Pub Date : 2025-06-26DOI: 10.1016/j.repc.2025.02.009
Sílvia Ribeiro , Paulo Fonseca , Pedro Semedo , Alexandra Castro , Daniel Bonhorst , Pedro Marques , Víctor Sanfins
Introduction and objectives
We present the results of the national cardiac electrophysiology registry of the Portuguese Association of Arrhythmology, Pacing and Electrophysiology (APAPE) and the Portuguese Institute of Cardiac Rhythm for 2021 and 2022.
Methods
Data were collected from 26 electrophysiology centers registered with APAPE using an online digital platform. Data collection included information on human and technological resources, electrophysiological studies, ablations performed, atrial fibrillation (AF) ablation, and ventricular tachycardia (VT) ablation procedures.
Results
In the 26 centers, 4491 ablations were performed in 2021 and 4968 ablations in 2022. AF ablation was the most frequently performed procedure: 1673 ablations in 2021 and 1994 in 2022, 70% paroxysmal AF, with clinically relevant complications was reported in 1.2–1.5% of the procedures. VT ablation was performed in 294 patients in 2021 (45% with structural disease), and in 331 in 2022 (42% with structural disease). Clinically relevant complications were reported in 2.7–2.4% of the procedures (2021 and 2022, respectively).
Conclusions
In Portugal, the number of cardiac electrophysiology procedures is on the rise, but it has not reached the levels expected based on European Society of Cardiology data. AF ablation is the most common procedure, accounting for 37% in 2021 and 40% in 2022. VT ablation is still low. Additionally, cardioneuroablation and Brugada syndrome ablation are gaining importance at several Portuguese centers.
{"title":"Portuguese National Registry on Cardiac Electrophysiology, 2021 and 2022","authors":"Sílvia Ribeiro , Paulo Fonseca , Pedro Semedo , Alexandra Castro , Daniel Bonhorst , Pedro Marques , Víctor Sanfins","doi":"10.1016/j.repc.2025.02.009","DOIUrl":"10.1016/j.repc.2025.02.009","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>We present the results of the national cardiac electrophysiology registry of the Portuguese Association of Arrhythmology, Pacing and Electrophysiology (APAPE) and the Portuguese Institute of Cardiac Rhythm for 2021 and 2022.</div></div><div><h3>Methods</h3><div>Data were collected from 26 electrophysiology centers registered with APAPE using an online digital platform. Data collection included information on human and technological resources, electrophysiological studies, ablations performed, atrial fibrillation (AF) ablation, and ventricular tachycardia (VT) ablation procedures.</div></div><div><h3>Results</h3><div>In the 26 centers, 4491 ablations were performed in 2021 and 4968 ablations in 2022. AF ablation was the most frequently performed procedure: 1673 ablations in 2021 and 1994 in 2022, 70% paroxysmal AF, with clinically relevant complications was reported in 1.2–1.5% of the procedures. VT ablation was performed in 294 patients in 2021 (45% with structural disease), and in 331 in 2022 (42% with structural disease). Clinically relevant complications were reported in 2.7–2.4% of the procedures (2021 and 2022, respectively).</div></div><div><h3>Conclusions</h3><div>In Portugal, the number of cardiac electrophysiology procedures is on the rise, but it has not reached the levels expected based on European Society of Cardiology data. AF ablation is the most common procedure, accounting for 37% in 2021 and 40% in 2022. VT ablation is still low. Additionally, cardioneuroablation and Brugada syndrome ablation are gaining importance at several Portuguese centers.</div></div>","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"44 8","pages":"Pages 489-499"},"PeriodicalIF":1.6,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-25DOI: 10.1016/j.repc.2025.06.003
Diogo Cavaco
{"title":"Continuity and contribution: Three decades of the Portuguese Electrophysiology Registry","authors":"Diogo Cavaco","doi":"10.1016/j.repc.2025.06.003","DOIUrl":"10.1016/j.repc.2025.06.003","url":null,"abstract":"","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"44 8","pages":"Pages 501-502"},"PeriodicalIF":1.6,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-06DOI: 10.1016/j.repc.2025.01.008
Ana Isabel Pinho , Sandra Amorim , Luís Adão , Carla Sousa , Rui André Rodrigues
{"title":"The apple doesn’t fall far from the tree – A Portuguese case of familial ST-segment depression","authors":"Ana Isabel Pinho , Sandra Amorim , Luís Adão , Carla Sousa , Rui André Rodrigues","doi":"10.1016/j.repc.2025.01.008","DOIUrl":"10.1016/j.repc.2025.01.008","url":null,"abstract":"","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"44 8","pages":"Pages 513-517"},"PeriodicalIF":1.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-02DOI: 10.1016/j.repc.2025.01.007
Ana Isabel Rodrigues , Inês V. Carvalho , Carolina Sousa Fernandes , Francisco Millet Barros , João Sousa , Pedro Faustino , Emanuel Martins , Diogo Damas , Catarina Bernardes , Carolina Teles , Telma Alves , Carolina Martins , Rita Ramalho , Carolina Maia , Henrique Queirós , Elisa Viegas , Filipa Costa Sousa , Inês Pinheiro , Laura Baptista , Ana Patrícia Gomes , Gustavo C. Santo
Introduction and objectives
Regional telestroke networks offer several advantages, including upstream selection of thrombectomy candidates. However, it is unclear whether the network performance and the functional outcome of patients with ischemic stroke treated with direct oral anticoagulants and transferred to thrombectomy differ from those of non-hypocoagulated patients.
To compare the time metrics and the functional status of patients with ischemic stroke treated with direct oral anticoagulants and transferred to thrombectomy with non-hypocoagulated patients.
Methods
This was a retrospective multicenter cohort study involving the eight hospitals involved a regional telestroke network. Clinical, imaging and time measures data were obtained from patients transferred for thrombectomy in the period between 01 January 2016 and 18 March 2021. Reperfusion was assumed for modified Thrombolysis in Cerebral Infarction scores 2b and 3. Functional status was assessed using the modified Rankin scale at 90 days.
Results
Of the 4341 patients evaluated in teleconsultation, 945 patients were transferred for thrombectomy and 15.98% had been previously treated with direct oral anticoagulants. There was no statistically significant difference between groups in the time interval, measured in minutes, between admission to the primary and tertiary hospital (231.59 versus 235.71, p=0.805) and, in patients undergoing thrombectomy, between admission to the tertiary hospital and reperfusion (100.45 versus 102.79, p=0.789). The reperfusion rate did not differ between groups (86.64% versus 83.57%, p=0.625). The functional outcome was not affected by direct oral anticoagulants intake (odds ratio 1.04 [95% confidence interval 0.69–1.55], p=0.857).
Conclusion(s)
Treatment with direct oral anticoagulants did not have an impact on the performance or the functional outcome of ischemic stroke patients transferred for thrombectomy.
介绍和目的：区域性远程中风网络提供了几个优势，包括上游血栓切除候选物的选择。然而，目前尚不清楚的是，直接口服抗凝药物治疗并转入血栓切除术的缺血性脑卒中患者的网络性能和功能结局是否与非低凝患者不同。比较直接口服抗凝药物治疗的缺血性脑卒中患者和非低凝患者的时间指标和功能状况。方法：这是一项回顾性多中心队列研究，涉及8家医院，涉及一个区域性的远程中风网络。从2016年1月1日至2021年3月18日转入血栓切除术的患者中获得临床、影像学和时间测量数据。脑梗死评分为2b和3的改良溶栓假定为再灌注。在第90天使用改良Rankin量表评估功能状态。结果：在远程会诊评估的4341例患者中，945例患者转院取栓，15.98%患者之前曾接受过直接口服抗凝药物治疗。在一级医院和三级医院入院的时间间隔（231.59分钟对235.71分钟，p=0.805）以及在行血栓切除术的患者中，三级医院入院和再灌注之间的时间间隔（100.45分钟对102.79分钟，p=0.789），组间差异无统计学意义。各组再灌注率无显著差异（86.64% vs 83.57%, p=0.625）。直接口服抗凝剂不影响功能结局（优势比1.04[95%置信区间0.69-1.55],p=0.857）。结论：直接口服抗凝剂治疗对转行取栓的缺血性脑卒中患者的表现和功能结局没有影响。
{"title":"Use of direct oral anticoagulants in patients with stroke transferred for thrombectomy","authors":"Ana Isabel Rodrigues , Inês V. Carvalho , Carolina Sousa Fernandes , Francisco Millet Barros , João Sousa , Pedro Faustino , Emanuel Martins , Diogo Damas , Catarina Bernardes , Carolina Teles , Telma Alves , Carolina Martins , Rita Ramalho , Carolina Maia , Henrique Queirós , Elisa Viegas , Filipa Costa Sousa , Inês Pinheiro , Laura Baptista , Ana Patrícia Gomes , Gustavo C. Santo","doi":"10.1016/j.repc.2025.01.007","DOIUrl":"10.1016/j.repc.2025.01.007","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Regional telestroke networks offer several advantages, including upstream selection of thrombectomy candidates. However, it is unclear whether the network performance and the functional outcome of patients with ischemic stroke treated with direct oral anticoagulants and transferred to thrombectomy differ from those of non-hypocoagulated patients.</div><div>To compare the time metrics and the functional status of patients with ischemic stroke treated with direct oral anticoagulants and transferred to thrombectomy with non-hypocoagulated patients.</div></div><div><h3>Methods</h3><div>This was a retrospective multicenter cohort study involving the eight hospitals involved a regional telestroke network. Clinical, imaging and time measures data were obtained from patients transferred for thrombectomy in the period between 01 January 2016 and 18 March 2021. Reperfusion was assumed for modified Thrombolysis in Cerebral Infarction scores 2b and 3. Functional status was assessed using the modified Rankin scale at 90 days.</div></div><div><h3>Results</h3><div>Of the 4341 patients evaluated in teleconsultation, 945 patients were transferred for thrombectomy and 15.98% had been previously treated with direct oral anticoagulants. There was no statistically significant difference between groups in the time interval, measured in minutes, between admission to the primary and tertiary hospital (231.59 versus 235.71, p=0.805) and, in patients undergoing thrombectomy, between admission to the tertiary hospital and reperfusion (100.45 versus 102.79, p=0.789). The reperfusion rate did not differ between groups (86.64% versus 83.57%, p=0.625). The functional outcome was not affected by direct oral anticoagulants intake (odds ratio 1.04 [95% confidence interval 0.69–1.55], p=0.857).</div></div><div><h3>Conclusion(s)</h3><div>Treatment with direct oral anticoagulants did not have an impact on the performance or the functional outcome of ischemic stroke patients transferred for thrombectomy.</div></div>","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"44 8","pages":"Pages 481-486"},"PeriodicalIF":1.6,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-02DOI: 10.1016/j.repc.2025.02.008
Sonia Peribáñez , Mario Martínez-Fleta , Pablo M. Corredoira
{"title":"Flecainide toxicity in a patient with a pacemaker","authors":"Sonia Peribáñez , Mario Martínez-Fleta , Pablo M. Corredoira","doi":"10.1016/j.repc.2025.02.008","DOIUrl":"10.1016/j.repc.2025.02.008","url":null,"abstract":"","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"44 8","pages":"Pages 519-520"},"PeriodicalIF":1.6,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.repc.2024.12.003
Rita Calé , Hélder Pereira , André Luz , Rui Campante Teles , Marco Costa , João Carlos Silva , Pedro Braga , Pedro Pinto Cardoso , Rui Cruz Ferreira , Filipe Seixo , João Costa , Hélder Ribeiro , João Brum da Silveira , Pedro Costa Ferreira , Jorge Guardado , Pedro Farto e Abreu , Renato Fernandes , Hugo Vinhas , Dinis Martins , Graça Caires , Manuel Almeida
Introduction and objectives
To present the report on the trends in percutaneous coronary activity data in Portugal from the last decade (from 2014 to 2023).
Methods
Data were extracted from the Portuguese National Registry of Interventional Cardiology (RNCI) and the numbers in recent years were compared and complemented by information from the 2023 European Society of Cardiology Atlas in Interventional Cardiology (IC) survey, which was administered to the director of every IC department. Linear regression analysis was used to assess trends in activity over time.
Results
From 2014 to 2023, there were 160 101 percutaneous coronary interventions reported in the RNCI. The number of annual PCI in the last decade remained constant (1360/million inhabitants in 2014 to 1322/million in 2023; R2=0.039, p=0.276). Importantly, there was a 22% increase in primary PCI (306/million inhabitants in 2014 to 374/million inhabitants in 2023; R2=0.759, p<0.001) and there was a decrease in the geographical disparities in primary PCI across Portugal. The following PCI trends were noted: a 43% increase in PCI performed by radial access (57.4% in 2014 to 82.1% in 2023; R2=0.908, p<0.001), a 27% increase in drug-eluting stents (78.4% in 2014 to 99.2% of all PCI with stents in 2023; R2=0.638, p=0.003), and a 47% decrease of thrombectomy in primary PCI (35.0% in 2014 to 18.6% in 2023; R2=0.649, p=0.003). There was a slight increase in the use of intracoronary diagnostic devices during PCI, with intravascular imaging and physiological assessments reaching 7.6% and 4.2%, respectively, in 2023.
Conclusion
The RNCI was able to depict changes in our practice along the study period. The annual PCI volume per million inhabitants remained stable, driven by an increase in primary PCI offset by a decrease in chronic coronary syndrome indications. The geographical asymmetries were markedly reduced due to the expansion on PCI capable centers, enabling a progress towards a more universal access to percutaneous coronary techniques.
{"title":"Portuguese National Registry of Interventional Cardiology: Official report of percutaneous coronary angiography and intervention from 2014 to 2023","authors":"Rita Calé , Hélder Pereira , André Luz , Rui Campante Teles , Marco Costa , João Carlos Silva , Pedro Braga , Pedro Pinto Cardoso , Rui Cruz Ferreira , Filipe Seixo , João Costa , Hélder Ribeiro , João Brum da Silveira , Pedro Costa Ferreira , Jorge Guardado , Pedro Farto e Abreu , Renato Fernandes , Hugo Vinhas , Dinis Martins , Graça Caires , Manuel Almeida","doi":"10.1016/j.repc.2024.12.003","DOIUrl":"10.1016/j.repc.2024.12.003","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>To present the report on the trends in percutaneous coronary activity data in Portugal from the last decade (from 2014 to 2023).</div></div><div><h3>Methods</h3><div>Data were extracted from the Portuguese National Registry of Interventional Cardiology (RNCI) and the numbers in recent years were compared and complemented by information from the 2023 European Society of Cardiology Atlas in Interventional Cardiology (IC) survey, which was administered to the director of every IC department. Linear regression analysis was used to assess trends in activity over time.</div></div><div><h3>Results</h3><div>From 2014 to 2023, there were 160<!--> <!-->101 percutaneous coronary interventions reported in the RNCI. The number of annual PCI in the last decade remained constant (1360/million inhabitants in 2014 to 1322/million in 2023; R<sup>2</sup>=0.039, p=0.276). Importantly, there was a 22% increase in primary PCI (306/million inhabitants in 2014 to 374/million inhabitants in 2023; R<sup>2</sup>=0.759, p<0.001) and there was a decrease in the geographical disparities in primary PCI across Portugal. The following PCI trends were noted: a 43% increase in PCI performed by radial access (57.4% in 2014 to 82.1% in 2023; R<sup>2</sup>=0.908, p<0.001), a 27% increase in drug-eluting stents (78.4% in 2014 to 99.2% of all PCI with stents in 2023; R<sup>2</sup>=0.638, p=0.003), and a 47% decrease of thrombectomy in primary PCI (35.0% in 2014 to 18.6% in 2023; R<sup>2</sup>=0.649, p=0.003). There was a slight increase in the use of intracoronary diagnostic devices during PCI, with intravascular imaging and physiological assessments reaching 7.6% and 4.2%, respectively, in 2023.</div></div><div><h3>Conclusion</h3><div>The RNCI was able to depict changes in our practice along the study period. The annual PCI volume per million inhabitants remained stable, driven by an increase in primary PCI offset by a decrease in chronic coronary syndrome indications. The geographical asymmetries were markedly reduced due to the expansion on PCI capable centers, enabling a progress towards a more universal access to percutaneous coronary techniques.</div></div>","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"44 6","pages":"Pages 335-345"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.repc.2025.04.004
Mário Oliveira
{"title":"Expanding left bundle branch area pacing – A new step in daily practice","authors":"Mário Oliveira","doi":"10.1016/j.repc.2025.04.004","DOIUrl":"10.1016/j.repc.2025.04.004","url":null,"abstract":"","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"44 6","pages":"Pages 387-388"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.repc.2025.05.002
Anaí Durazzo
{"title":"Exercise prescription in cardiac rehabilitation for heart failure patients: Why threshold-based training matters","authors":"Anaí Durazzo","doi":"10.1016/j.repc.2025.05.002","DOIUrl":"10.1016/j.repc.2025.05.002","url":null,"abstract":"","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"44 6","pages":"Pages 373-375"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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