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- How can we improve the success of cardiac resynchronization therapy implantation?Publication . Nunes-Ferreira, Afonso; Antonio Silverio, P.; Agostinho, João R.; Aguiar-Ricardo, Inês; Rigueira, Joana; Santos, R.; Cunha, N.; Rodrigues, T.; Bernardes, A.; Pinto, Fausto J.; Sousa, J. de; Marques, P.Introduction: The left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT) is one of the most important and complex steps, leading to implantation failure in 10–15% of cases. New LV lead implantation techniques are needed to allow better resynchronization and decrease mortality and hospitalizations. Objectives: To evaluate the efficacy and safety of the snare technique in the LV lead implantation in cases of standard technique failure.
- Accuracy and utility of a pacemaker respiratory monitoring algorithm for the detection of obstructive sleep apnea in patients with atrial fibrillationPublication . Gonçalves, Inês S.; Agostinho, João R.; Silva, Gustavo; Guimarães, Tatiana Isabel Oliveira; Bernardes, Ana; Santos, Igor; Pinto, Paula; Bárbara, Cristina; Sousa, João de; Pinto, Fausto J.; Marques, PedroIntroduction: The usefulness and diagnostic value of new-generation pacemakers (PM) with enhanced monitoring capabilities are not yet clearly established. The aim of this study was to evaluate the diagnostic utility and accuracy of a PM-incorporated respiratory monitoring algorithm and its interaction with atrial fibrillation (AF). Methods: A single-center prospective study was performed in consecutive patients who underwent PM implantation featuring a respiratory monitoring algorithm. All patients had polysomnography recording. The respiratory disturbance index of the polysomnography and pacemaker (RDI-PM) were recorded on the same night. Occurrence and burden of AF were also recorded. The diagnostic utility of RDI-PM and its interaction with AF were evaluated. Results: A total of 81 patients were included (age 73 ± 11 years). Obstructive sleep apnea syndrome (OSAS) was diagnosed in 62%. RDI-PM had good diagnostic accuracy for OSAS (area under the curve: 0.767 [95% CI: 0.65e0.88]; p < 0.001), with an ideal diagnostic cut-off of 13.3 (sensitivity 78%; specificity 78%) and 90% sensitivity for the diagnosis of moderate-to-severe OSAS. Time to AF first episode and total AF burden were not significantly different between patients with and without OSAS. However, in those whose OSAS diagnosis was based on RDI-PM, there was a significantly greater AF burden in patients with vs without OSAS (cut-off 13, 488 vs 83 min, p ¼ 0.05). In patients with AF, the RDI-PM cut-off of 13.3 decreased specificity (57%) vs the general population, but in patients without AF the specificity was 100% and sensitivity 77%. Conclusion: OSAS was prevalent in PM patients. RDI-PM diagnosed OSAS accurately, with high sensitivity for the detection of moderate-to-severe OSAS, making it a suitable screening method. AF, however, significantly decreased the specificity of RDI-PM for OSAS diagnosis.
- Right ventricular lead in cardiac resynchronization therapy : what is the most electrically favorable stimulation site?Publication . Goncalves, I. S. S.; Marques, P.; Hyde Congo, K.; Ribeiro Agostinho, João Pedro; Aguiar-Ricardo, Inês; Rigueira, Joana; Nunes-Ferreira, Afonso; Santos, R.; Sousa, JoanaIntroduction: The most recent studies in cardiac resynchronization therapy (CRT) have been focused on attempts to improve response rate, such as the determination of the optimal placement of the left ventricular (LV) lead. The position of the LV lead guided by the site of latest electrical delay (ED), seems to be a promising strategy. The same strategy may be useful in assessing the ideal positioning of right ventricular (RV) lead in CRT. Purpose: To determine the most favorable position of the RV lead (septal versus apical) in CRT, by measuring the ED of the LV poles during septal or apical RV pacing in patients with triple-site CRT (TRIV). Methods: A single-center prospective study of consecutive patients (Oct. 2014 to Oct. 2017) submited to CRT device implantation (Quadra Allure MPTM, which allows post-implantation ED measurement) in TRIV mode - with a quadripolar lead in the LV, a RV lead positioned at the septum and a RV lead at the apex. In the follow-up, the lead position was confirmed and determined by fluoroscopic evaluation (anterior, lateral and postero-lateral in the short axis and basal, mid and apical on the long axis). The ED was measured at the 4-pole LV lead, during apical and septal RV pacing and the relation between the ED and lead position was evaluated. Results: Twenty two patients were included: 82% male, median age 78 years; 50% implanted CRT with defibrillator; 27% had ischemic heart disease and 73% non-ischemic etiology; all patients had permanent atrial fibrillation and the QRS duration was of 176±29ms. The position of the LE lead poles was classified as lateral in 44% and postero-lateral in 56%, basal in 28%, medial in 39% and apical in 34%. We evaluated 160 ED. The mean ED between the apical RV lead and the LV poles was significantly higher than the delay between septal RV lead and the LV poles [161±33ms vs 75±45ms (p<0.001)]. This difference remained significant in LV poles located in a lateral position (76±62 vs. 166±36ms; p<0.001) or in a postero-lateral position (74±30 vs. 157±31ms; p<0.001); the same ocurred for LV poles in a basal (99±62 vs. 179±24ms, p<0.001), mid (72±38 vs. 167±31ms, p<0.001) and apical location (57±24 vs. 140±32ms, p<0.001). Conclusion: The LV lead position is an important determinant of the success of CRT, but is conditioned by anatomical and technical characteristics. The optimization of CRT may then depend on the positioning of RV lead. This study demonstrated that the apical (vs. septal) RV lead positioning presents higher ED in relation to LV lead, regardless of the latter position.
- iBox-CRT : better response, less complicated, equally fastPublication . Aguiar-Ricardo, Inês; Nunes-Ferreira, Afonso; Rigueira, Joana; Agostinho, João R.; Santos, R.; Lima da Silva, G.; Antonio, Pedro Silverio; Rodrigues, T.; Cunha, N.; Goncalves, S.; Santos, L.; Bernardes, A.; Pinto, Fausto J.; Marques, P.; Sousa, J.Introduction: The optimization of the left ventricle (LV) pacing site guided by the electrical delay increases CRT response rate (RR), however it’s necessary to develop technology that allows its universal use. Purpose: The aim is automatically, and operator-independent, access the conduction delay between the right ventricular (RV) stimulus and the LV available veins in order to select the LV pacing site. It is further intended to compare the total procedure and radiation times in relation to an historical control group.
- From wristbands to implants: the transformative role of wearables in heart failure carePublication . Gregório, Catarina; Agostinho, João R.; Rigueira, Joana; Santos, Rafael; Pinto, Fausto J.; Brito, DulceBackground: Heart failure (HF) management increasingly relies on innovative solutions to enhance monitoring and care. Wearable devices, originally popularized for fitness tracking, show promise in clinical decision-making for HF. This study explores the application and potential for the broader integration of wearable technology in HF management, emphasizing remote monitoring and personalized care. Methods: A comprehensive literature review was performed to assess the role of wearables in HF management, focusing on functionalities like vital sign tracking, patient engagement, and clinical decision support. Clinical outcomes and barriers to adopting wearable technology in HF care were critically analyzed. Results: Wearable devices increasingly track physiological parameters relevant to HF, such as heart rate, physical activity, and sleep. They can identify at-risk patients, promote lifestyle changes, facilitate early diagnosis, and accurately detect arrhythmias that lead to decompensation. Additionally, wearables may assess fluid status, identifying early signs of decompensation to prevent hospitalization and supporting therapeutic adjustments. They also enhance physical activity and optimize cardiac rehabilitation programs, improving patient outcomes. Both wearable and implanted cardiac devices enable continuous, non-invasive monitoring through small devices. However, challenges like data integration, regulatory approval, and reimbursement impede their widespread adoption. Conclusions: Wearable technology can transform HF management through continuous monitoring and early interventions. Collaboration among involved parties is essential to overcome integration challenges and validate most of these devices in clinical practice.
- Left atrial abnormal mechanics by speckle tracking as an early subclinical manifestation in patients with systemic sclerosisPublication . Rodrigues, T. E. Graça; Cunha, Nelson; Nunes-Ferreira, Afonso; Santos, R.; Aguiar-Ricardo, Inês; Rigueira, Joana; Gonçalves, Inês; Agostinho, João R.; Plácido, Rui; David, Cláudio; Pinto, Fausto J.; G. Almeida, AnaIntroduction: Heart involvement in systemic sclerosis (SSc) affects the prognosis of the disease when clinically evident. SSc may be associated with myocardial microvascular obstruction and micronecrosis is a presumible determinant of ventricular dysfunction, heart failure and sudden death. The aim of this study was to assess whether there were early changes of left atrial (LA) deformation by speckle tracking in patients with normal ejection fraction.
- Aortic valve endocarditis by a rare infectious agent in a patient with a rare congenital mitral valve abnormalityPublication . Agostinho, João R.; Plácido, Rui; Almeida, Ana G.; Pinto, Fausto J.Case description: A 66-year-old woman with a past medical history of high blood pressure, Type 2 diabetes mellitus and no clinical evidence of immunocompromise, presented to the emergency room with fever and acute pulmonary oedema. The patient had presented low-grade fever and anorexia in the previous 3 weeks.
- conTemporary reflectiOns regarding heart failure manaGEmenT – How to ovERcome the PorTuguese barriers (TOGETHER-PT)Publication . Silva-Cardoso, José; Santos, Jonathan; Araújo, Inês; Andrade, Aurora; Morais Sarmento, Pedro; Santos, Paulo; Moura, Brenda; Marques, Irene; Peres, Marisa; Ferreira, João Pedro; Agostinho, João R.; Pimenta, JoanaIntroduction and objectives: Heart failure (HF) is a complex clinical syndrome that is a significant burden in hospitalisations, morbidity, and mortality. Although a significant effort has been made to better understand its consequences and current barriers in its management, there are still several gaps to address. The present work aimed to identify the views of a multidisciplinary group of health care professionals on HF awareness and literacy, diagnosis, treatment and organization of care, identifying current challenges and providing insights into the future. Methods: A steering committee was established, including members of the Heart Failure Study Group of the Portuguese Society of Cardiology (GEIC-SPC), the Heart Failure Study Group of the Portuguese Society of Internal Medicine (NEIC-SPMI) and the Cardiovascular Study Group (GEsDCard) of the Portuguese Association of General and Family Medicine (APMGF). This steering committee produced a 16-statement questionnaire regarding different HF domains that was answered to by a diversified group of 152 cardiologists, internists, general practitioners, and nurses with an interest or dedicated to HF using a five-level Likert scale. Full agreement was defined as ≥80% of level 5 (fully agree) responses. Results: Globally, consensus was achieved in all but one of the 16 statements. Full agreement was registered in seven statements, namely 3 of 4 statements for patient education and HF awareness and 2 in 4 statements of both HF diagnosis and healthcare organization, with proportions of fully agree responses ranging from 82.9% to 96.7%. None of the HF treatment statements registered full agreement but 3 of 4 achieved ≥80% of level 4 (agree) responses. Conclusion: This document aims to be a call-to-action to improve HF patients' quality of life and prognosis, by promoting a change in HF care in Portugal.
- Acute coronay syndrome in a patient with severe hemophilia A: dificult decisionsPublication . Aguiar-Ricardo, Inês; Agostinho, João R.; Pereira, Artur; Rodrigues, Fatima; Brito, Dulce; Pinto, Fausto J.; Catarino, Cristina; Mendes Pedro, MónicaHemophilia A is an inherited coagulation disease characterized by factor VIII (FVIII) deficiency and is associated with high hemorrhagic risk, especially in its severe forms. As the average life expectancy of patients with hemophilia has increased, so has the prevalence of acute coronary events. There is however limited experience in dealing with them. The strategy of acting on acute coronary events in patients with hemophilia, as demonstrated in the present case, is a real challenge, not only due to the need for antiplatelet therapy (which is essential in the prevention of stent thrombosis, but increases hemorrhagic risk), but also due to the lack of specific recommendations related to the most adequate and safe replacement therapy in these situations. The authors describe the case of a 48-year-old man with unstable angina and a previous diagnosis of severe hemophilia A who underwent percutaneous coronary intervention under FVIII therapy without hemorrhagic complications.
- Long-standing persistent atrial fibrillation : what can we achieve with ablation?Publication . Nunes-Ferreira, Afonso; Cortez-Dias, Nuno; Silverio Antonio, P.; Silva, Gustavo Lima da; Gonçalves, Inês; Aguiar-Ricardo, Inês; Rigueira, Joana; Agostinho, João R.; Santos, R.; Rodrigues, T.; Cunha, N.; Barreiros, C.; Carpinteiro, L.; Pinto, Fausto J.; Sousa, J. deIntroduction: Atrial fibrillation (AF) ablation presents suboptimal results in patients (pts) with persistent long-lasting forms (LSPAF, AF ≥12 months). Recently, the STAR AF-II trial has shown that in these pts complex additional strategies do not improve success compared to only performing pulmonary vein isolation (PVI). Objectives: To evaluate the success of AF ablation, particularly in long-standing persistent AF