in patients with HF. The study aimed to evaluate the prognostic value of real-time three-dimensional echocardiography (RT3DE).

Diabetes and cardiovascular events in high-risk patients: Insights from a multicenter registry in a middle-income country.

Aims: The aim of this study was to determine the rate of major clinical events and its determinants in patients with previous cardiovascular event or not, and with or without diabetes from a middle-income country.

Methods: REACT study is a multicenter registry conducted between July 2010 and May 2013 in Brazil. Patients were eligible if they were over 45years old and high cardiovascular risk.

Rationale and design of the First Brazilian Cardiovascular Registry of Atrial Fibrillation: The RECALL study.

Background: Atrial fibrillation (AF) is an important and growing public health problem worldwide, but data about its actual prevalence, therapeutic management, and clinical outcomes in middle- to low-income countries are scarce.

Design: The First Brazilian Cardiovascular Registry of Atrial Fibrillation (the RECALL study) will assess demographic characteristics and evidence-based practice of a representative sample of patients with AF in Brazil. The prospective, multicenter registry has a planned sample size of around 5,000 patients at approximately 80 sites.

Correlation of accessory pathway location with gender and their manifest or concealed presentation.

Background: Atrioventricular reentrant tachycardias account for approximately one third of cases referred for electrophysiological study (EPS). The anatomical substrate responsible for the reentry is an accessory pathway (AP) able to conduct the electrical stimulus in an anterograde, retrograde or bidirectional manner.

Objective: To evaluate the correlation of AP location with the male and female genders and AP clinical presentation, whether manifest or concealed.

Validation of a novel sleep-quality questionnaire to assess sleep in the coronary care unit: a polysomnography study.

Introduction: The sleep of patients admitted to coronary care unit (CCU) may be compromised. A feasible and cost-effective tool to evaluate sleep in this scenario could provide important data. The aim of this study was to evaluate sleep with a questionnaire developed specifically for the CCU and to validate it with polysomnography (PSG).

Clinical use of the volume-time curve for endotracheal tube cuff management.

Background: Previous investigation showed that the volume-time curve technique could be an alternative for endotracheal tube (ETT) cuff management. However, the clinical impact of the volume-time curve application has not been documented. The purpose of this study was to compare the occurrence and intensity of a sore throat, cough, thoracic pain, and pulmonary function between these 2 techniques for ETT cuff management: volume-time curve technique versus minimal occlusive volume (MOV) technique after coronary artery bypass grafting.

Ventricular arrhythmias are not a short-term reproducible phenomenon--why long recording monitoring is necessary.

Background: The variability of ventricular arrhythmias (VA) among different days of the week is not well detected by one-day Holter monitoring.

Aims: To evaluate whether there are differences in VA distribution pattern during long recording period.

Methods: The EKG was recorded for 14 h per day during 7 days by Holter system in 34 consecutive pat ventricular couplets and non-sustained ventricular tachycardia (NSVT) recording from patients provided graphic data.

CHronic use of Amiodarone aGAinSt Implantable cardioverter-defibrillator therapy for primary prevention of death in patients with Chagas cardiomyopathy Study: rationale and design of a randomized clinical trial.

Background: The implantable cardioverter defibrillator (ICD) is better than antiarrhythmic drug therapy for the primary and secondary prevention of all-cause mortality and sudden cardiac death in patients with either coronary artery disease or idiopathic dilated cardiomyopathy. This study aims to assess whether the ICD also has this effect for primary prevention in chronic Chagas cardiomyopathy (CCC).

Methods: In this randomized (concealed allocation) open-label trial, we aim to enroll up to 1,100 patients with CCC, a Rassi risk score for death prediction of ≥10 points, and at least 1 episode of nonsustained ventricular tachycardia on a 24-hour Holter monitoring.