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Mitacchione G, Bontempi L, Arabia G, Forleo G, Cimino G, Amore L, Cerini M, Curnis A. Predicting long-term mortality following transvenous lead extraction using the lead extraction difficulty (LED) index score. Europace 2022. [DOI: 10.1093/europace/euac053.538] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Transvenous Lead Extraction (TLE) scoring systems have proven to be a reliable method to predict TLE difficulty, thus improving procedure safety and efficacy. Nevertheless, TLE has shown a significant mortality rate during the subsequent follow-up, up to 33% at 10 years, with historical data showing several procedural and clinical characteristics associate with this poor outcome.
Purpose
We aimed to investigate the association between difficult TLE procedures and long-term mortality, using a specific scoring system [Lead Extraction Difficulty (LED)] to identify difficult/simple procedures.
Methods
Consecutive patients underwent TLE procedures between January 2014 and January 2016 at Spedali Civili Hospital, Brescia, Italy, were prospectively considered to receive a follow-up during 2021. TLE difficulty was retrospectively assessed in all patients using the LED index score (number of leads to extract + years from implant of the oldest lead to remove + 1 [for a dual-coil implantable cardioverter defibrillator lead] – 1 [in case of confirmed vegetations along the lead]). According to the score, "high-difficult" procedures were defined for a LED >10. Patient long-term follow-up was obtained by review of medical records from patient surveys or from the referring institution/family practitioner. Univariate analysis and multivariate logistic regression were used to identify factors associated with long-term mortality. Kaplan-Meier estimates were used to investigate survival during the follow-up. Two-sided P<.05 was considered significant.
Results
A total of 466 permanent leads were removed in 249 patients with a clinical success rate of 99.1%, and without major acute complications. The mean time follow-up was 6.7 (5.9-7.1) years, with a cumulative all-cause mortality rate of 17.7%. Clinical characteristics, indication for TLE, and mortality during follow-up are reported in the Table. Among all variable associated with mortality at univariate analysis, only LED index >10 independently predicted the mortality during the follow-up at logistic regression (OR 2.98; 95% CI: 0.081-1.4; p=0.028). Survival plots for individuals underwent high/low difficult TLE are shown in the Figure. Mortality at 1, 3, and 5 years following TLE was highest among patients with LED index >10 (1.1%, 12.6%, and 26.3%, respectively).
Conclusions
Cumulative long-term mortality following TLE was confirmed to be high. Of interest it resulted highest among patients following high-difficult TLE procedure. LED index score resulted a useful tool to predict long-term mortality after procedure. This finding should be considered when approaching TLE procedures in order to estimate the risk/benefit ratio over the time.
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Affiliation(s)
| | - L Bontempi
- Civil Hospital of Brescia, Brescia, Italy
| | - G Arabia
- Civil Hospital of Brescia, Brescia, Italy
| | - G Forleo
- Luigi Sacco University Hospital, Milan, Italy
| | - G Cimino
- Civil Hospital of Brescia, Brescia, Italy
| | - L Amore
- Civil Hospital of Brescia, Brescia, Italy
| | - M Cerini
- Civil Hospital of Brescia, Brescia, Italy
| | - A Curnis
- Civil Hospital of Brescia, Brescia, Italy
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2
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Magnocavallo M, Della Rocca D, Vetta G, Lavalle C, Mariani M, Schiavone M, Carola G, Mohanty S, Bassiouny M, Forleo G, Burkhardt D, Al–Ahmad A, Gallinghouse J, Horton R, Lakireddy D, Di Biase L, Natale A. P94 LOWER RATE OF MAJOR BLEEDING IN HIGH–RISK PATIENTS UNDERGOING LEFT ATRIAL APPENDAGE OCCLUSION: A PROPENSITY MATCHED COMPARISON WITH DIRECT ORAL ANTICOAGULATION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.091] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Stroke prophylaxis in very high risk (CHA2DS2–VASc ≥ 5) patients with atrial fibrillation (AF) is one of the major challenges faced by physicians. Specifically, initiating direct oral anticoagulants (DOACs) in these patients poses a therapeutic conundrum due to the concomitant high risk of bleeding. Left atrial appendage occlusion (LAAO) might be a potential alternative for thromboembolic (TE) prevention; however, there are no studies comparing these two strategies in very high–risk patients.
Objective
To evaluate the efficacy of LAAO versus DOACs in AF patients at very high TE risk.
Methods
Data were extracted from two prospective databases including 1053 Watchman and 1328 DOAC patients. Watchman patients with a CHA2DS2–VASc ≥ 5 accounted for 26.3% (n = 277). In order to attenuate the imbalance in covariates, a 1:1 propensity score matching technique was used (co–variates: age, sex, CHA2DS2–VASc and HAS–BLED scores). This method resulted in 554 matched patients (277 patients per group; mean age: 79±7y; 57.4% F; CHA2DS2–VASc: 5.8±0.9). The primary endpoint was a composite of cardiovascular (CV) death, TE events (Stroke/TIA/peripheral embolism) and clinically significant bleeding. The annual TE and major bleeding risks were estimated based on the CHA2DS2–VASc score and compared with the annualized observed risk.
Results
After a mean follow–up of 26±7 months, total events were 55 (9.4 event rates per 100 patient–years) in LAAO group vs. 78 (14.9 event rates per 100 patient–years) in DOAC group. DOACs had a significantly higher risk of the primary endpoint (hazard ratio [HR]: 1.30; 95% confidence interval [CI]: 1.08 to 1.56; p = 0.03). TE events (HR: 1.15; 95% CI: 0.84 to 1.57; p = 0.63) and CV death (HR: 1.13; 95% CI: 0.84 to 1.54; p = 0.63) did not differ between groups. Major bleeding events were significantly lower in LAAO patients (HR: 0.75; 95% CI: 0.51 to 0.82; p = 0.04). The unadjusted estimated risk of TE events was 12.3% with LAAO and 12.4% with DOACs. The annualized incidence of TE was 3.2% with LAAO and 4.1% with DOACs, which led to a risk reduction of 74% and 67%, respectively.
Conclusion
In a large cohort of AF patients at very high TE risk (CHA2DS2–VASc ≥ 5), LAAO showed similar stroke prevention but a significantly lower risk of major bleeding than DOACs during a > 2year follow–up.
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Affiliation(s)
- M Magnocavallo
- DEPARTMENT OF CLINICAL, INTERNAL, ANESTHESIOLOGY AND CARDIOVASCULAR SCIENCES, POLICLINICO UNIVERSITARIO UMBERTO I, SAPIENZA UNIVERSITY OF ROME, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, ST. DAVID‘S MEDICAL CENTER, AUSTIN; HEART RHYTHM CENTER, CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO
| | - D Della Rocca
- DEPARTMENT OF CLINICAL, INTERNAL, ANESTHESIOLOGY AND CARDIOVASCULAR SCIENCES, POLICLINICO UNIVERSITARIO UMBERTO I, SAPIENZA UNIVERSITY OF ROME, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, ST. DAVID‘S MEDICAL CENTER, AUSTIN; HEART RHYTHM CENTER, CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO
| | - G Vetta
- DEPARTMENT OF CLINICAL, INTERNAL, ANESTHESIOLOGY AND CARDIOVASCULAR SCIENCES, POLICLINICO UNIVERSITARIO UMBERTO I, SAPIENZA UNIVERSITY OF ROME, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, ST. DAVID‘S MEDICAL CENTER, AUSTIN; HEART RHYTHM CENTER, CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO
| | - C Lavalle
- DEPARTMENT OF CLINICAL, INTERNAL, ANESTHESIOLOGY AND CARDIOVASCULAR SCIENCES, POLICLINICO UNIVERSITARIO UMBERTO I, SAPIENZA UNIVERSITY OF ROME, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, ST. DAVID‘S MEDICAL CENTER, AUSTIN; HEART RHYTHM CENTER, CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO
| | - M Mariani
- DEPARTMENT OF CLINICAL, INTERNAL, ANESTHESIOLOGY AND CARDIOVASCULAR SCIENCES, POLICLINICO UNIVERSITARIO UMBERTO I, SAPIENZA UNIVERSITY OF ROME, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, ST. DAVID‘S MEDICAL CENTER, AUSTIN; HEART RHYTHM CENTER, CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO
| | - M Schiavone
- DEPARTMENT OF CLINICAL, INTERNAL, ANESTHESIOLOGY AND CARDIOVASCULAR SCIENCES, POLICLINICO UNIVERSITARIO UMBERTO I, SAPIENZA UNIVERSITY OF ROME, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, ST. DAVID‘S MEDICAL CENTER, AUSTIN; HEART RHYTHM CENTER, CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO
| | - G Carola
- DEPARTMENT OF CLINICAL, INTERNAL, ANESTHESIOLOGY AND CARDIOVASCULAR SCIENCES, POLICLINICO UNIVERSITARIO UMBERTO I, SAPIENZA UNIVERSITY OF ROME, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, ST. DAVID‘S MEDICAL CENTER, AUSTIN; HEART RHYTHM CENTER, CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO
| | - S Mohanty
- DEPARTMENT OF CLINICAL, INTERNAL, ANESTHESIOLOGY AND CARDIOVASCULAR SCIENCES, POLICLINICO UNIVERSITARIO UMBERTO I, SAPIENZA UNIVERSITY OF ROME, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, ST. DAVID‘S MEDICAL CENTER, AUSTIN; HEART RHYTHM CENTER, CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO
| | - M Bassiouny
- DEPARTMENT OF CLINICAL, INTERNAL, ANESTHESIOLOGY AND CARDIOVASCULAR SCIENCES, POLICLINICO UNIVERSITARIO UMBERTO I, SAPIENZA UNIVERSITY OF ROME, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, ST. DAVID‘S MEDICAL CENTER, AUSTIN; HEART RHYTHM CENTER, CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO
| | - G Forleo
- DEPARTMENT OF CLINICAL, INTERNAL, ANESTHESIOLOGY AND CARDIOVASCULAR SCIENCES, POLICLINICO UNIVERSITARIO UMBERTO I, SAPIENZA UNIVERSITY OF ROME, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, ST. DAVID‘S MEDICAL CENTER, AUSTIN; HEART RHYTHM CENTER, CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO
| | - D Burkhardt
- DEPARTMENT OF CLINICAL, INTERNAL, ANESTHESIOLOGY AND CARDIOVASCULAR SCIENCES, POLICLINICO UNIVERSITARIO UMBERTO I, SAPIENZA UNIVERSITY OF ROME, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, ST. DAVID‘S MEDICAL CENTER, AUSTIN; HEART RHYTHM CENTER, CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO
| | - A Al–Ahmad
- DEPARTMENT OF CLINICAL, INTERNAL, ANESTHESIOLOGY AND CARDIOVASCULAR SCIENCES, POLICLINICO UNIVERSITARIO UMBERTO I, SAPIENZA UNIVERSITY OF ROME, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, ST. DAVID‘S MEDICAL CENTER, AUSTIN; HEART RHYTHM CENTER, CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO
| | - J Gallinghouse
- DEPARTMENT OF CLINICAL, INTERNAL, ANESTHESIOLOGY AND CARDIOVASCULAR SCIENCES, POLICLINICO UNIVERSITARIO UMBERTO I, SAPIENZA UNIVERSITY OF ROME, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, ST. DAVID‘S MEDICAL CENTER, AUSTIN; HEART RHYTHM CENTER, CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO
| | - R Horton
- DEPARTMENT OF CLINICAL, INTERNAL, ANESTHESIOLOGY AND CARDIOVASCULAR SCIENCES, POLICLINICO UNIVERSITARIO UMBERTO I, SAPIENZA UNIVERSITY OF ROME, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, ST. DAVID‘S MEDICAL CENTER, AUSTIN; HEART RHYTHM CENTER, CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO
| | - D Lakireddy
- DEPARTMENT OF CLINICAL, INTERNAL, ANESTHESIOLOGY AND CARDIOVASCULAR SCIENCES, POLICLINICO UNIVERSITARIO UMBERTO I, SAPIENZA UNIVERSITY OF ROME, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, ST. DAVID‘S MEDICAL CENTER, AUSTIN; HEART RHYTHM CENTER, CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO
| | - L Di Biase
- DEPARTMENT OF CLINICAL, INTERNAL, ANESTHESIOLOGY AND CARDIOVASCULAR SCIENCES, POLICLINICO UNIVERSITARIO UMBERTO I, SAPIENZA UNIVERSITY OF ROME, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, ST. DAVID‘S MEDICAL CENTER, AUSTIN; HEART RHYTHM CENTER, CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO
| | - A Natale
- DEPARTMENT OF CLINICAL, INTERNAL, ANESTHESIOLOGY AND CARDIOVASCULAR SCIENCES, POLICLINICO UNIVERSITARIO UMBERTO I, SAPIENZA UNIVERSITY OF ROME, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, ST. DAVID‘S MEDICAL CENTER, AUSTIN; HEART RHYTHM CENTER, CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO
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3
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Schiavone M, Gasperetti A, Vogler J, Mitacchione G, Gulletta S, Palmisano P, Breitenstein A, Laredo M, Compagnucci P, Angeletti A, Kaiser L, Hakmi S, Russo G, Ricciardi D, De Bonis S, Arosio R, Casella M, Santini L, Pignalberi C, Piro A, Lavalle C, Pisanò E, Denora M, Viecca M, Curnis A, Badenco N, Dello Russo A, Tondo C, Kuschyk J, Della Bella P, Tilz R, Biffi M, Forleo G. C9 SUBCUTANEOUS IMPLANTABLE CARDIOVERTER DEFIBRILLATOR IN PATIENTS WITH LOW BMI: REAL–WORLD DATA FROM A EUROPEAN MULTICENTER ANALYSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.008] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
One of the current limitations of the S–ICD is the relatively large size of the generator compared to the TV (transvenous) ICD. There is little evidence whether the size of the current S–ICD generator is associated with an elevated risk of device–related complications in patients with a low body mass index (BMI).
Purpose
Aim of this study was to compare the device–related complications and long–term outcomes in a large real world cohort of S–ICD recipients in patients with a BMI <18 kg/m2 compared to patients with a BMI >18 kg/m2.
Methods
All consecutive patients meeting current guideline indications for ICD implantation and undergoing implantation of a S–ICD device (Boston Scientific, Marlborough, Massachusetts, USA) at 21 European institutions enrolled in the extended ELISIR registry were used for the current analysis. Patients were classified into two cohorts, depending on the BMI at the time of device implantations: BMI < 18 kg/m2 versus > 18 kg/m2.
Results
Out of a total of 1497 pts, 58 pts (3.9%) had a BMI < 18 kg/m2. Patients with BMI <18 kg/m2 were younger (44.6±2.4 vs 50.8±0.4; p = 0.004) and more frequently female (58.6% vs 22.3%, p < 0.001). No differences in any of the other baseline characteristic were observed. Implantation techniques resulted comparable between the groups (rates of 2–incision technique: 87.8% vs 91.9%; p = 0.256; inter–muscular placement: 89.7% vs 83.3%; p = 0.198). Of note, the mean PRAETORIAN score at implantation of patients with BMI <18 kg/m2 was significantly lower (33.8±9.1 vs 54.1±47.3; p = 0.035), although the vast majority of patients in both cohorts qualified as at low risk of conversion failure (100% vs 91.4%; p = 0.436). Over a median follow up time of 22.4 [11.6–36.8] months, both overall device–related complications (5.2% vs 7.4%) and rates of inappropriate shocks (12.0% vs 8.8%) resulted comparable between the two groups (p = 0.517 and p = 0.385, respectively). Figure 1 reports Kaplan–Meier curves showing the combined incidence of device–related complications and inappropriate shocks in the two groups (log–rank p = 0.576).
Conclusion
No differences in device–related complications and long–term outcomes after S–ICD implantation were observed in patients with BMI <18 kg/m2 compared to the remaining recipients in a large multicentered real–world analysis.
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Affiliation(s)
- M Schiavone
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - A Gasperetti
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - J Vogler
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - G Mitacchione
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - S Gulletta
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - P Palmisano
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - A Breitenstein
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - M Laredo
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - P Compagnucci
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - A Angeletti
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - L Kaiser
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - S Hakmi
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - G Russo
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - D Ricciardi
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - S De Bonis
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - R Arosio
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - M Casella
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - L Santini
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - C Pignalberi
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - A Piro
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - C Lavalle
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - E Pisanò
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - M Denora
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - M Viecca
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - A Curnis
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - N Badenco
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - A Dello Russo
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - C Tondo
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - J Kuschyk
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - P Della Bella
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - R Tilz
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - M Biffi
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - G Forleo
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
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Schiavone M, Gasperetti A, Gulletta S, Vogler J, Fastenrath F, Breitenstein A, Laredo M, Mitacchione G, Palmisano P, Compagnucci P, Kaiser L, Denora M, Hakmi S, Angeletti A, De Bonis S, Picarelli F, Casella M, Steffel J, Ferro N, Guarracini F, Santini L, Pignalberi C, Piro A, Lavalle C, Russo G, Pisanò E, Viecca M, Curnis A, Badenco N, Ricciardi D, Dello Russo A, Tondo C, Kuschyk J, Della Bella P, Biffi M, Tilz R, Forleo G. P21 AGE–RELATED DIFFERENCES AND ASSOCIATED OUTCOMES OF S–ICD: INSIGHTS FROM A LARGE, EUROPEAN, MULTICENTER REGISTRY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.019] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
The subcutaneous implantable cardioverter defibrillator (S–ICD) has become an alternative to transvenous ICDs (TV–ICD) in patients who do not need pacing. To date, there is little evidence directly comparing the rates of inappropriate shocks (IAS) in young vs old S–ICD recipients.
Purpose
Aim of our study was to assess differences in device–related complications and inappropriate shocks (IS) between teenagers/young adults and adult recipients of a subcutabeous implantable cardioverter defibrillator (S–ICD) device.
Methods
Two propensity–matched cohorts of teenagers + young adults (≤ 30–year–old) and adults (> 30–year–old) were retrieved from the ELISIR registry. The primary outcome was the comparison of the inappropriate shock (IAS) rate; complications, freedom from sustained ventricular arrhythmic events, overall and cardiovascular mortality were deemed secondary outcomes.
Results
A total of 1491 patients were extracted from the ELISIR project. Teenagers + young adults represented 11.0% of the entire cohort. Two propensity–matched groups of 161 patients each were used for the analysis (Figure 1); median follow–up was 23.1 [13.2–40.5] months. 15.2% patients experienced inappropriate S–ICD shocks and 9.3% device related complications were observed with no age–related differences in IAS (16.1% vs 14.3%; p = 0.642) and complication rates (9.9% vs 8.7%; p = 0.701); Figure 2 shows a survival analysis from inappropriate shocks in the teen–ager/young adult cohort (red) and in the adult cohort (blue). At univariate analysis, young age was not associated with increased rates of IAS (HR 1.204 [0.675–2.148]: p = 0.529). At multivariate analysis (Figure 3), the use of SMART pass algorithm was associated to a strong reduction in IAS (aHR 0.292 [0.161–0.525]; p < 0.001), while ARVC was associated with higher rates of IAS (aHR 2.380 [1.205–4.697]; p = 0.012).
Conclusion
In a large multicentered European registry of patients with S–ICD, 11.0% of all recipients were teenagers or young adults. The use of S–ICD in teenagers/young adults resulted safe and effective, and the rates of complications and IAS between teenagers/young adults and adults were not significantly different. The only predictor of increased IAS was a diagnosis of ARVC.
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Affiliation(s)
- M Schiavone
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - A Gasperetti
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - S Gulletta
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - J Vogler
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - F Fastenrath
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - A Breitenstein
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - M Laredo
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - G Mitacchione
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - P Palmisano
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - P Compagnucci
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - L Kaiser
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - M Denora
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - S Hakmi
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - A Angeletti
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - S De Bonis
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - F Picarelli
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - M Casella
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - J Steffel
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - N Ferro
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - F Guarracini
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - L Santini
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - C Pignalberi
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - A Piro
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - C Lavalle
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - G Russo
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - E Pisanò
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - M Viecca
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - A Curnis
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - N Badenco
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - D Ricciardi
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - A Dello Russo
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - C Tondo
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - J Kuschyk
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - P Della Bella
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - M Biffi
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - R Tilz
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - G Forleo
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
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Schiavone M, Gasperetti A, Mitacchione G, Angeletti A, Vogler J, Laredo M, Breitenstein A, Gulletta S, Fastenrath F, Kaiser L, Compagnucci P, Palmisano P, Ricciardi D, Santini L, De Bonis S, Piro A, Pignalberi C, Pisanò E, Hakmi S, Arosio R, Casella M, Lavalle C, Badenco N, Della Bella P, Dello Russo A, Curnis A, Tondo C, Steffel J, Viecca M, Kuschyk J, Tilz R, Biffi M, Forleo G. P25 SUBCUTANEOUS–ICD IN PATIENTS WITH HEART FAILURE: RESULTS FROM A MULTICENTER, EUROPEAN ANALYSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.023] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Data on patients with heart failure (HF) with a subcutaneous implantable cardioverter defibrillator (S–ICD) are scarce.
Objective
Aim of this study was to assess clinical outcomes of the S–ICD in HF patients in a real–world analysis from the largest European retrospective S–ICD registry (ELISIR).
Methods
All consecutive patients undergoing S–ICD implantation at several European institutions were used for the current analysis. The population was classified into two groups: the HF (classified as HF with reduced and mid–range ejection fraction – HFrEF and HFmrEF) vs the no–HF cohort. The primary outcome of the study was the inappropriate shock (IS) rate across the two cohorts. As secondary outcomes, appropriate shocks, cardiovascular mortality and device–related complications during follow–up were assessed
Results
A total of 1409 patients from the ELISIR registry were included; HF patients represented 57.3% of the entire cohort (n = 701, 86.9% HFrEF; n = 106,13.1% HFmrEF). Over a median follow–up of approximately 2 years, a total of 133 inappropriate shocks were observed in the entire cohort, without significant differences among the two groups (9.2% vs 9.8%, p = 0.689). 133 complex ventricular arrhythmias were adequately recognized and treated, with similar rates of appropriate shocks (9.2% vs 9.8%, p = 0.689). Inappropriate and effective shocks–free survival has been represented in Figure 1 (Kaplan–Meier estimates). At multivariate analysis (Figure 2), age (HR = 0.974 [0.955–0.992], p = 0.005), LVEF (HR = 0.954 [0.926–0.984], p = 0.003), arrhythmogenic right ventricular cardiomyopathy – ARVC (HR = 3.364 [1.206–9.384], p = 0.020) and smart pass + (HR = 0.321 [0.184–0.560], p < 0.001) remained associated with inappropriate shocks. Moreover, a low number of patients (n = 76) experienced device–related complications, more frequently in the HF cohort (6.2% vs 3.8%, p = 0.031) with no significant differences regarding any specific outcome of interest: lead infection (1.1% vs 0.7%, p = 0.381), pocket infection (1.9% vs 0.8%, p = 0.107), pocket hematoma (3.2% vs 2.8%, p = 0.668).
Conclusion
The use of S–ICD in HF patients did not result in a higher rate of inappropriate shocks when compared to no–HF patients, even when stratifying for LVEF. Only age, LVEF, ARVC e Smart Pass algorithm were predictors of the primary outcome at multivariate analysis. Despite a lower overall rate of complications in the entire cohort, HF patients experienced device–related complications more frequently.
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Affiliation(s)
- M Schiavone
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - A Gasperetti
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - G Mitacchione
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - A Angeletti
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - J Vogler
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - M Laredo
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - A Breitenstein
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - S Gulletta
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - F Fastenrath
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - L Kaiser
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - P Compagnucci
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - P Palmisano
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - D Ricciardi
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - L Santini
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - S De Bonis
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - A Piro
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - C Pignalberi
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - E Pisanò
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - S Hakmi
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - R Arosio
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - M Casella
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - C Lavalle
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - N Badenco
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - P Della Bella
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - A Dello Russo
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - A Curnis
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - C Tondo
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - J Steffel
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - M Viecca
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - J Kuschyk
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - R Tilz
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - M Biffi
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - G Forleo
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
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Santini L, Legramante J, Condemi F, Santucci L, Panattoni M, Crobeddu P, Sergi D, Forleo G, Romeo F. Non-invasive hemodynamic analysis in cardiac resynchronization therapy patients wearing quadripolar left ventricular leads: the importance of pacing electrode selection. Minerva Cardioangiol 2014; 62:449-459. [PMID: 25275712] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Quadripolar left ventricular (LV) leads offer multiple choices for LV pacing increasing programming flexibility. Aim of this study is to assess the influence of LV pacing vector selection on hemodynamic parameters for patients who underwent cardiac resynchronization therapy (CRT) using quadripolar LV lead chronically evaluated with a non-invasive approach by Nexfin(®) system provided analysis (BMEYE B.V., Amsterdam, The Netherlands). METHODS AND RESULTS In 16 CRT patients implanted with a quadripolar LV lead (mean follow-up 8,8 ±13,4 months after implantation), we measured Cardiac Output (CO), Mean Blood Pressure (MBP), Total Peripheral Resistance (TPR), LV dP/dt max and Stroke volume (SV) from each one of the ten available bipolar pacing configurations. All the recorded parameters showed marked differences among the ten pacing configurations, but dP/dt max, SV and TPR were those showing the wider range, depending of the selected pacing vector. The average delta for the whole group of subjects between the maximum and minimum hemodynamic values for each pacing configuration were 15.9% for SV, 21.1% for dP/dt max and 20.3% for TPR. Inter-individual analysis of data failed to identify a link between a specific pacing vector and the hemodynamic response. CONCLUSION Our study demonstrates that different bipolar pacing configurations, even if arising from a single CS branch, substantially modify the hemodynamic effect of LV pacing in CRT patients. Moreover, the non-invasive hemodynamic analysis suggests the better pacing configuration should be established individually and could represent an important issue in optimizing CRT during follow-up.
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Affiliation(s)
- L Santini
- Department of Cardiology Tor Vergata University, Rome, Italy -
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Iliuta L, Uno K, Ebihara A, Hayashi N, Chigira M, Yoshikawa T, Kimura K, Yamagata H, Yatomi Y, Takenaka K, Neves A, Mathias L, Leshko J, Linask K, Henriques-Coelho T, Areias J, Huhta J, Barbier P, Castiglioni L, Colazzo F, Fontana L, Nobili E, Franzosi M, Li Causi T, Sironi L, Tremoli E, Guerrini U, Stankovic I, Claus P, Jasaityte R, Putnikovic B, Neskovic A, Voigt J, Kutty S, Attebery J, Yeager E, Truemper E, Li L, Hammel J, Danford D, Tumasyan L, Adamyan K, Chilingaryan A, Mjolstad O, Andersen G, Dalen H, Graven T, Kleinau J, Skjetne K, Haugen B, Sucu M, Uku O, Sari I, Ercan S, Davutoglu V, Ozer O, Kim S, Na JO, Im S, Choi C, Lim H, Kim J, Han S, Seo H, Park C, Oh D, Hammoudi N, Duprey M, Regnier P, Vignalou J, Boubrit L, Pousset F, Jobard O, Isnard R, Shin SH, Woo S, Kim D, Park K, Kwan J, Andersen G, Mjolstad O, Graven T, Kleinau J, Skjetne K, Haugen B, Dalen H, Grigoryan S, Tunyan L, Hazarapetyan L, Shkolnik E, Vasyuk Y, Nesvetov V, Ruddox V, Edvardsen T, Otterstad J, Patrianakos A, Zacharaki A, Kalogerakis A, Nyktari E, Psathakis E, Parthenakis F, Vardas P, Yodwut C, Weinert L, Lang R, Mor-Avi V, Bandera F, Arena R, Labate V, Castelvecchio S, Menicanti L, Guazzi M, Nedeljkovic I, Ostojic M, Stepanovic J, Giga V, Beleslin B, Popovic D, Djordjevic-Dikic A, Petrovic M, Nedeljkovic M, Seferovic P, Popovic D, Ostojic M, Popovic B, Petrovic M, Vujisic-Tesic B, Nedeljkovic I, Arandjelovic A, Banovic M, Seferovic P, Damjanovic S, Horovitz A, Iriart X, De Guillebon D, Reant P, Lafitte S, Thambo J, Venkatesh A, Shahgaldi K, Johnson J, Brodin L, Winter R, Sahlen A, Manouras A, Szulik M, Streb W, Kalarus Z, Kukulski T, Lesniak-Sobelga AM, Kostkiewicz M, Tomkiewicz-Pajak L, Olszowska M, Hlawaty M, Rubis P, Podolec P, Spinelli L, Di Panzillo EA, Morisco C, Crispo S, Trimarco B, Lutay Y, Parkhomenko A, Stepura A, Zamfir D, Tautu O, Nestoruc A, Onut R, Comanescu I, Scafa Udriste A, Dorobantu M, Guseva O, Zhuravskaya N, Bartosh-Zelenaya S, Zagatina A, Kekovic P, Isailovic-Kekovic M, Squeri A, Macri' G, Anglano F, Censi S, Conti R, Pizzarelli M, Trecroci U, Bosi S, Le Tourneau T, Probst V, Kyndt F, Duval D, Trochu J, Bernstein J, Hagege A, Levine R, Le Marec H, Schott J, Enache R, Muraru D, Popescu B, Mateescu A, Purcarea F, Calin A, Beladan C, Rosca M, Ginghina C, Urdaniz MM, Rodriguez Palomares JF, Rius JB, Acosta Velez JG, Garcia-Moreno LG, Tura GT, Alujas MTG, Mas PT, Masip AE, Dorado DG, Zito C, Cusma-Piccione M, Miceli M, Di Bella G, Mohammed M, Oreto L, Di Matteo I, Crea P, Alongi G, Carerj S, Mizariene V, Zaliaduonyte-Peksiene D, Vaskelyte J, Jonkaitiene R, Jurkevicius R, D'auria F, Stinziani V, Grego S, Polisca P, Chiariello L, Cardoso M, Almeida A, David C, Marques J, Jorge C, Silva D, Magalhaes A, Goncalves S, Diogo A, Shiran A, Adawi S, Sachner R, Asmer I, Ganaeem M, Rubinshtein R, Gaspar T, Necas J, Kovalova S, Bombardini T, Sicari R, Ciampi Q, Gherardi S, Costantino M, Picano E, Casartelli M, Bombardini T, Simion D, Gaspari M, Procaccio F, Tsatsopoulou A, Prappa E, Kalantzi M, Patrianakos A, Anastasakis A, Protonotarios N, Monteforte N, Bloise R, Napolitano C, Priori S, Davos C, Varela A, Tsilafakis C, Kostavassili I, Mavroidis M, Di Molfetta A, Musca F, Fresiello L, Santini L, Forleo G, Lunati M, Ferrari G, Romeo F, Moreo A, Lourenco M, Azevedo O, Machado I, Nogueira I, Fernandes M, Pereira V, Quelhas I, Lourenco A, Estensen M, Langesaeter E, Gullestad L, Aakhus S, Skulstad H, Gronlund C, Gustavsson S, Morner S, Suhr O, Lindqvist P, Sunbul M, Kepez A, Durmus E, Ozben B, Mutlu B, Esposito R, Santoro A, Ippolito R, Schiano Lomoriello V, De Palma D, Santoro C, Muscariello R, Ierano P, Galderisi M, Mohammed M, Zito C, Cusma-Piccione M, Di Bella G, Antonini-Canterin F, Taha N, Di Bello V, Vriz O, Pugliatti P, Carerj S, Beladan C, Popescu B, Calin A, Rosca M, Matei F, Enache E, Gurzun M, Ginghina C, Stanescu C, Manoliu V, Branidou K, Daha I, Baicus C, Adam C, Ene I, Dan G, Von Bibra H, Wulf G, Schuster T, Pfuetzner A, Heilmeyer P, Dobson G, Smith B, Grapsa J, Nihoyannopoulos P, Montoro Lopez M, Alonso Ladreda A, Florez Gomez R, Itziar Soto C, Rios Blanco J, Gemma D, Iniesta Manjavacas A, Moreno Yanguela M, Lopez Sendon J, Guzman Martinez G, O'driscoll J, Marciniak A, Perez-Lopez M, Sharma R, Bombardini T, Cini D, Gherardi S, Del Bene R, Serra W, Moreo A, Sicari R, Picano E, Fernandez Cimadevilla O, De La Hera Galarza J, Pasanisi E, Alvarez Pichel I, Diaz Molina B, Martin Fernandez M, Corros C, Lambert Rodriguez J, Sicari R, Jedrzychowska-Baraniak J, Jarosz K, Jozwa R, Kasprzak J, Mohty D, Petitalot V, El Hamel C, Damy T, Lavergne D, Echahidi N, Virot P, Cogne M, Jaccard A, Weng KP, Hsieh KS, Yang YY, Wutthachusin T, Kaier T, Grapsa J, Morgan D, Hakky S, Purkayastha S, Connolly S, Fox K, Ahmed A, Cousins J, Nihoyannopoulos P, Sveric K, Richter U, Wunderlich C, Strasser R, Spethmann S, Dreger H, Baldenhofer G, Mueller E, Stuuer K, Stangl V, Laule M, Baumann G, Stangl K, Knebel F, Ruiz Ortiz M, Mesa D, Delgado M, Romo E, Castillo F, Morenate M, Baeza F, Toledano F, Leon C, De Lezo JS, Ishizu T, Seo Y, Kameda Y, Enomoto M, Atsumi A, Yamamoto M, Nogami Y, Aonuma K, Theodosis-Georgilas A, Tountas H, Fousteris E, Tsaoussis G, Margetis P, Deligiorgis A, Katidis Z, Melidonis A, Beldekos D, Foussas S, Butz T, Faber L, Piper C, Reckefuss N, Wirdeier S, Van Bracht M, Prull M, Plehn G, Horstkotte D, Trappe HJ, Winter S, Martinek M, Ebner C, Nesser H, Kilickiran Avci B, Yurdakul S, Sahin S, Tanrikulu A, Ermis E, Aytekin S, Cefalu C, Barbier P, Santoro A, Ippolito R, Esposito R, Schiano Lomoriello V, De Palma D, Muscariello R, Galderisi M, Karamanou A, Hamodraka E, Vrakas S, Paraskevaides I, Lekakis I, Kremastinos D, Enache R, Piazza R, Muraru D, Mateescu A, Popescu B, Calin A, Beladan C, Rosca M, Nicolosi G, Ginghina C, Erdogan E, Bacaksiz A, Akkaya M, Tasal A, Vatankulu M, Turfan M, Sonmez O, Ertas G, Uyarel H, Goktekin O, Singelton J, Petraco R, Shaikh R, Cole G, Francis D, Manisty C, Almeida A, Cortez-Dias N, Sousa J, Carpinteiro L, Marques J, Silva D, Jorge C, Carrilho-Ferreira P, Pinto F, Diogo A, Kleczynski P, Legutko J, Rakowski T, Dziewierz A, Siudak Z, Zdzienicka J, Brzozowska-Czarnek A, Dubiel J, Dudek D, Carvalho MS, De Araujo Goncalves P, Dores H, Sousa P, Marques H, Pereira Machado F, Gaspar A, Aleixo A, Mota Carmo M, Roquette J, Obase K, Sakakura T, Matsushita S, Takeuchi M, Tamai S, Komeda M, Yoshida K, Jimenez Rubio C, Isasti Aizpurua G, Miralles Ibarra J, Gianstefani S, Catibog N, Whittaker A, Wathen P, Kogoj P, Reiken J, Monaghan M, Salvetti M, Muiesan M, Paini A, Agabiti Rosei C, Aggiusti C, Bertacchini F, Stassaldi D, Rubagotti G, Comaglio A, Agabiti Rosei E, Soldati E, Corciu A, Zucchelli G, Di Cori A, Segreti L, De Lucia R, Paperini L, Viani S, Vannozzi A, Bongiorni M, Kablak-Ziembicka A, Przewlocki T, Stepien E, Wrotniak L, Karch I, Podolec P, Kleczynski P, Rakowski T, Dziewierz A, Jakala J, Legutko J, Dubiel J, Dudek D. Poster session Friday 7 December - PM: Effect of systemic illnesses on the heart. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes266] [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: 11/12/2022] Open
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Bertaglia E, Tondo C, De Simone A, Zoppo F, Mantica M, Turco P, Iuliano A, Forleo G, La Rocca V, Stabile G. Does catheter ablation cure atrial fibrillation? Single-procedure outcome of drug-refractory atrial fibrillation ablation: a 6-year multicentre experience. Europace 2009; 12:181-7. [DOI: 10.1093/europace/eup349] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Resta N, Stella A, Susca FC, Di Giacomo M, Forleo G, Miccolis I, Rossini FP, Genuardi M, Piepoli A, Grammatico P, Guanti G. Two novel mutations and a new STK11/LKB1 gene isoform in Peutz-Jeghers patients. Hum Mutat 2002; 20:78-9. [PMID: 12112668 DOI: 10.1002/humu.9046] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Peutz-Jeghers syndrome (PJS) is a rare autosomal dominantly inherited disorder with variable expression and incomplete penetrance characterized by mucocutaneous pigmentation, predisposition to hamartomatous intestinal polyposis, and various other neoplasms. It occurs in approximately 1 in 8,300 to 29,000 live births. In nearly 50% of patients PJS is caused by germ line mutations in the STK11/LKB1 serine/threonine kinase gene, the only kinase gene currently known to act as a tumor suppressor. We have performed a mutation search in the STK11/LKB1 gene in 8 sporadic cases and 3 PJS families using a combination of different screening techniques. We have identified four mutations, two of which I177N and the IVS2+1A->G, were previously unreported. We have also evaluated the presence of cDNA alterations by means of RT-PCR analysis and direct cDNA sequencing and have found two aberrant transcripts in a single PJS case despite the lack of any apparent genomic alteration. Finally, we report the presence of a novel STK11/LKB1 cDNA isoform observed in all the normal subjects studied as well as in the majority of the PJS patients.
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Affiliation(s)
- N Resta
- Sez. Genetica Medica DIMIMP, Università di Bari, Italy
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De Rito V, Natali R, Vigna C, Perna GP, Stanislao M, Lombardo A, Russo A, Forleo G, Fanelli R, Loperfido F. Analysis of agreement between dobutamine stress echocardiography and exercise nuclear angiography in severe aortic regurgitation. Am J Cardiol 2000; 86:104-7. [PMID: 10867105 DOI: 10.1016/s0002-9149(00)00839-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- V De Rito
- Division of Cardiology, Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo, Italy
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