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Migliore F, Pittorru R, De Lazzari M, Tarzia V, Pastore G, Marcantoni L, Catanzariti D, Gerosa G, Zanon F. Transvenous lead extraction of lumenless 3830 pacing lead in conduction system pacing: a single-center experience. J Interv Card Electrophysiol 2024; 67:175-182. [PMID: 37365481 PMCID: PMC10769925 DOI: 10.1007/s10840-023-01590-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND The Medtronic SelectSecure Model 3830 lumenless lead (Medtronic, Inc., Minneapolis, MN) is commonly used for conduction system pacing (CSP). However, with this increased use, the potential need for transvenous lead extraction (TLE) also will increase. While extraction of endocardial 3830 leads is rather well described especially in pediatric and adult congenital heart disease population, there is very limited data on extraction of CSP leads. In the present study, we reported our preliminary experience on TLE of CSP leads and provided technical considerations. METHODS The study population comprised 6 consecutive patients (67% male; mean age 70 ± 22 years) with CSP leads (3830 leads), including left bundle branch pacing (LBBP) lead (n = 3) and His pacing lead (n = 3) undergoing TLE. Overall target leads were 17. The mean implant duration time of CSP leads was 97 ± 90 months [range 8-193). RESULTS Manual traction was successful in 2 cases and mechanical extraction tools were required in the remaining cases. Sixteen leads (94%) were completely extracted, whereas incomplete removal was observed in one lead (6%) among 1 patient. Of note, in the only lead incompletely removed, we observed retention of < 1-cm remnant of lead material consisting of the screw of 3830 LBBP lead into the interventricular septum. No failure of lead extraction was reported and no major complications occurred. CONCLUSIONS Our findings demonstrated that at an experienced center the success of TLE of chronically implanted CSP leads is high in the absence of major complications also when mechanical extraction tools are needed.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, Padova, Italy.
| | - Raimondo Pittorru
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, Padova, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, Padova, Italy
| | - Vincenzo Tarzia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, Padova, Italy
| | - Gianni Pastore
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Santa Maria Della Misericordia General Hospital, Rovigo, Italy
| | - Lina Marcantoni
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Santa Maria Della Misericordia General Hospital, Rovigo, Italy
| | | | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, Padova, Italy
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Santa Maria Della Misericordia General Hospital, Rovigo, Italy
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Vergara C, Stella S, Maines M, Africa PC, Catanzariti D, Demattè C, Centonze M, Nobile F, Quarteroni A, Del Greco M. Computational electrophysiology of the coronary sinus branches based on electro-anatomical mapping for the prediction of the latest activated region. Med Biol Eng Comput 2022; 60:2307-2319. [PMID: 35729476 PMCID: PMC9293833 DOI: 10.1007/s11517-022-02610-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 06/07/2022] [Indexed: 01/18/2023]
Abstract
This work dealt with the assessment of a computational tool to estimate the electrical activation in the left ventricle focusing on the latest electrically activated segment (LEAS) in patients with left bundle branch block and possible myocardial fibrosis. We considered the Eikonal-diffusion equation and to recover the electrical activation maps in the myocardium. The model was calibrated by using activation times acquired in the coronary sinus (CS) branches or in the CS solely with an electroanatomic mapping system (EAMS) during cardiac resynchronization therapy (CRT). We applied our computational tool to ten patients founding an excellent accordance with EAMS measures; in particular, the error for LEAS location was less than 4 mm. We also calibrated our model using only information in the CS, still obtaining an excellent agreement with the measured LEAS. The proposed tool was able to accurately reproduce the electrical activation maps and in particular LEAS location in the CS branches, with an almost real-time computational effort, regardless of the presence of myocardial fibrosis, even when information only at CS was used to calibrate the model. This could be useful in the clinical practice since LEAS is often used as a target site for the left lead placement during CRT.
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Affiliation(s)
- Christian Vergara
- LABS, Dipartimento Di Chimica, Materiali E Ingegneria Chimica “Giulio Natta”, Politecnico Di Milano, Piazza Leonardo da Vinci 32, 20233 Milan, Italy
| | - Simone Stella
- Dipartimento Di Matematica, MOX, Politecnico Di Milano, Piazza Leonardo da Vinci 32, 20233 Milan, Italy
| | - Massimiliano Maines
- Department of Cardiology, S. Maria del Carmine Hospital, corso Verona 4, 38068 Rovereto, TN Italy
| | - Pasquale Claudio Africa
- Dipartimento Di Matematica, MOX, Politecnico Di Milano, Piazza Leonardo da Vinci 32, 20233 Milan, Italy
| | - Domenico Catanzariti
- Department of Cardiology, S. Maria del Carmine Hospital, corso Verona 4, 38068 Rovereto, TN Italy
| | - Cristina Demattè
- Department of Cardiology, S. Maria del Carmine Hospital, corso Verona 4, 38068 Rovereto, TN Italy
| | - Maurizio Centonze
- U.O. Di Radiologia Di Borgo-Pergine, Borgo Valsugana Hospital, viale Vicenza 9, 38051 Borgo Valsugana, (TN) Italy
| | - Fabio Nobile
- Institute of Mathematics, CSQI, École Polytechnique Fédérale de Lausanne, Route Cantonale, 1015 Lausanne, Switzerland
| | - Alfio Quarteroni
- Dipartimento Di Matematica, MOX, Politecnico Di Milano, Piazza Leonardo da Vinci 32, 20233 Milan, Italy
- Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Maurizio Del Greco
- Department of Cardiology, S. Maria del Carmine Hospital, corso Verona 4, 38068 Rovereto, TN Italy
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Dal Porto M, Dematte" C, Maines M, Giovanelli C, Vinco G, Setti E, Cemin C, Rossi A, Benfari G, Fezzi S, Catanzariti D, Ribichini FL, Del Greco M. Left atrial functional remodeling assessed by echocardiography in patients undergoing ablation for atrial fibrillation: correlation with the presence of fibrosis and invasive atrial pressure. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Radiofrequency catheter ablation of pulmonary veins has become a common procedure for treatment of atrial fibrillation (AF). Nevertheless, the procedure is characterized by an extremely variable success rate, which reflects a great heterogeneity of factors implicated in AF recurrence and AF burden.
Purpose
We focused on the role of left atrium (LA) in patients with paroxysmal and persistent AF who underwent catheter pulmonary veins ablation procedure. In particular we paid attention to three factors: echocardiographic evaluation of LA function, LA scar evaluated by electroanatomic mapping and LA pressures (LAP) during ablation procedure. The aim of the study was to investigate the correlation between echocardiographic parameters indicating atrial dysfunction (LA volume indexed, E/E’, LAA contraction velocity, LA stiffness and LA longitudinal strain during reservoir phase (LASr)) and intraprocedural parameters (such as LAPpeak and the amount of fibrosis).
Methods
The study included 25 patients; mean age was 63 ± 8 years; nineteen patients (76%) had paroxysmal AF, eighteen patients (72%) were in sinus rhythm at the time of ablation. The population was divided into two subgroups according to the amount of fibrosis evaluated by electroanatomic mapping: patients with fibrosis ≥ 5% of the total LA volume were considered as having an atrial scar. All patients underwent a comprehensive transthoracic echocardiography and a transesophageal echocardiography before the ablation procedure. Intraprocedural data regarding LAPpeak and electroanatomic mapping were collected. Measurements were acquired during both sinus rhythm (SR) and AF.
Results
Patients with atrial scar had similar LA volume compared to patients without scar (44 ml vs 37.4 ml, p = 0.108) , but presented a trend towards higher LAPpeak (24.3 mmHg vs 15.9 mmHg, p = 0.053) and had higher E/E’ (11 vs 7, p = 0.037) and consequently increased LA stiffness (0.72 vs 0.23, p= 0.006). Still, they had lower LASr (16.6% vs 33.2%, p = 0.013) and tended to have reduced LAA contraction velocity (0.4 m/sec vs 0.7 m/sec, p= 0.005).
Conclusions
The present findings suggest that functional remodeling of the LA, more than morphological changes, are correlated with the presence of atrial fibrosis and elevated atrial pressure detected during ablation procedures. These parameters may represent potential criteria to guide patients’ selection for ablation procedure and deserve dedicated studies to be confirmed. Abstract Figure.
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Affiliation(s)
- M Dal Porto
- University of Verona, Cardiology, Verona, Italy
| | - C Dematte"
- Santa Maria Del Carmine Hospital, Cardiology, Rovereto, Italy
| | - M Maines
- Santa Maria Del Carmine Hospital, Cardiology, Rovereto, Italy
| | - C Giovanelli
- Santa Maria Del Carmine Hospital, Cardiology, Rovereto, Italy
| | - G Vinco
- Santa Maria Del Carmine Hospital, Cardiology, Rovereto, Italy
| | - E Setti
- Santa Maria Del Carmine Hospital, Cardiology, Rovereto, Italy
| | - C Cemin
- Santa Maria Del Carmine Hospital, Cardiology, Rovereto, Italy
| | - A Rossi
- University of Verona, Cardiology, Verona, Italy
| | - G Benfari
- University of Verona, Cardiology, Verona, Italy
| | - S Fezzi
- University of Verona, Cardiology, Verona, Italy
| | - D Catanzariti
- Santa Maria Del Carmine Hospital, Cardiology, Rovereto, Italy
| | | | - M Del Greco
- Santa Maria Del Carmine Hospital, Cardiology, Rovereto, Italy
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Maines M, Zorzi A, Peruzza F, Catanzariti D, Moggio P, Angheben C, Del Greco M. Endocavitary electrophysiological study by percutaneous antecubital vein and without X-ray for risk stratification of asymptomatic ventricular pre-excitation in young athletes. Int J Cardiol Heart Vasc 2021; 36:100879. [PMID: 34604501 PMCID: PMC8463852 DOI: 10.1016/j.ijcha.2021.100879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
Evaluation of AP is usually performed by transesophageal and intracardiac studies. In young athletes with AVP, our standard of care is to perform ESnoXR. ESnoXR may considered a less invasive alternative for risk stratification of AP.
Athletes with asymptomatic ventricular pre-excitation (VP) should undergo electrophysiological study for risk stratification. We aimed to evaluate the feasibility, efficacy, safety and tolerability of an electrophysiological study using a percutaneous antecubital vein access and without the use of X-ray (ESnoXr). Methods: We collected data from all young athletes < 18 year-old with AVP, who underwent ESnoXr from January 2000 to September 2020 for evaluation of accessory pathway refractoriness and arrhythmia inducibility using an antecubital percutaneous venous access. Endocavitary signals were used to advance the catheter in the right atrium and ventricle. Results: We included 63 consecutive young athletes (mean age 14.6 ± 1.9 years, 46% male). Feasibility of the ESnoXr technique was 87% while in 13% fluoroscopy and/or a femoral approach were needed. Specifically, fluoroscopy was used in 7 cases to position the catheter inside the heart cavities with an average exposure of 43 ± 38 s while in 2 femoral venous access was needed. The mean procedural time was 35 ± 11 min. The exam was diagnostic in all patients, there were no procedural complications and tolerability was excellent. 53% of the patients had an accessory pathway with high refractoriness and no inducible atrio-ventricular reentry tachycardia: this subgroup was considered eligible to competitive sports and no event was observed during long-term follow-up (13.6 ± 5.2 years) without drug use. The others underwent catheter ablation. Conclusion. ESnoXr has been shown to be a feasible, effective, safe and well-tolerated procedure for the assessment of arrhythmic risk in a population of young athletes with asymptomatic VP.
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Affiliation(s)
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | | | | | - Paolo Moggio
- Santa Maria del Carmine Hospital (Rovereto-TN), Italy
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Migliore F, Aruta P, Cecchetto A, Iliceto S, Gerosa G, Catanzariti D. Extraction of left bundle branch pacing lead: a safe procedure? Europace 2021; 23:1921. [PMID: 34095950 DOI: 10.1093/europace/euab082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, 35121 Padova, Italy
| | - Patrizia Aruta
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, 35121 Padova, Italy
| | - Antonella Cecchetto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, 35121 Padova, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, 35121 Padova, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, 35121 Padova, Italy
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Peruzza F, Maines M, Angheben C, Moggio P, Catanzariti D, Del Greco M. The use of noninvasive electrocardiographic mapping in an exercise-induced and nonsustained atrial tachycardia ablation. HeartRhythm Case Rep 2021; 7:278-282. [PMID: 34026515 PMCID: PMC8134776 DOI: 10.1016/j.hrcr.2021.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Francesco Peruzza
- Address reprint requests and correspondence: Dr Francesco Peruzza, Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068, Rovereto (TN), Italy.
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Maines M, Tomasi G, Moggio P, Poian L, Peruzza F, Catanzariti D, Angheben C, Cont N, Valsecchi S, Del Greco M. Scheduled versus alert transmissions for remote follow-up of cardiac implantable electronic devices: Clinical relevance and resource consumption. Int J Cardiol 2021; 334:49-54. [PMID: 33930512 DOI: 10.1016/j.ijcard.2021.04.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/01/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The remote follow-up of pacemakers and implantable cardiac defibrillators (ICDs) usually includes scheduled checks and alert transmissions. However, this results in a high volume of remote data reviews to be managed. We measured the relative contribution of scheduled and alert transmissions to the detection of relevant conditions, and the workload generated by their management. METHODS At our center, the frequency of remote scheduled transmissions is 4/year. Moreover, all system-integrity and clinical alerts are turned on for wireless notification. We calculated the number of transmissions received from January to December 2020, and identified transmissions that necessitated in-hospital access for further assessment and transmissions that required clinical discussion with the physician. For all alert transmissions, we identified whether the alert was clinically meaningful (i.e. center was not previously aware of the condition and no action had yet been taken to treat it). RESULTS Of 8545 transmissions received from 1697 pacemakers and ICDs, 5766 (67%) were scheduled and 2779 (33%) were alert transmissions received from 764 patients (45%); 499 (9%) scheduled transmissions required clinical discussion with the physician, but only 2 of these necessitated in-hospital visits for further assessment. Of the alert transmissions, 664 (24%) required clinical discussion, and 75 (3%) necessitated in-hospital visits. The proportion of alerts judged clinically meaningful was 7%. CONCLUSION Scheduled transmissions generate 67% of remote data reviews for pacemakers and ICDs, but their ability to detect clinically relevant events is very low. A strategy that relies exclusively on alert transmissions could ensure continuity of patient monitoring while reducing the workload at the center.
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Affiliation(s)
| | | | - Paolo Moggio
- Santa Maria del Carmine Hospital, Rovereto, TN, Italy
| | - Luisa Poian
- Santa Maria del Carmine Hospital, Rovereto, TN, Italy
| | | | | | | | - Natascia Cont
- Santa Maria del Carmine Hospital, Rovereto, TN, Italy
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Moltrasio M, Iacopino S, Arena G, Pieragnoli P, Molon G, Manfrin M, Verlato R, Ottaviano L, Rovaris G, Catanzariti D, Cipolletta L, Nicolis D, Cattafi G, Tondo C. First-line therapy: insights from a real-world analysis of cryoablation in patients with atrial fibrillation. J Cardiovasc Med (Hagerstown) 2021; 22:618-623. [PMID: 34009837 DOI: 10.2459/jcm.0000000000001176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Pulmonary vein isolation (PVI) using cryoballoon ablation (CBA) is mainly reserved for patients with drug-refractory or drug-intolerant symptomatic atrial fibrillation. We evaluated a large cohort of patients treated in a real-world setting and examined the safety and efficacy profile of CBA when applied as a first-line treatment for atrial fibrillation. METHODS In total, 249 patients (23% women; 56 ± 13 years; mean left atrial diameter 41 ± 7 mm; 73.5% paroxysmal atrial fibrillation; and 26.5% persistent atrial fibrillation) underwent an index PVI by CBA. Data were collected prospectively in the framework of the 1STOP ClinicalService project, involving 26 Italian cardiology centers. RESULTS Median procedure and fluoroscopy times were 90.0 and 21.0 min, respectively. Acute procedural success was 99.8%. Acute/periprocedural complications were observed in seven patients (2.8%), including: four transient diaphragmatic paralyses, one pericardial effusion (not requiring any intervention), one transient ischemic attack, and one minor vascular complication. The Kaplan--Meier freedom from atrial fibrillation recurrence was 86.3% at 12 months and 76% at 24 months. Seventeen patients (6.8%) had a repeat catheter ablation procedure during the follow-up period. At last follow-up, 10% of patients were on an anticoagulation therapy, whereas 6.8% were on an antiarrhythmic drug. CONCLUSION In our multicenter real-world experience, PVI by CBA in a first-line atrial fibrillation patient population was well tolerated, effective, and promising. CBA with a PVI strategy can be used to treat patients with paroxysmal and persistent atrial fibrillation with good acute procedural success, short procedure times, and acceptable safety. CLINICAL TRIAL REGISTRATION clinicaltrials.gov (NCT01007474).
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Affiliation(s)
| | | | | | | | - Giulio Molon
- IRCCS Sacro Cuore Don Calabria Don Calabria, Negrar
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Peruzza F, Angheben C, Maines M, Moggio P, Catanzariti D, Bonvicini C, Indiani S, Del Greco M. Focal or Macro-reentrant (Dual-loop) Atrial Tachycardia? The Role of the Ligament of Marshall. J Innov Card Rhythm Manag 2021; 12:22-23. [PMID: 33604111 PMCID: PMC7885960 DOI: 10.19102/icrm.2021.120116s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
| | | | | | - Paolo Moggio
- Santa Maria del Carmine Hospital, Rovereto, TN, Italy
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Maines M, Peruzza F, Angheben C, Moggio P, Catanzariti D, Greco M. Hypnotic communication in interventional electrophysiology procedures in the COVID-19 period. Heart Mind 2021. [DOI: 10.4103/hm.hm_28_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Maines M, Peruzza F, Zorzi A, Moggio P, Angheben C, Catanzariti D, Coletti M, Pangrazzi C, Del Greco M. Coronary sinus and great cardiac vein electroanatomic mapping predicts the activation delay of the coronary sinus branches. J Cardiovasc Electrophysiol 2020; 31:2061-2067. [DOI: 10.1111/jce.14609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Francesco Peruzza
- Department of CardiologySanta Maria del Carmine Hospital Rovereto Italy
| | - Alessandro Zorzi
- Department of Cardiac Thoracic, Vascular Sciences, and Public HealthUniversity of Padova Padova Italy
| | - Paolo Moggio
- Department of CardiologySanta Maria del Carmine Hospital Rovereto Italy
| | - Carlo Angheben
- Department of CardiologySanta Maria del Carmine Hospital Rovereto Italy
| | | | - Marco Coletti
- Department of CardiologySanta Maria del Carmine Hospital Rovereto Italy
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Maines M, Tomasi G, Moggio P, Peruzza F, Catanzariti D, Angheben C, Simoncelli M, Degiampietro M, Piffer L, Valsecchi S, Del Greco M. Implementation of remote follow-up of cardiac implantable electronic devices in clinical practice: organizational implications and resource consumption. J Cardiovasc Med (Hagerstown) 2020; 21:648-653. [DOI: 10.2459/jcm.0000000000001011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Verlato R, Pieragnoli P, Iacopino S, Rauhe W, Molon G, Stabile G, Rebellato L, Allocca G, Arena G, Rovaris G, Sacchi R, Catanzariti D, Pepi P, Tondo C. Cryoballoon or radiofrequency ablation? Alternating technique for repeat procedures in patients with atrial fibrillation. Pacing Clin Electrophysiol 2020; 43:687-697. [PMID: 32510595 DOI: 10.1111/pace.13975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/21/2020] [Accepted: 05/31/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Which technique is better for repeat ablation in patients with atrial fibrillation (AF) remains unclear. The aim of the study was to compare long-term efficacy of repeat ablation using the alternative technique for the first redo ablation procedure: (a) cryoballoon (CB) re-ablation after a failed index pulmonary vein isolation (PVI) with radiofrequency (RF) ablation, RF-then-CB group or (b) RF repeat ablation following a failed CB ablation, CB-then-RF group. METHODS Within the 1STOP Italian Project, consecutive patients undergoing repeat ablation with a different technique from the index procedure were included. RESULTS We studied 474 patients, 349 in RF-then-CB and 125 in CB-then-RF group. Less women (21% vs 30%; P = .041), more persistent AF (33% vs 22%; P = .015), longer duration of AF (60 vs 31 months; P < .001), and more hypertension (50% vs 36%; P = .007) were observed in the RF-then-CB cohort as compared with the CB-then-RF group. The number of reconnected PVs was 3.7 ± 0.7 and 1.4 + 1.3 in RF-then-CB and CB-then-RF group, respectively (P < .001). During the follow-up, significantly less AF recurrence occurred in the CB-then-RF group (22% vs 8%, HR = 0.46; 95% CI: 0.24-0.92; P = .025). Cohort designation was the only independent predictor of AF recurrence. CONCLUSION Alternation of energy source for repeat ablation was safe and effective, regardless the energy used first. However, patients initially treated with CB PVI undergoing repeat ablation with RF current had less AF recurrence at long-term follow-up as compared with those originally treated by RF ablation receiving a CB repeat ablation.
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Affiliation(s)
- Roberto Verlato
- AULSS 6 Euganea, Ospedale di Cittadella-Camposampiero, Padova, Italy
| | | | | | | | | | - Giuseppe Stabile
- Casa di Cura Montevergine, Mercogliano, Italy.,Clinica San Michele, Maddaloni, Italy
| | - Luca Rebellato
- Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Giuseppe Allocca
- Santa Maria dei Battuti, Presidio Ospedaliero, Conegliano, Italy
| | | | | | | | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS Milan, Milan, Italy
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Perego GB, Iacopino S, Molon G, Arena G, Verlato R, Pieragnoli P, Curnis A, Allocca G, Nicolis D, Sciarra L, Catanzariti D, Senatore G, Rovaris G, Brasca F, Tondo C. Cryoablation for paroxysmal and persistent AF in patients with structural heart disease and preserved ejection fraction: Clinical outcomes from 1STOP, a multicenter observational project. J Cardiol 2019; 74:19-26. [DOI: 10.1016/j.jjcc.2019.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/25/2019] [Accepted: 02/17/2019] [Indexed: 12/15/2022]
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Arena G, Iacopino S, Pieragnoli P, Curnis A, Manfrin M, Tondo C, Catanzariti D, Allocca G, Senatore G, Molon G, Sciarra L, Bertaglia M, Verlato R. P5762Are the repeat cryoablations after index RF ablation safe and effective? Insight from a multicentric observational data collection. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
| | - P Pieragnoli
- Careggi University Hospital (AOUC), Florence, Italy
| | - A Curnis
- Civil Hospital of Brescia, Brescia, Italy
| | - M Manfrin
- Regional Hospital of Bolzano, Bolzano, Italy
| | - C Tondo
- Institute Monzino, Milan, Italy
| | | | - G Allocca
- Conegliano General Hospital, Conegliano, Italy
| | - G Senatore
- Civic Hospital of Cirie, Ciriè (Turin), Italy
| | - G Molon
- Sacred Heart Hospital of Negrar, Negrar-Verona, Italy
| | - L Sciarra
- Polyclinic Casilino of Rome, Rome, Italy
| | | | - R Verlato
- Hospital of Camposampiero, Camposampiero, Italy
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Peruzza F, Maines M, Catanzariti D, Tomasi G, Angheben C, Del Greco M. [A misleading prolonged asystole: a case of implantable loop recorder dehiscence]. G Ital Cardiol (Rome) 2018; 19:246-247. [PMID: 29912240 DOI: 10.1714/2898.29220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Francesco Peruzza
- Dipartimento di Cardiologia, Ospedale Santa Maria del Carmine, Rovereto (TN)
| | - Massimiliano Maines
- Dipartimento di Cardiologia, Ospedale Santa Maria del Carmine, Rovereto (TN)
| | | | - Giancarlo Tomasi
- Dipartimento di Cardiologia, Ospedale Santa Maria del Carmine, Rovereto (TN)
| | - Carlo Angheben
- Dipartimento di Cardiologia, Ospedale Santa Maria del Carmine, Rovereto (TN)
| | - Maurizio Del Greco
- Dipartimento di Cardiologia, Ospedale Santa Maria del Carmine, Rovereto (TN)
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Verlato R, Pieragnoli P, Curnis A, Manfrin M, Tondo C, Catanzariti D, Allocca G, Senatore G, Molon G, Sciarra L, Arena G, Bertaglia M, Iacopino S. P1103Safety and efficacy of repeat cryoablation after index RF ablation: insight from a multicentric observational data collection. Europace 2018. [DOI: 10.1093/europace/euy015.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Verlato
- Hospital of Camposampiero, Camposampiero, Italy
| | | | - A Curnis
- Civil Hospital of Brescia, Brescia, Italy
| | - M Manfrin
- Regional Hospital of Bolzano, Bolzano, Italy
| | - C Tondo
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - G Allocca
- Conegliano General Hospital, Conegliano, Italy
| | - G Senatore
- Civic Hospital of Cirie, Ciriè (Turin), Italy
| | - G Molon
- Sacred Heart Hospital of Negrar, Negrar-Verona, Italy
| | - L Sciarra
- Polyclinic Casilino of Rome, Rome, Italy
| | - G Arena
- Nuovo Ospedale delle Apuane, Massa, Italy
| | | | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
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18
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Zecchin M, Severgnini M, Fiorentino A, Malavasi VL, Menegotti L, Alongi F, Catanzariti D, Jereczek-Fossa BA, Stasi M, Russi E, Boriani G. Management of patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy: A consensus document from Associazione Italiana Aritmologia e Cardiostimolazione (AIAC), Associazione Italiana Radioterapia Oncologica (AIRO), Associazione Italiana Fisica Medica (AIFM). Int J Cardiol 2017; 255:175-183. [PMID: 29310933 DOI: 10.1016/j.ijcard.2017.12.061] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 12/04/2017] [Accepted: 12/19/2017] [Indexed: 11/15/2022]
Abstract
The management of patients with a cardiac implanted electronic device (CIED) receiving radiotherapy (RT) is challenging and requires a structured multidisciplinary approach. A consensus document is presented as a result of a multidisciplinary working group involving cardiac electrophysiologists, radiation oncologists and physicists in order to stratify the risk of patients with CIED requiring RT and approaching RT sessions appropriately. When high radiation doses and beam energy higher than 6MV are used, CIED malfunctions can occur during treatment. In our document, we reviewed the different types of RT and CIED behavior in the presence of ionizing radiations and electromagnetic interferences, from the cardiologist's, radiation oncologist's and medical physicist's point of view. We also reviewed in vitro and in vivo literature data and other national published guidelines on this issue so far. On the basis of literature data and consensus of experts, a detailed approach based on risk stratification and appropriate management of RT patients with CIEDs is suggested, with important implications for clinical practice.
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Affiliation(s)
- Massimo Zecchin
- Struttura Complessa di Cardiologia, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | - Mara Severgnini
- Struttura Complessa di Fisica Sanitaria, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | - Alba Fiorentino
- Unità Operativa Complessa di Radioterapia Oncologica, Ospedale Sacro Cuore-Don Calabria, Cancer Care Center Negrar, Verona, Italy
| | - Vincenzo Livio Malavasi
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Italy
| | - Loris Menegotti
- Servizio di Fisica Sanitaria, Azienda Provinciale per i Servizi Sanitari di Trento, Italy
| | - Filippo Alongi
- Unità Operativa Complessa di Radioterapia Oncologica, Ospedale Sacro Cuore-Don Calabria, Cancer Care Center Negrar, Verona (Italy) and Università di Brescia, Brescia, Italy
| | - Domenico Catanzariti
- Unità Operativa di Cardiologia, Azienda Provinciale per i Servizi Sanitari di Trento, Italy
| | - Barbara Alicja Jereczek-Fossa
- Divisione di Radioterapia, Istituto Europeo di Oncologia, Milano (Italy) and Dipartimento di Oncologia e Emato-oncologia dell'Università degli Studi di Milano, Milan, Italy
| | - Michele Stasi
- Struttura Complessa di Fisica Sanitaria, A.O. Ordine Mauriziano di Torino, Italy
| | - Elvio Russi
- Struttura Complessa di Radioterapia, Azienda Sanitaria Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Italy.
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Maines M, Zorzi A, Tomasi G, Angheben C, Catanzariti D, Piffer L, Del Greco M. Clinical impact, safety, and accuracy of the remotely monitored implantable loop recorder Medtronic Reveal LINQTM. Europace 2017; 20:1050-1057. [DOI: 10.1093/europace/eux187] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/26/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Massimiliano Maines
- Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto-TN, Italy
| | - Alessandro Zorzi
- Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto-TN, Italy
| | - Giancarlo Tomasi
- Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto-TN, Italy
| | - Carlo Angheben
- Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto-TN, Italy
| | - Domenico Catanzariti
- Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto-TN, Italy
| | - Lucio Piffer
- Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto-TN, Italy
| | - Maurizio Del Greco
- Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto-TN, Italy
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Padeletti L, Curnis A, Tondo C, Lunati M, Porcellini S, Verlato R, Sciarra L, Senatore G, Catanzariti D, Leoni L, Landolina M, Delise P, Iacopino S, Pieragnoli P, Arena G. Pulmonary Vein Isolation with the Cryoballoon Technique: Feasibility, Procedural Outcomes, and Adoption in the Real World: Data from One Shot Technologies TO Pulmonary Vein Isolation (1STOP) Project. Pacing Clin Electrophysiol 2016; 40:46-56. [PMID: 27862043 DOI: 10.1111/pace.12975] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/20/2016] [Accepted: 10/25/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Catheter ablation (CA) is recommended for patients with drug refractory symptomatic atrial fibrillation (AF). "One Shot" catheters have been introduced to simplify CA and cryoballoon ablation (CBA) is spreading rapidly. Few real-world data are available on standard clinical practice, mainly from single-center experience. We aimed to evaluate clinical settings, demographics, and acute procedural outcomes in a large cohort of patients treated with CBA. METHODS A total of 903 patients (73% male, mean age 59 ± 11) underwent pulmonary vein CBA. Correlations between the patient's inclusion time and clinical characteristics, procedure duration, acute success rate, and intraprocedural complications were evaluated. RESULTS Seventy-seven percent of patients were affected by paroxysmal AF and 23% by persistent AF. Overall, acute success rate was 97.9% and periprocedural complications were observed in 35 (3.9%) patients, 13 (1.4%) of which were classified as major complications. With respect to the patient's inclusion time analysis, an increase in treatment of persistent AF was observed, a significant decrease in CBA times (procedure, ablation, and fluoroscopy: 136.0 ± 46.5 minutes, 28.8 ± 19.6 minutes, and 34.3 ± 15.4 minutes, respectively) was observed, with comparable acute success rate and intraprocedural complications over time. The rate of major complications was extremely low (1.4%); no death, atrioesophageal fistula, stroke, or other major periinterventional or late complications occurred. CONCLUSION This series represents the largest experience of CBA in the treatment of AF that also describes the adoption curve of this relatively recent technology. CBA showed an excellent safety profile when performed in a large real-world clinical setting, with satisfactory acute success rate and, on average, short procedural times. CLINICAL TRIAL REGISTRATION clinicaltrials.gov (NCT01007474).
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Affiliation(s)
- Luigi Padeletti
- University of Florence, Firenze, Italy.,IRCCS Multimedica, Milano, Italy
| | | | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, University of Milan, Milano, Italy
| | | | | | | | | | | | | | - Loira Leoni
- Azienda Ospedaliera di Padova, Padova, Italy
| | | | - Pietro Delise
- Ospedale Civile di Conegliano, Conegliano Veneto, Italy
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21
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Del Greco M, Zorzi A, Di Matteo I, Cima A, Maines M, Angheben C, Catanzariti D. Coronary sinus activation patterns in patients with and without left bundle branch block undergoing electroanatomic mapping system-guided cardiac resynchronization therapy device implantation. Heart Rhythm 2016; 14:225-233. [PMID: 27989791 DOI: 10.1016/j.hrthm.2016.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Implantation of the left ventricular (LV) lead in segments with delayed electrical activation may improve response to cardiac resynchronization therapy (CRT). OBJECTIVE The purpose of this study was to evaluate the amount and regional distribution of LV electrical delay (LVED) in patients with or without left bundle branch block (LBBB). METHODS We enrolled 60 patients who underwent electroanatomic mapping system-guided CRT device implantation. Activation mapping of the coronary sinus (CS) branches was performed using an insulated guidewire. LVED was defined as the interval between the beginning of the QRS complex on the surface electrocardiogram (ECG) and the local electrogram and expressed in milliseconds or as percentage of the total QRS duration (LVED%). RESULTS Forty-three patients showed a LBBB and 17 a non-LBBB electrocardiographic pattern. A total of 148 CS branches (mean 2.5 per patient; range 2-4 per patient) were mapped. Patients with LBBB showed higher maximum LVED (135 ms [108-150 ms] vs 100 ms [103-110 ms]; P < .001) and LVED% (86% [79%-89%] vs 72% [54%-80%]; P < .001) than did patients without LBBB. The maximum LVED was recorded in mid-basal anterolateral or inferolateral LV segments (traditional CRT targets), significantly more often in patients with LBBB than in patients without LBBB (85% vs 59%; P = .02). The number of CS branches showing LVED >50% of the total QRS duration, >75% of the total QRS duration, and >85 ms was significantly higher in patients with LBBB than in patients without LBBB. CONCLUSION Patients without LBBB showed lower LVED and more heterogeneous electrical activation of the CS than did patients with LBBB. This finding may contribute to a lower rate of response to CRT of patients without LBBB and suggests the use of activation mapping to guide LV lead placement.
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Affiliation(s)
| | - Alessandro Zorzi
- Santa Maria del Carmine Hospital, Rovereto TN, Italy,; Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | | | - Anna Cima
- Santa Maria del Carmine Hospital, Rovereto TN, Italy
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Greco MD, Cima A, Carlo A, Maines M, Catanzariti D, Viliani D, Indiani S, Pertile R. 136-60: Can the QRS morphology predict the latest activated site during CRT implantation using an electroanatomic mapping of the coronary venous? Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i105b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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23
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Greco MD, Cima A, Carlo A, Maines M, Catanzariti D, Viliani D, Indiani S, Pertile R. 96-68: The QRS morphology influences the amount of LV activation delay mapped during coronary venous electroanatomic mapping in CRT implantation. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i78a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Landolina M, Arena G, Bontempi L, Fassini G, Padeletti L, Verlato R, Porcellini S, Sciarra L, Senatore G, Leoni L, Catanzariti D, Lunati M. 178-01: Low incidence of peri-procedural complications after Cryoballoon ablation of atrial fibrillation based on atrial fibrillation type (paroxysmal vs persistent) and left expertise (high volume vs low volume). Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i182c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Lunati M, Proclemer A, Boriani G, Landolina M, Locati E, Rordorf R, Daleffe E, Ricci RP, Catanzariti D, Tomasi L, Gulizia M, Baccillieri MS, Molon G, Gasparini M. Reduction of inappropriate anti-tachycardia pacing therapies and shocks by a novel suite of detection algorithms in heart failure patients with cardiac resynchronization therapy defibrillators: a historical comparison of a prospective database. Europace 2016; 18:1391-8. [PMID: 26826135 DOI: 10.1093/europace/euv420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/18/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Implantable cardioverter defibrillators improve survival of patients at risk for ventricular arrhythmias, but inappropriate shocks occur in up to 30% of patients and have been associated with worse quality of life and prognosis. In heart failure patients with cardiac resynchronization therapy defibrillators (CRT-Ds), we evaluated whether a new generation of detection and discrimination algorithms reduces inappropriate shocks. METHODS AND RESULTS We analysed 1983 Medtronic CRT-D patients (80% male, 67 ± 10 years), 1368 with standard devices (Control CRT-D) and 615 with new generation devices (New CRT-D). Expert electrophysiologists reviewed and classified the electrograms of all device-detected ventricular tachycardia/fibrillation episodes. Total follow-up was 3751 patients-years. Incidence of inappropriate shocks at 1 year was 2.8% [95% confidence interval (CI) = 2.0-3.5] in Control CRT-D and 0.9% (CI = 0.4-2.2) in New CRT-D (hazard ratio = 0.37, CI = 0.21-0.66, P < 0.001). In New CRT-D, inappropriate shocks were reduced by 77% [incidence rate ratio (IRR) = 0.23, CI = 0.16-0.35, P < 0.001] and inappropriate anti-tachycardia pacing by 81% (IRR = 0.19, CI = 0.11-0.335, P < 0.001). Annual rate per 100 patient-years for appropriate VF detections was 3.0 (CI = 2.1-4.2) in New CRT-D and 3.2 (CI = 2.1-5.0) in Control CRT-D (P = 0.68), for syncope was 0.4 (CI = 0.2-0.9) in New CRT-D and 0.7 (CI = 0.5-1.0) in Control CRT-D (P = 0.266), and for death was 1.0 (CI = 0.6-1.6) in New CRT-D and 3.5 (CI = 3.0-4.1) in Control CRT-D (P < 0.001). CONCLUSION Detection and discrimination algorithms used in new generation CRT-D significantly reduced inappropriate shocks when compared with standard CRT-D. This result, with no compromise on VF sensitivity or risk of syncope, has important implications for patients' quality of life and prognosis.
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Affiliation(s)
- Maurizio Lunati
- 'A De Gasperis' Cardiac Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore, 3, 20162 Milano, Italy
| | | | - Giuseppe Boriani
- University of Bologna and Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy
| | - Maurizio Landolina
- Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy Ospedale Maggiore, Crema (Cremona), Italy
| | - Emanuela Locati
- 'A De Gasperis' Cardiac Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore, 3, 20162 Milano, Italy
| | | | | | | | | | - Luca Tomasi
- Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | - Giulio Molon
- Ospedale Sacro Cuore Don Calabria, Negrar, Italy
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Palamara S, Vergara C, Catanzariti D, Faggiano E, Pangrazzi C, Centonze M, Nobile F, Maines M, Quarteroni A. Computational generation of the Purkinje network driven by clinical measurements: the case of pathological propagations. Int J Numer Method Biomed Eng 2014; 30:1558-77. [PMID: 25319252 DOI: 10.1002/cnm.2689] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/25/2014] [Accepted: 09/25/2014] [Indexed: 05/16/2023]
Abstract
To properly describe the electrical activity of the left ventricle, it is necessary to model the Purkinje fibers, responsible for the fast and coordinate ventricular activation, and their interaction with the muscular propagation. The aim of this work is to propose a methodology for the generation of a patient-specific Purkinje network driven by clinical measurements of the activation times related to pathological propagations. In this case, one needs to consider a strongly coupled problem between the network and the muscle, where the feedback from the latter to the former cannot be neglected as in a normal propagation. We apply the proposed strategy to data acquired on three subjects, one of them suffering from muscular conduction problems owing to a scar and the other two with a muscular pre-excitation syndrome (Wolff-Parkinson-White). To assess the accuracy of the proposed method, we compare the results obtained by using the patient-specific Purkinje network generated by our strategy with the ones obtained by using a non-patient-specific network. The results show that the mean absolute errors in the activation time is reduced for all the cases, highlighting the importance of including a patient-specific Purkinje network in computational models.
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Affiliation(s)
- Simone Palamara
- Modellistica e Calcolo Scientifico (MOX), Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
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La Torre A, Giupponi G, Duffy D, Conca A, Catanzariti D. Sexual dysfunction related to drugs: a critical review. Part IV: cardiovascular drugs. Pharmacopsychiatry 2014; 48:1-6. [PMID: 25405774 DOI: 10.1055/s-0034-1395515] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Sexual dysfunction is a potential side effect of cardiovascular drugs: this article is a critical review of the current literature. Many studies have been published on this topic. Most of these studies are not methodologically robust, few are RCTs and most did not use a validated rating scale to evaluate sexual functioning. In addition, other methodological flaws limit greatly the conclusions of these studies. Most studies relate to male populations and only a few have been conducted on women. Also, the majority of studies on sexual dysfunction induced by cardiovascular drugs relate to antihypertensive drugs. While there is evidence to suggest that older antihypertensive drugs (diuretics, beta-blockers, centrally acting agents) have a negative impact on erectile function, newer agents seem to have either neutral (ACE inhibitors, calcium antagonists) or beneficial effects (i. e., angiotensin receptor blockers, nebivolol). Other cardiovascular drugs analyzed in this review also appear to have an inhibitory action on sexual function. For men, there is some weak evidence supporting the use of specific treatment strategies for sexual dysfunction associated with these drugs. METHODS This study was conducted in 2014 using the paper and electronic resources of the library of the "Azienda Provinciale per i Servizi Sanitari (APSS)" in Trento, Italy (http://atoz.ebsco.com/Titles/2793). The library has access to a wide range of databases including DYNAMED, MEDLINE Full Text, CINAHL Plus Full Text, The Cochrane Library, Micromedex healthcare series, BMJ Clinical Evidence. The full list of available journals can be viewed at http://atoz.ebsco.com/Titles/2793 or at the APSS web site (http://www.apss.tn.it). In completing this review, a literature search was conducted using the key words "cardiovascular", "adrenergic beta antagonist", "α1-adrenoceptor antagonist", "angiotensin converting enzyme inhibitor", "angiotensin receptor antagonist", "angiotensin receptor blocker", "beta blocker", "beta receptor antagonist", "calcium channel blocker", "diuretic", "antihypertensive", "sexual dysfunction", "sexual side effects", "treatment-emergent sexual dysfunction". All resulting listed articles were reviewed. CONCLUSION The review includes studies that investigated the relationship between these drug treatments and sexual dysfunction. The purpose was to identify possible intervention strategies for sexual dysfunction related to these drugs.
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Affiliation(s)
- A La Torre
- Department of Psychiatry, Ospedale di Rovereto, Rovereto, Italy
| | - G Giupponi
- Department of Psychiatry, S. Maurizio Hospital, Bolzano Italy
| | - D Duffy
- Department of Psychiatry, S. Maurizio Hospital, Bolzano Italy
| | - A Conca
- Department of Psychiatry, S. Maurizio Hospital, Bolzano Italy
| | - D Catanzariti
- U. O. di Cardiologia, Ospedale di Rovereto, Rovereto, Italy
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Vergara C, Palamara S, Catanzariti D, Nobile F, Faggiano E, Pangrazzi C, Centonze M, Maines M, Quarteroni A, Vergara G. Patient-specific generation of the Purkinje network driven by clinical measurements of a normal propagation. Med Biol Eng Comput 2014. [PMID: 25151397 DOI: 10.1007/sll517-014-1183-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The propagation of the electrical signal in the Purkinje network is the starting point for the activation of the ventricular muscular cells leading to the contraction of the ventricle. In the computational models, describing the electrical activity of the ventricle is therefore important to account for the Purkinje fibers. Until now, the inclusion of such fibers has been obtained either by using surrogates such as space-dependent conduction properties or by generating a network based on an a priori anatomical knowledge. The aim of this work was to propose a new method for the generation of the Purkinje network using clinical measures of the activation times on the endocardium related to a normal electrical propagation, allowing to generate a patient-specific network. The measures were acquired by means of the EnSite NavX system. This system allows to measure for each point of the ventricular endocardium the time at which the activation front, that spreads through the ventricle, has reached the subjacent muscle. We compared the accuracy of the proposed method with the one of other strategies proposed so far in the literature for three subjects with a normal electrical propagation. The results showed that with our method we were able to reduce the absolute errors, intended as the difference between the measured and the computed data, by a factor in the range 9-25 %, with respect to the best of the other strategies. This highlighted the reliability of the proposed method and the importance of including a patient-specific Purkinje network in computational models.
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Affiliation(s)
- Christian Vergara
- Dipartimento di Ingegneria, Università di Bergamo, Viale Marconi 5, 24044, Dalmine, BG, Italy,
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Molon G, Zanotto G, Rahue W, Facchin D, Leoni L, Morani G, Calvi V, Catanzariti D, Costa A, Zago L, Comisso J, Varbaro A, Santini M. Pulmonary fluid overload monitoring in heart failure patients with single and dual chamber defibrillators. J Cardiovasc Med (Hagerstown) 2014; 15:307-14. [PMID: 24698971 DOI: 10.2459/jcm.0b013e328364bf50] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Heart failure has a relevant healthcare impact. Monitoring of pulmonary fluid overload (PFO), measured by intrathoracic impedance, has been proposed to alert to heart failure worsening before symptoms become patent. The aim of our research was to evaluate whether PFO diagnostics reduce heart failure hospitalizations in heart failure patients receiving single-chamber or dual-chamber implantable cardioverter-defibrillator (ICD) for primary prevention of sudden death. METHODS Twenty-five Italian cardiological centers prospectively followed 221 ICD patients (86% men, 66 ± 11 years, 79% New York Heart Association II and left ventricular ejection fraction 28 ± 5%), of whom 123 received an ICD with PFO monitoring (diagnostics group) and 98 an ICD without such a diagnostics (control group). The association of each patient to a group was assigned a priori, independently of patients' characteristics but based on regional device allocation policies. RESULTS Patient clinical characteristics and observation period were similar between groups. In a mean follow-up of 17 ± 11 months, heart failure hospitalizations or emergency-room admissions occurred in eight (7%) patients of the diagnostics group and in 16 of the control group (16%; P = 0.02), with an incidence, measured by Kaplan-Meier analysis, of 23% at 2 years and 34% at 3 years in patients of the control group compared with 8% at 2 and 3 years in patients of the diagnostics group (Log rank test P = 0.044). CONCLUSION Our data show that in heart failure patients receiving single-chamber or dual-chamber ICD, the use of intrathoracic impedance monitoring is associated with a significant reduction of heart failure hospitalizations. Our results support the hypothesis that PFO diagnostics improve the likelihood of timely detection of heart failure worsening.
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Affiliation(s)
- Giulio Molon
- aSacro Cuore Don Calabria, Negrar bMater Salutis, Legnago Verona cS. Maurizio, Bolzano dSanta Maria della Misericordia, Udine eAzienda Ospedaliera di Padova, Padova fBorgo Trento, Verona gAOU 'Policlinico-Vittorio Emanuele' Ferrarotto, Catania hS. Maria del Carmine, Rovereto iMedtronic Italia, Sesto San Giovanni. jSan Filippo Neri, Roma, Italy
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Ricci RP, Pignalberi C, Landolina M, Santini M, Lunati M, Boriani G, Proclemer A, Facchin D, Catanzariti D, Morani G, Gulizia M, Mangoni L, Grammatico A, Gasparini M. Ventricular rate monitoring as a tool to predict and prevent atrial fibrillation-related inappropriate shocks in heart failure patients treated with cardiac resynchronisation therapy defibrillators. Heart 2014; 100:848-54. [DOI: 10.1136/heartjnl-2013-305259] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Berisso MZ, Bongiorni MG, Curnis A, Calvi V, Catanzariti D, Gaita F, Gulizia MM, Inama G, Landolina ME, La Rovere MT, Mantovan R, Mascioli G, Occhetta E, Padeletti L, Salerno-Uriarte JA, Santini M, Sassone B, Senni M, Zecchin M. [Remarks on the guideline recommendations for cardioverter-defibrillator implantation for primary prevention of sudden cardiac Death in patients with severe ventricular dysfunction. Consensus Document of the Italian Association of Hospital Cardiologists (ANMCO)/Italian Society of Cardiology (SIC)/Italian Association of Arrhythmology and Cardiac Pacing (AIAC)]. G Ital Cardiol (Rome) 2013; 14:752-72. [PMID: 24326639 DOI: 10.1714/1360.15089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The indications for implantable cardioverter-defibrillator (ICD) therapy for the prevention of sudden cardiac death in patients with severe left ventricular dysfunction have rapidly expanded over the last 10 years on the basis of the very satisfying results of the numerous randomized clinical trials that have provided the framework for guidelines. However, the analysis of clinical practice in the real world has highlighted some important criticisms in the complex process of selection-management of those patients candidates for ICD therapy: 1) approximately one fourth of all ICD implantations is not justified by clinical evidence, 2) approximately one half of patients with an indication for ICD therapy do not undergo implantation, 3) the benefits from ICD therapy do not apply uniformly to all patients, 4) the relationship between the lifesaving benefit and the potential for harm of ICD therapy is still scarcely known. The main reason for this clinical scenario can be ascribed to the guideline recommendations that are based only on few standard cut-off criteria and therefore too generic and insufficiently detailed. This does not help cardiologists in their decision-making process, and results in fear, uncertainty, and sometimes emotional choices. The aim of this consensus document is to discuss current guideline recommendations and to provide the Italian cardiologists with the most updated information to optimize the selection of patients with severe left ventricular dysfunction who should receive ICD therapy.
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Proclemer A, Zoppo F, Molon G, Zanotto G, Gasparini G, Catanzariti D, Baccillieri MS, Menard C, Gentili A, Grammatico A. Improving atrial fibrillation detection and stroke prevention capability by a WEB-based application. A multicenter Italian research on AFinder application. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Verlato R, Facchin D, Catanzariti D, Molon G, Zanotto G, Morani G, Brieda M, Zanon F, Delise P, Leoni L, Comisso J, Campo C. Clinical outcomes in patients with implantable cardioverter defibrillators and Sprint Fidelis leads. Heart 2013; 99:799-804. [PMID: 23434626 DOI: 10.1136/heartjnl-2012-303259] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The performances of implantable cardioverter defibrillators and leads are important issues for healthcare providers and patients. In 2007 Sprint Fidelis leads were found to be associated with an increased failure rate and so the purpose of the study was to evaluate long-term mortality and clinical outcomes in patients implanted with Sprint Fidelis leads compared with Sprint Quattro leads. DESIGN, SETTING, PATIENTS 508 patients with Sprint Fidelis leads and 468 with Sprint Quattro leads were prospectively followed in 12 Italian cardiology centres. MAIN OUTCOME MEASURES Information on hospitalisations and other clinical events were collected during scheduled and unscheduled hospital visits. Deaths were identified from medical records or via phone contacts with patients' family members or through the National Office of Vital Statistics. RESULTS Over a mean follow-up of 27±18 months 141 deaths occurred in the overall population. No death was observed in patients with diagnosed failing lead. Kaplan-Meier patient survival differed between the two lead groups (80±2% in Fidelis leads vs 70±4% in the Sprint Quattro leads at 4 years, p=0.002). Multivariate analyses showed that mortality was neither associated with lead type nor with diagnosed failed lead. The annual rate of lead failure was 1.8% patient-year for Fidelis leads and 0.2% for the Sprint Quattro leads. CONCLUSIONS In our multicentre research, the clinical outcomes of patients with Fidelis leads differed from those of patients with Sprint Quattro leads. Nevertheless, neither mortality nor the combined endpoint of mortality and heart failure hospitalisations was associated with the lead type. http://clinicaltrials.gov/ct2/show/NCT01007474.
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Affiliation(s)
- Roberto Verlato
- Department of Cardiology, General Hospital Cosma, Via P Cosma 1, Camposampiero 35012, Italy.
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Catanzariti D, Maines M, Angheben C. [How to identify non-responders to cardiac resynchronization therapy]. G Ital Cardiol (Rome) 2012; 13:152S-156S. [PMID: 23096395 DOI: 10.1714/1167.12940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cardiac resynchronization therapy (CRT) has been shown to improve survival, morbidity, symptoms, quality of life and exercise capacity, and to promote a beneficial reverse remodeling of the left ventricle in patients with heart failure, dilated hypokinetic left ventricle and wide QRS. The totality of evidence supports the use of CRT also in patients with mild symptoms (NYHA class II). However, the wider diffusion of CRT is determining a growing clinical and economic impact on national health systems. In clinical practice, in spite of "all-or-none" response, variable degrees of therapy response are commonly observed, but several evidence gaps remain to be addressed. According to recent guidelines for CRT implantation, a multiparametric combination of predictive factors emerging from the analysis of clinical trials, observational studies and registries, represents a useful tool for patient selection.
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Catanzariti D, Maines M, Manica A, Angheben C, Varbaro A, Vergara G. Permanent His-bundle pacing maintains long-term ventricular synchrony and left ventricular performance, unlike conventional right ventricular apical pacing. Europace 2012; 15:546-53. [PMID: 22997222 DOI: 10.1093/europace/eus313] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Right ventricular apical pacing (RVAP) may be deleterious, determining abnormal left ventricular (LV) electrical activation and progressive LV dysfunction. Permanent His-bundle pacing (HBP) has been proposed to prevent this detrimental effect. The aim of our study was to compare the long-term effects of HBP on LV synchrony and systolic performance with those of RVAP in the same group of patients. METHODS Our analysis included 26 patients who received both an HBP lead and an RVAP lead, as backup, in our electrophysiology laboratory between 2004 and 2007. After implantation, all devices were programmed to obtain HBP. An intra-patient comparison of the effects of HBP and RVAP on LV dyssynchrony and function was performed at the last available follow-up examination. RESULTS After a mean of 34.6 ± 11 months, the pacing modality was temporarily switched to RVAP. During RVAP, LV ejection fraction significantly decreased (50.1 ± 8.8% vs. 57.3 ± 8.5%, P < 0.001), mitral regurgitation significantly increased (22.5 ± 10.9% vs.16.3 ± 12.4%; P = 0.018), and inter-ventricular delay significantly worsened (33.4 ± 19.5 ms vs. 7.1 ± 4.7 ms, P = 0.003) in comparison with HBP. However, the myocardial performance index was not statistically different between the two pacing modalities (P = 0.779). No asynchrony was revealed by tissue Doppler imaging during HBP, while during RVAP the asynchrony index was significantly higher in both the four-chamber (125.8 ± 63.9 ms; P = 0.035 vs. HBP) and two-chamber (126 ± 86.5 ms; P = 0.037 vs. HBP) apical views. CONCLUSION His-bundle pacing has long-term positive effects on inter- and intra-ventricular synchrony and ventricular contractile performance in comparison with RVAP. It prevents asynchronous pacing-induced LV ejection fraction depression and mitral regurgitation.
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Themistoclakis S, Tritto M, Bertaglia E, Berto P, Bongiorni MG, Catanzariti D, De Fabrizio G, De Ponti R, Grimaldi M, Pandozi C, Tondo C, Gulizia M. [Catheter ablation of atrial fibrillation: Health Technology Assessment Report from the Italian Association of Arrhythmology and Cardiac Pacing (AIAC)]. G Ital Cardiol (Rome) 2011; 12:726-776. [PMID: 22048448 DOI: 10.1714/966.10545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and significantly impact patients' quality of life, morbidity and mortality. The number of affected patients is expected to increase as well as the costs associated with AF management, mainly driven by hospitalizations. Over the last decade, catheter ablation techniques targeting pulmonary vein isolation have demonstrated to be effective in treating AF and preventing AF recurrence. This Health Technology Assessment report of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) aims to define the current role of catheter ablation of AF in terms of effectiveness, efficiency and appropriateness. On the basis of an extensive review of the available literature, this report provides (i) an overview of the epidemiology, clinical impact and socio-economic burden of AF; (ii) an evaluation of therapeutic options other than catheter ablation of AF; and (iii) a detailed presentation of clinical outcomes and cost-benefit ratio associated with catheter ablation. The costs of catheter ablation of AF in Italy were obtained using a bottom-up analysis of a resource utilization survey of 52 hospitals that were considered a representative sample, including 4 Centers that contributed with additional unit cost information in a separate questionnaire. An analysis of budget impact was also performed to evaluate the impact of ablation on the management costs of AF. Results of this analysis show that (1) catheter ablation is effective, safe and superior to antiarrhythmic drug therapy in maintaining sinus rhythm; (2) the cost of an ablation procedure in Italy typically ranges from €8868 to €9455, though current reimbursement remains insufficient, covering only about 60% of the costs; (3) the costs of follow-up are modest (about 8% of total costs); (4) assuming an adjustment of reimbursement to the real cost of an ablation procedure and a 5-10% increase in the annual rate of ablation procedures, after approximately 5-6 years this would result in significant incremental savings for the Italian Healthcare System. In conclusion, catheter ablation of AF is a cost-effective procedure that is inadequately reimbursed in Italy. Insufficient reimbursement may serve as disincentive to perform AF ablation, thereby limiting patient access to this treatment. Considering the healthcare system perspective, higher initial costs for ablation procedures in the short term may be offset by cost savings mainly associated with decreased hospitalizations over time.
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Santini M, Gasparini M, Landolina M, Lunati M, Proclemer A, Padeletti L, Catanzariti D, Molon G, Botto GL, La Rocca L, Grammatico A, Boriani G. Device-Detected Atrial Tachyarrhythmias Predict Adverse Outcome in Real-World Patients With Implantable Biventricular Defibrillators. J Am Coll Cardiol 2011; 57:167-72. [DOI: 10.1016/j.jacc.2010.08.624] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 06/28/2010] [Accepted: 08/10/2010] [Indexed: 10/18/2022]
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Zanon F, Svetlich C, Occhetta E, Catanzariti D, Cantù F, Padeletti L, Santini M, Senatore G, Comisso J, Varbaro A, Denaro A, Sagone A. Safety and performance of a system specifically designed for selective site pacing. Pacing Clin Electrophysiol 2010; 34:339-47. [PMID: 21070258 DOI: 10.1111/j.1540-8159.2010.02951.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In the right ventricle, selective site pacing (SSP) has been shown to avoid detrimental hemodynamic effects induced by right ventricular apical pacing and, in the right atrium, to prevent the onset of atrial fibrillation and to slow down disease progression. The purpose of our multicenter observational study was to describe the use of a transvenous 4-French catheter-delivered lead for SSP in the clinical practice of a large number of centers. METHODS We enrolled 574 patients in whom an implantable device was indicated. In all patients, SSP was achieved by using the Select Secure System™ (Medtronic Inc., Minneapolis, MN, USA). RESULTS In 570 patients, the lead was successfully implanted. In 125 patients, atrial SSP was performed: in 75 (60%) the lead was placed in the interatrial septum, in 31 (25%) in the coronary sinus ostium, and in 19 (15%) in the Bachman bundle. Ventricular SSP was undertaken in 138 patients: in 105 (76%) the high septal right ventricular outflow tract (RVOT) position was paced, in seven (5%) the high free-wall RVOT, in 25 (18%) the low septal RVOT, and in one (1%) the low free-wall RVOT. In the remaining 307 patients, the His zone was paced: in 87 (28%) patients, direct His-bundle pacing and in 220 (72%) patients para-hisian pacing was achieved. Adequate pacing parameters and a lead-related complication rate of 2.6% were recorded during a follow-up of 20 ± 10 months. CONCLUSIONS Our results demonstrated that many sites, in the right atrium, in the right ventricle, and in His-bundle region, can be paced using the Select Secure System™.
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Affiliation(s)
- Francesco Zanon
- Division of Cardiology, Ospedale Santa Maria della Misericordia, Rovigo, Italy.
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Maines M, Catanzariti D, Cirrincione C, Valsecchi S, Comisso J, Vergara G. Intrathoracic impedance and pulmonary wedge pressure for the detection of heart failure deterioration. Europace 2010; 12:680-5. [DOI: 10.1093/europace/eup419] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Catanzariti D, Lunati M, Landolina M, Zanotto G, Lonardi G, Iacopino S, Oliva F, Perego GB, Varbaro A, Denaro A, Valsecchi S, Vergara G. Monitoring intrathoracic impedance with an implantable defibrillator reduces hospitalizations in patients with heart failure. Pacing Clin Electrophysiol 2009; 32:363-70. [PMID: 19272067 DOI: 10.1111/j.1540-8159.2008.02245.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Some implantable cardioverter-defibrillators (ICDs) are now able to monitor intrathoracic impedance. The aim of the study was to describe the use of such monitoring in clinical practice and to evaluate the clinical impact of the fluid accumulation alert feature of these ICDs. METHODS AND RESULTS Five hundred thirty-two heart failure (HF) patients implanted with these ICDs were followed up for 11 +/- 7 months. A clinical event (CE) was deemed to have occurred if it resulted in hospitalization or milder manifestations of HF deterioration. Three hundred sixty-two acute decreases in intrathoracic impedance (Z events) occurred in 230 patients. Of these episodes, 171 (47%) were associated with a CE within 2 weeks of the Z event. In another 71 (20%) Z events, drug therapy was adjusted despite the absence of overt signs of clinical deterioration. The rate of unexplained Z events was 0.25 per patient-year and 25 hospitalizations were not associated with Z events. The audible alert was disabled in a group of 102 patients (OFF group). HF hospitalizations occurred in 29 (7%) patients in the ON group and 20 (20%, P < 0.001) patients in the OFF group. The rate of combined cardiac death and HF hospitalization was lower in patients with Alert ON (log-rank test, P = 0.007). CONCLUSIONS The ICD reliably detected CE and yielded low rates of unexplained and undetected events. The alert capability seemed to reduce the number of HF hospitalizations by allowing timely detection and therapeutic intervention.
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Arbelo Lainez E, Garcia Quintana A, Caballero Dorta E, Diaz Escofet M, Moreno Djadou B, Rios Diaz C, Novoa Medina J, Medina Fernandez-Aceytuno A, Fatemi M, Le Gal G, Castellant P, Fersi I, Etienne Y, Blanc JJ, Zanon F, Aggio S, Baracca E, Pastore F, Vaccari D, Verlato R, Davinelli M, Comisso J, Barsheshet A, Abu Sham'a R, Sandach A, Luria D, Bar Lev D, Gurevitz O, Eldar M, Glikson M, Ramos R, Oliveira M, Nogueira Da Silva M, Toste A, Lousinha A, Branco L, Alves S, Ferreira RC, Baptista R, Saraiva F, Jorge E, Hermida P, Monteiro P, Elvas L, Providencia LA, Delnoy PPHM, Ottervanger JP, Oude Luttikhuis H, Elvan A, Ramdat Misier AR, Beukema WP, Van Hemel NM, Lunati M, Maines M, Landolina M, Santini M, Proclemer A, Sassara M, Marchesini S, Varbaro A, Maines M, Catanzariti D, Cemin C, Vimercati M, Valsecchi S, Vergara G, Bertini M, Ajmone Marsan N, Delgado V, Van Bommel RJ, Nucifora G, Borleffs CJW, Schalij MJ, Bax JJ. Moderated posters: Cardiac resynchronisation therapy. Europace 2009. [DOI: 10.1093/europace/euq242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Maines M, Catanzariti D, Cemin C, Vaccarini C, Vergara G. Usefulness of intrathoracic fluids accumulation monitoring with an implantable biventricular defibrillator in reducing hospitalizations in patients with heart failure: A case-control study. J Interv Card Electrophysiol 2007; 19:201-7. [PMID: 17805952 DOI: 10.1007/s10840-007-9155-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2007] [Accepted: 07/24/2007] [Indexed: 01/28/2023]
Abstract
BACKGROUND The reduction of hospitalizations in patients with heart failure (HF) may have clinical and economical implications. MATERIALS AND METHODS In a case-control study, we compared the number of hospital admissions for congestive HF during the same follow-up period in two homogeneous groups of patients, each consisting of 27 consecutive patients treated with biventricular pacing and back-up defibrillator (B-ICD) in our institution. The first group was implanted with an InSync Sentry, (Medtronic Inc, Minneapolis, MN, US), a B-ICD device with the OptiVol feature for monitoring intrathoracic fluid accumulation and equipped with an active acoustic alarm (Group 1); the second group was implanted with an InSync III Marquis (Medtronic), a B-ICD device with similar features except for the absence of the OptiVol (Group 2). Follow-up visits were performed at 3 month interval or in case of acoustic alarm. RESULTS The patient clinical characteristics of the two groups were similar. In Group 1, with 359 +/- 98 days follow-up, 12 of the 27 patients, experienced 18 OptiVol alarms with only one hospital admission for congestive HF occurring in a patient who ignored the acoustic alarm for 13 days. In Group 2, eight HF hospitalizations occurred in seven patients (p < 0.05). CONCLUSIONS The OptiVol feature is a useful tool for the clinical management of HF patients as it can result in early treatment during the pre-clinic stage of HF decompensation and in a significant reduction of hospital admissions for congestive HF.
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Affiliation(s)
- Massimiliano Maines
- Division of Cardiology, Santa Maria del Carmine Hospital, Corso Verona, 4, 38068, Rovereto (TN), Italy.
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Catanzariti D, Maines M, Cemin C, Broso G, Marotta T, Vergara G. Permanent direct his bundle pacing does not induce ventricular dyssynchrony unlike conventional right ventricular apical pacing. An intrapatient acute comparison study. J Interv Card Electrophysiol 2006; 16:81-92. [PMID: 17115267 DOI: 10.1007/s10840-006-9033-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Accepted: 07/10/2006] [Indexed: 02/03/2023]
Abstract
BACKGROUND Benefits of A-V synchrony during right ventricular apical pacing are neutralized by induction of ventricular dyssynchrony. Only a few data are reported about direct His bundle pacing influence on ventricular synchronism. AIM Was to assess the capability of direct His bundle pacing to prevent pacing-induced ventricular dyssynchrony comparing DDD- (or VVI- in case of Atrial Fibrillation) right ventricular apical pacing with DDD- (or VVI-) direct His bundle pacing in the same patients cohort. METHODS 23 of 24 patients (mean age 75.1 +/- 6.4 years) with narrow QRS (HV < 65 ms) underwent permanent direct His bundle pacing for "brady-tachy syndrome" (11) or supra-Hisian II/III-degree AV Block (permanent atrial fibrillation 7, AV Node ablation 1). A 4.1 F screw-in lead was fixed in His position, guided by endocardial pacemapping and unipolar recordings. Additional permanent (13 patients) or temporary right ventricular apical pacing leads were also positioned. Inter- and left intra-ventricular dyssynchrony, mitral regurgitation and left systolic ventricular function Tei index were assessed during either direct His bundle pacing or right ventricular apical pacing. RESULTS Permanent direct His bundle pacing was obtained in 23 of 24 patients. Indexes of ventricular dyssynchrony were drastically reduced, mitral regurgitation decreased and left systolic ventricular function Tei index improved during direct His bundle pacing (or His bundle and septum pacing) in comparison to apical pacing (p < 0.05). No statistically significant differences were observed between direct His bundle pacing and combined His bundle and septum pacing. CONCLUSION Direct His bundle pacing (also fused with adjacent septum capture) prevents pacing-induced ventricular dyssynchrony.
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Affiliation(s)
- Domenico Catanzariti
- Divisione di Cardiologia, Ospedale S. Maria del Carmine, Corso Verona, n. 4, 38068, Rovereto, TN, Italy.
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Maines M, Catanzariti D, Cemin C, Musuraca G, Vaccarini C, Vergara G. AB48-4. Heart Rhythm 2006. [DOI: 10.1016/j.hrthm.2006.02.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Catanzariti D, Maines M, Ferro A, Cemin C, Vaccarini C, Broso G, Marotta T, Vergara G. AB12-6. Heart Rhythm 2006. [DOI: 10.1016/j.hrthm.2006.02.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Catanzariti D, Vergara G. Lessons from catheter ablation: how a proarrhythmic effect has become a therapeutic chance. The case of class IC/III drugs in atrial flutter. Ital Heart J 2005; 6:591-4. [PMID: 16274022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Catanzariti D, Maines M, De Girolamo P, Cozzi F, Cemin C, Vergara G. [Reduction of radiological exposure time during radiofrequency catheter ablation procedures using a novel intracardiac localization system based on the Ohm's law]. Ital Heart J Suppl 2004; 5:639-46. [PMID: 15554019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND Three-dimensional nonfluoroscopic system may be helpful to guide radiofrequency catheter ablation procedures and to reduce the radiological exposure. A new intracardiac navigation and multicatheter visualization system based on Ohm's law (LocaLisa, Medtronic, Minneapolis, MN, USA) has been recently introduced. The aim of our study was to assess the efficacy of the Loca-Lisa system in comparison to fluoroscopy-based approach in reducing the radiological exposure time required for radiofrequency catheter ablation procedures. METHODS One hundred and thirty-seven consecutive patients underwent LocaLisa-based radiofrequency catheter ablation procedures in our cardiac electrophysiology laboratory during 19 months of LocaLisa utilization (from October 2001 to April 2003): 46 atrial flutter, 44 atrioventricular node reentrant tachycardia, 16 atrioventricular reentry tachycardia due to atrioventricular accessory pathway, 14 atrial fibrillation, 11 ectopic atrial tachycardia, and 6 atrioventricular node modulation. We retrospectively compared the radiological exposure times of this group of patients to those of the last 137 patients undergone fluoroscopy-based radiofrequency catheter ablation procedures for curing the same index arrhythmia by the same procedural protocol. RESULTS The mean radiological exposure time was significantly shorter for the LocaLisa-based radiofrequency catheter ablation procedures (16 +/- 12 vs 34 +/- 17 min; reduction of 53%, p < 0.01) and it occurred for all the arrhythmia types. The reduction was of 64% (from 39 +/- 18 to 14 +/- 12 min, p < 0.01) for atrial flutter, 42% (from 24 +/- 10 to 14 +/- 11 min, p < 0.01) for atrioventricular nodal reentrant tachycardia, 30% (from 40 +/- 14 to 28 +/- 14 min, p = 0.02) for atrioventricular reentry tachycardia, 57% (from 49 +/- 12 to 21 +/- 13 min, p < 0.01) for atrial fibrillation (right atrial linear lesions), 50% (from 38 +/- 12 to 19 +/- 8 min, p < 0.01) for ectopic atrial tachycardia and 42% (from 12 +/- 11 to 7 +/- 5 min, p = NS) for atrioventricular node modulation. The reduction in the radiological exposure time progressively increased as our team got used with the nonfluoroscopic navigation system. CONCLUSIONS Overall and single arrhythmia-divided mean radiological exposure times can be significantly reduced by the LocaLisa system during radiofrequency catheter ablation procedures. The reduction of radiation increases progressively by becoming friendly to the system with a very short duration of learning curve phase.
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Imperadore F, Catanzariti D, Recla M, Miorelli L, Vergara G. A rare metastatic tumor presenting as outflow obstruction to the right ventricle: synovial sarcoma. Ital Heart J 2002; 3:337-8. [PMID: 12066568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Ferdinando Imperadore
- Divisione di Cardiologia Azienda Provinciale per i Servizi Sanitari del Trentino Ospedale S. Maria del Carmine Corso Verona, 4, 38068 Rovereto, TN.
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Vergara G, Accardi R, Imperadore F, Catanzariti D, Cozzi F, Bonadies D, Morani G, Spagnolli W, Della Mea MT, Girardini D, Ferro A. [Hemodynamic and coronary angiographic performance at a center with medium-low activity: organization model, activity indicators, and costs]. Ital Heart J Suppl 2000; 1:1443-50. [PMID: 11109194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND In order to evaluate the cost-effectiveness of coronary angiography performed in a low volume Center, we examined our 1-year activity. METHODS The organizational model of the multipurpose cardiac catheterization laboratory is described. In this type of facility both coronary angiographic and electrophysiological studies are performed. To evaluate the laboratory performance we examined the utilization level, the appropriateness of the studies, the complication rates and the number of studies that had to be repeated because of inadequate data or image quality. The costs were calculated for the in-house laboratory setting (the actual scenario) and for the 25 km distant laboratory setting (the historical scenario). RESULTS The laboratory caseload of coronary angiography was 342 studies, 46% of the overall laboratory activity; 175 patients (51%) underwent non-pharmacological therapy, 129 patients (38%) were treated with medical therapy; the percentage of patients with normal coronary arteries was 11%. Two patients (0.58%) had vascular complications, 1 patient (0.29%) developed an acute myocardial infarction 2 hours after coronary angiography without any evidence of angiographic modifications at the repeated study. In no patient the study had to be repeated because of inadequate data or image quality. The mean cost of a coronary angiography was Lit. 512,000 (265 Euro) for the actual scenario; it would have been Lit. 694,000 (359 Euro) for the historical scenario, with Lit. 182,000 (94 Euro) saved. CONCLUSIONS These findings are consistent with the accepted criteria of good laboratory performance and cost-effectiveness. Thus coronary angiography can be performed effectively and efficiently in a low volume Center.
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Affiliation(s)
- G Vergara
- Azienda Provinciale per i Servizi Sanitari del Trentino, Unità Operativa di Cardiologia, Ospedale S. Maria del Carmine, Rovereto, TN.
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Imperadore F, Accardi R, Spagnolli W, Catanzariti D, Morani G, Vergara G. [Efficacy of treatment with rt-PA of massive pulmonary embolism in patients with contraindications for thrombolytic therapy]. Ital Heart J Suppl 2000; 1:803-7. [PMID: 11204014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Pulmonary embolism is a life-threatening condition that is accompanied by significant morbidity and mortality. In massive pulmonary embolism, where restoration of pulmonary arterial flow is urgently required, the only options available are surgical thromboembolectomy and/or thrombolytic therapy. Unfortunately, a large part of thromboembolic diseases is also considered as an absolute or relative contraindication to thrombolysis. The purpose of this paper was to emphasize the possibility of new thrombolytic agents of disregarding, according to circumstances, the contraindications to thrombolytic treatment.
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Affiliation(s)
- F Imperadore
- Unità Operativa di Cardiologia, Ospedale S. Maria del Carmine, Rovereto
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