Editorial comment
Ablation of ventricular arrhythmic substrate: When the whole is more than the sum of its parts
Ablação do substrato arrítmico ventricular: quando o todo é mais do que a soma das suas partes
João Primo
Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
Lido
2837
Vezesque se leu este artigo
1206
Total PDF
1631
Total HTML
Compartilhar estatísticas
array:25 [ "pii" => "S0870255121004005" "issn" => "08702551" "doi" => "10.1016/j.repc.2021.09.004" "estado" => "S300" "fechaPublicacion" => "2021-11-01" "aid" => "1824" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2021;40:875-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "en" => array:20 [ "pii" => "S2174204921003287" "issn" => "21742049" "doi" => "10.1016/j.repce.2021.10.023" "estado" => "S300" "fechaPublicacion" => "2021-11-01" "aid" => "1824" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2021;40:875-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Ablation of ventricular arrhythmic substrate: When the whole is more than the sum of its parts" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "875" "paginaFinal" => "876" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Ablação do substrato arrítmico ventricular: quando o todo é mais do que a soma das suas partes" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "João Primo" "autores" => array:1 [ 0 => array:2 [ "nombre" => "João" "apellidos" => "Primo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255121004005" "doi" => "10.1016/j.repc.2021.09.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255121004005?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204921003287?idApp=UINPBA00004E" "url" => "/21742049/0000004000000011/v1_202111300759/S2174204921003287/v1_202111300759/en/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S0870255121003966" "issn" => "08702551" "doi" => "10.1016/j.repc.2021.01.013" "estado" => "S300" "fechaPublicacion" => "2021-11-01" "aid" => "1820" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2021;40:877-87" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Current state of cardiac rehabilitation in Portugal: Results of the 2019 national survey" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "877" "paginaFinal" => "887" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Reabilitação cardíaca em Portugal: resultados do inquérito nacional 2019" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1755 "Ancho" => 2500 "Tamanyo" => 134053 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Changes in numbers of cardiac rehabilitation centers in Portugal over the last two decades.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Paulo Fontes, Eduardo M. Vilela, Anaí Durazzo, Madalena Teixeira" "autores" => array:4 [ 0 => array:2 [ "nombre" => "José Paulo" "apellidos" => "Fontes" ] 1 => array:2 [ "nombre" => "Eduardo M." "apellidos" => "Vilela" ] 2 => array:2 [ "nombre" => "Anaí" "apellidos" => "Durazzo" ] 3 => array:2 [ "nombre" => "Madalena" "apellidos" => "Teixeira" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204921003299" "doi" => "10.1016/j.repce.2021.10.024" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204921003299?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255121003966?idApp=UINPBA00004E" "url" => "/08702551/0000004000000011/v1_202111140551/S0870255121003966/v1_202111140551/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S0870255121003942" "issn" => "08702551" "doi" => "10.1016/j.repc.2020.12.014" "estado" => "S300" "fechaPublicacion" => "2021-11-01" "aid" => "1818" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2021;40:865-73" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Impact of substrate-based ablation for ventricular tachycardia in patients with frequent appropriate implantable cardioverter-defibrillator therapy and dilated cardiomyopathy: Long-term experience with high-density mapping" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "865" "paginaFinal" => "873" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Impacto da ablação de taquicardia ventricular baseada na modificação do substrato arrítmico em doentes com terapêutica apropriada recorrente via CDI e miocardiopatia dilatada: experiência a longo-prazo com mapeamento de alta-densidade" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1308 "Ancho" => 2167 "Tamanyo" => 239477 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Conduction channels visualized in high-density electroanatomic mapping by adjusting the color threshold on the voltage map (left lateral view) in an ischemic cardiomyopathy patient.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mário Oliveira, Pedro Cunha, Bruno Valente, Guilherme Portugal, Ana Lousinha, Mariana Pereira, Manuel Braz, Ana Delgado, Rui C. Ferreira" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Mário" "apellidos" => "Oliveira" ] 1 => array:2 [ "nombre" => "Pedro" "apellidos" => "Cunha" ] 2 => array:2 [ "nombre" => "Bruno" "apellidos" => "Valente" ] 3 => array:2 [ "nombre" => "Guilherme" "apellidos" => "Portugal" ] 4 => array:2 [ "nombre" => "Ana" "apellidos" => "Lousinha" ] 5 => array:2 [ "nombre" => "Mariana" "apellidos" => "Pereira" ] 6 => array:2 [ "nombre" => "Manuel" "apellidos" => "Braz" ] 7 => array:2 [ "nombre" => "Ana" "apellidos" => "Delgado" ] 8 => array:2 [ "nombre" => "Rui C." "apellidos" => "Ferreira" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204921003585" "doi" => "10.1016/j.repce.2021.11.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204921003585?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255121003942?idApp=UINPBA00004E" "url" => "/08702551/0000004000000011/v1_202111140551/S0870255121003942/v1_202111140551/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Ablation of ventricular arrhythmic substrate: When the whole is more than the sum of its parts" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "875" "paginaFinal" => "876" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "João Primo" "autores" => array:1 [ 0 => array:3 [ "nombre" => "João" "apellidos" => "Primo" "email" => array:1 [ 0 => "joaojoseprimo@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Ablação do substrato arrítmico ventricular: quando o todo é mais do que a soma das suas partes" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ablation of ventricular tachycardia (VT) is just one example in interventional electrophysiology in which treatment has shifted from focal ablation of the tachycardia exit point or circuit to wider ablation of the arrhythmic substrate which underlies the origin of the arrhythmia. Other examples of substrate ablation are known. I am specifically referring to the ablation of atrial fibrillation or atypical atrial flutter. Haissaguerre and colleagues began by ablating arrhythmogenic foci within the pulmonary veins, but, given the increased risk of complications associated with this strategy (such as pulmonary vein stenosis), they moved from this approach to the segmental isolation of the pulmonary veins. This subsequently gave rise to antral ablation, which eliminates an important substrate that can trigger and allow the perpetuation of atrial fibrillation.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In a similar fashion, ablation of the VT substrate destroys tissue that may be responsible for the appearance of potentially fatal arrhythmias in patients with significant left ventricular systolic dysfunction who do not tolerate the induction of such arrhythmias in the electrophysiology laboratory. Following studies by Arenal and colleagues on the identification and characterization of late ventricular potentials (local abnormal ventricular activity [LAVA]) which are seen in channels that enable reentry to occur, it became possible to treat a large number of patients who would otherwise be at high risk of death.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> The advent of high-density three-dimensional mapping and multipolar catheters facilitated the creation of detailed maps of the scar tissue, its edges and LAVAs which constitute the arrhythmic substrate to be ablated.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Journal</span>, Mário Oliveira and colleagues<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> provide follow-up data on 20 patients from their tertiary center with ischemic or non-ischemic dilated cardiomyopathy, left ventricular systolic dysfunction and implanted cardioverter-defibrillators (ICDs) that had been implanted for the primary prevention of sudden death. All patients underwent radiofrequency ablation due to recurrent ICD therapies refractory to antiarrhythmic drugs or arrhythmic storms. The authors described the methods used to achieve their long-term goal of freedom from ventricular arrhythmias and ICD therapies. They treated a group of patients at high risk of cardiovascular events and complications during and after the procedure, which highlights the need for careful planning to reduce procedure time and to maintain hemodynamic stability in sinus rhythm. Therefore, substrate ablation was the preferred technique rather than VT induction with activation mapping.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In this setting, cardiac magnetic resonance imaging (MRI) is valuable.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> This exam provides useful information on scar extent and location, and potentially the presence of narrow channels within scar tissue. It helps determine the most appropriate approach for each patient: endocardial ablation only, epi-endocardial or epicardial. The number of patients who underwent cardiac MRI in the present study was small, as the exam is not always easy in patients with ICDs. However, although image quality may be reduced, it is often possible to perform cardiac MRI in ICD patients and this option should be considered.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> In our practice we usually request cardiac MRI prior to ICD implantation, particularly in patients with non-ischemic cardiomyopathy, in the expectation that this information could be useful in the future.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The authors used the PentaRay multipolar catheter in all cases to create a detailed map of the left ventricle with careful delineation of scar tissue. They further performed extensive ablation of all areas showing fractionated, double, prolonged, delayed, pre-systolic or low-voltage potentials. This differs from the approach used by other operators who ablate areas showing post-QRS potentials only. Nevertheless, more extensive substrate ablation is also used by some operators, who start by defining scar channels and arrhythmia exit points with pacemapping and apply more localized ablation, but then move to wider ablation. This may be justified by the concern that non-ablated (bystander) circuits may trigger future arrhythmias requiring further ablation procedures.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The authors performed mapping in sinus rhythm, but other operators may choose to do this in right ventricular pacing (either with a quadripolar catheter or via the ICD), and some may even perform more than one map with pacing from multiple sites to allow for more than one wavefront. Using premature ventricular stimulation from certain areas of the map may further enable better characterization of LAVA tissue.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> Mapping while pacing from the ventricle may also be quicker, which is advantageous in these cases.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In this setting, programmed ventricular stimulation at the beginning of the procedure may be less useful, as it will not significantly impact on the main strategy, which is the elimination of the arrhythmic substrate.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> In fact, it will lengthen the procedure and may even lead to hemodynamic decompensation when fast VT is induced requiring electrical cardioversion. While mapping the substrate with a multipolar catheter, spontaneous induction of the clinical VT is occasionally seen, enabling activation mapping.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The good results seen in this study show that VT substrate ablation is the way forward. Although the ICD may reduce the risk of sudden death, ICD shocks have a detrimental effect on these patients, increasing their overall mortality risk.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> This may sound paradoxical, but in both the SCD-HeFT and MADIT-II trials, patients receiving ICD shocks were at higher risk of death than ICD patients with no ICD therapies, but also higher than patients in the control groups who received pharmacological treatment only. Our duty is therefore to prevent such therapies and prolong the life of these patients with ventricular arrhythmic substrate ablation, perhaps at an earlier stage.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Haïssaguerre" 1 => "P. Jaïs" 2 => "D.C. Shah" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199809033391003" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1998" "volumen" => "339" "paginaInicial" => "659" "paginaFinal" => "666" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9725923" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0065" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Electrophysiological breakthroughs from the left atrium to the pulmonary veins" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Haïssaguerre" 1 => "D.C. Shah" 2 => "P. Jaïs" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.cir.102.20.2463" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2000" "volumen" => "102" "paginaInicial" => "2463" "paginaFinal" => "2465" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11076817" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0070" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Pappone" 1 => "G. Oreto" 2 => "S. Rosanio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/hc4601.098517" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2001" "volumen" => "104" "paginaInicial" => "2539" "paginaFinal" => "2544" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11714647" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0075" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ablation of electrograms with an isolated, delayed component as treatment of unmappable monomorphic ventricular tachycardias in patients with structural heart disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Arenal" 1 => "E. Glez-Torrecilla" 2 => "M. Ortiz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0735-1097(02)02623-2" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2003" "volumen" => "41" "paginaInicial" => "81" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12570949" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0080" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Substrate mapping and ablation for ventricular tachycardia in patients with structural heart disease: how to identify ventricular tachycardia substrate" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Kitamura" 1 => "C. Martin" 2 => "K. Vlachos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Innov Cardiac Rhythm Manage" "fecha" => "2019" "volumen" => "10" "paginaInicial" => "3565" "paginaFinal" => "3580" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0085" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of substrate-based ablation for ventricular tachycardia in patients with frequent appropriate ICD therapy and dilated cardiomyopathy: long-term term with high-density mapping" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Oliveira" 1 => "P. Cunha" 2 => "B. Valente" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2020.12.014" "Revista" => array:2 [ "tituloSerie" => "Rev Portuguesa Cardiol" "fecha" => "2021" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0090" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Scar dechanneling: new method for scar-related left ventricular tachycardia substrate ablation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Berruezo" 1 => "J. Fernandez-Armenta" 2 => "D. Andreu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Circ Arrhythm Electrophysiol" "fecha" => "2015" "volumen" => "8" "paginaInicial" => "326" "paginaFinal" => "336" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0095" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Magnetic resonance imaging in patients with cardiac implanted electronic devices: focus on contraindications to magnetic resonance imaging protocols" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L. Horwood" 1 => "A. Attili" 2 => "F. Luba" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/europace/euw122" "Revista" => array:6 [ "tituloSerie" => "Europace" "fecha" => "2017" "volumen" => "19" "paginaInicial" => "812" "paginaFinal" => "817" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27256419" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0100" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Defining the substrate for ventricular tachycardia ablation: the impact of rhythm at the time of mapping" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.K. Kella" 1 => "S.H. Sheldon" 2 => "A. Noheria" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Indian Pac Electrophysiol J" "fecha" => "2020" "volumen" => "20" "paginaInicial" => "147" "paginaFinal" => "215" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0105" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Substrate modification or ventricular tachycardia induction, mapping, and ablation as the first step? A randomized study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Fernández-Armenta" 1 => "D. Penela" 2 => "J. Acosta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.hrthm.2016.05.013" "Revista" => array:6 [ "tituloSerie" => "Heart Rhythm" "fecha" => "2016" "volumen" => "13" "paginaInicial" => "1589" "paginaFinal" => "1595" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27180621" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0110" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic importance of defibrillator shocks in patients with heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.E. Poole" 1 => "G.W. Johnson" 2 => "A.S. Hellkamp" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa071098" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2008" "volumen" => "359" "paginaInicial" => "1009" "paginaFinal" => "1011" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18768944" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000004000000011/v1_202111140551/S0870255121004005/v1_202111140551/en/main.assets" "Apartado" => array:4 [ "identificador" => "29261" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Artigos Originais" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000004000000011/v1_202111140551/S0870255121004005/v1_202111140551/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255121004005?idApp=UINPBA00004E" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 7 | 7 | 14 |
| 2024 Outubro | 111 | 42 | 153 |
| 2024 Setembro | 53 | 23 | 76 |
| 2024 Agosto | 80 | 37 | 117 |
| 2024 Julho | 53 | 30 | 83 |
| 2024 Junho | 31 | 20 | 51 |
| 2024 Maio | 36 | 18 | 54 |
| 2024 Abril | 56 | 27 | 83 |
| 2024 Maro | 61 | 27 | 88 |
| 2024 Fevereiro | 70 | 28 | 98 |
| 2024 Janeiro | 45 | 32 | 77 |
| 2023 Dezembro | 29 | 26 | 55 |
| 2023 Novembro | 68 | 44 | 112 |
| 2023 Outubro | 36 | 12 | 48 |
| 2023 Setembro | 26 | 22 | 48 |
| 2023 Agosto | 20 | 17 | 37 |
| 2023 Julho | 33 | 11 | 44 |
| 2023 Junho | 33 | 13 | 46 |
| 2023 Maio | 41 | 29 | 70 |
| 2023 Abril | 16 | 8 | 24 |
| 2023 Maro | 32 | 28 | 60 |
| 2023 Fevereiro | 29 | 19 | 48 |
| 2023 Janeiro | 20 | 16 | 36 |
| 2022 Dezembro | 29 | 27 | 56 |
| 2022 Novembro | 34 | 32 | 66 |
| 2022 Outubro | 38 | 32 | 70 |
| 2022 Setembro | 26 | 40 | 66 |
| 2022 Agosto | 29 | 40 | 69 |
| 2022 Julho | 38 | 39 | 77 |
| 2022 Junho | 35 | 36 | 71 |
| 2022 Maio | 26 | 38 | 64 |
| 2022 Abril | 31 | 43 | 74 |
| 2022 Maro | 43 | 49 | 92 |
| 2022 Fevereiro | 35 | 29 | 64 |
| 2022 Janeiro | 35 | 40 | 75 |
| 2021 Dezembro | 62 | 70 | 132 |
| 2021 Novembro | 105 | 63 | 168 |
| 2021 Outubro | 79 | 90 | 169 |
| 2021 Setembro | 0 | 2 | 2 |
Mostrar tudo
