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Pandozi C, Botto GL, Loricchio ML, D'Ammando M, Lavalle C, Del Giorno G, Matteucci A, Mariani MV, Nicolis D, Segreti L, Papa AA, Casale MC, Galeazzi M, Russo M, Di Belardino N, Pelargonio G, Centurion Aznaran C, Malacrida M, Maddaluno F, Treglia S, Piccolo F, Colivicchi F. High-density mapping of Koch's triangle during sinus rhythm and typical atrioventricular nodal re-entrant tachycardia, integrated with direct recording of atrio-ventricular node structure potential. J Cardiovasc Electrophysiol 2024; 35:379-388. [PMID: 38185855 DOI: 10.1111/jce.16168] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND The mechanism of typical slow-fast atrioventricular nodal re-entrant tachycardia (AVNRT) and its anatomical and electrophysiological circuit inside the right atrium (RA) and Koch's Triangle (KT) are not well known. OBJECTIVE To identify the potentials of the compact AV node and inferior extensions and to perform accurate mapping of the RA and KT in sinus rhythm (SR) and during AVNRT, to define the tachycardia circuit. METHODS Consecutive patients with typical AVNRT were enrolled in 12 Italian centers and underwent mapping and ablation by means of a basket catheter with small electrode spacing for ultrahigh-density mapping and a modified signal-filtering toolset to record the potentials of the AV nodal structures. RESULTS Forty-five consecutive cases of successful ablation of typical slow-fast AVNRT were included. The mean SR cycle length (CL) was 784.1 ± 6 ms and the mean tachycardia CL was 361.2 ± 54 ms. The AV node potential had a significantly shorter duration and higher amplitude in sinus rhythm than during tachycardia (60 ± 40 ms vs. 160 ± 40 ms, p < .001 and 0.3 ± 0.2 mV vs. 0.09 ± 0.12 mV, p < .001, respectively). The nodal potential duration extension was 169.4 ± 31 ms, resulting in a time-window coverage of 47.6 ± 9%. The recording of AV nodal structure potentials enabled us to obtain 100% coverage of the tachycardia CL during slow-fast AVNRT. CONCLUSION Detailed recording of the potentials of nodal structures is possible by means of multipolar catheters for ultrahigh-density mapping, allowing 100% of the AVNRT CL to be covered. These results also have clinical implications for the ablation of right-septal and para-septal arrhythmias.
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Affiliation(s)
- Claudio Pandozi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | | | | | | | - Carlo Lavalle
- Azienda ospedaliero-universitaria Policlinico Umberto I, Rome, Italy
| | | | - Andrea Matteucci
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
- Department of System and Experimental Medicine, University of Rome 'Tor Vergata, Rome, Italy
| | | | | | | | - Andrea Antonio Papa
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli"-Monaldi Hospital, Naples, Italy
| | | | - Marco Galeazzi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Maurizio Russo
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | | | - Gemma Pelargonio
- Istituto di Cardiologia Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Arrhythmology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
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Bianchi S, De Simone A, Iacopino S, Fassini G, Malacrida M, Rossi P, Stabile G, Petretta A, Tundo F, Cauti FM, Iuliano S, Filannino P, Moltrasio M, Morlacchi Bonfanti M, Pelargonio G, Pecora D, Ferraro A, Tondo C. Pulmonary vein isolation by means of a novel cryoballoon technology in paroxysmal atrial fibrillation patients: 1-year outcome from a large Italian multicenter clinical registry. Pacing Clin Electrophysiol 2023; 46:1302-1309. [PMID: 37846769 DOI: 10.1111/pace.14839] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 07/04/2023] [Accepted: 10/01/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Recently, a new cryoballoon (CB) technology (POLARx; Boston Scientific) has come onto the market. Preliminary data have shown that its acute safety and efficacy are similar to those of the first-generation CB. The aim of this study was to assess the medium-term outcome of pulmonary vein isolation (PVI) with the POLARxTM CB in a large multicenter registry. METHODS We prospectively collected data on 125 consecutive patients with paroxysmal atrial fibrillation (AF) who underwent PVI by means of a novel CB system. Two cases of transient phrenic nerve palsy occurred, with full recovery in the 48h post procedure; no major procedure-related adverse events were reported. During the 90-day blanking period, 4 (3.2%) patients experienced an early recurrence. After the blanking period, over a mean follow-up of 411 ± 62 days, 19 patients (15.2%) suffered an AF/atrial tachycardia (AT) recurrence. The 1-year freedom from AF/AT recurrence was 86.4% (n = 17): 10 (8%) patients had an AF recurrence, 6 (4.8%) had an AT occurrence and 1 (0.8%) suffered both events. Patients with AF/AT recurrences had both a shorter deflation time and total deflation time. Moreover, CB ablations with measured TTI < 90 s and TTI < 60 s were more frequent in patients without AF/AT recurrence (88.5% and 77.4%, respectively) than in those who experienced at least one AF/AT recurrence (67.5% and 55.0%, p = .001 and p = .005, respectively). CONCLUSION The novel POLARx cryo-balloon system is safe and effective for PV isolation, displaying a 1-year freedom from atrial arrhythmia recurrence of 86.4%, which is in line to that reported with AFA-Pro CB or RF ablation. CLINICAL TRIAL REGISTRATION Catheter Ablation of Arrhythmias with a High-Density Mapping System in Real-World Practice (CHARISMA). URL: http://clinicaltrials.gov/ Identifier: NCT03793998. Registration date: January 4, 2019.
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Affiliation(s)
- Stefano Bianchi
- Arrhythmology Unit, San Giovanni Calibita Hospital, Fatebefratelli, Rome, Italy
| | - Antonio De Simone
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | | | - Gaetano Fassini
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Pietro Rossi
- Arrhythmology Unit, San Giovanni Calibita Hospital, Fatebefratelli, Rome, Italy
| | - Giuseppe Stabile
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
- Mediterranea Cardiocentro, Napoli, Italy
- Anthea Hospital, Bari, Italy
| | | | - Fabrizio Tundo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Filippo Maria Cauti
- Arrhythmology Unit, San Giovanni Calibita Hospital, Fatebefratelli, Rome, Italy
| | - Sara Iuliano
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | | | - Massimo Moltrasio
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Gemma Pelargonio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Domenico Pecora
- Electrophysiology Unit, Cardiovascular Department, Poliambulanza Institute Hospital Foundation, Brescia, Italy
| | - Anna Ferraro
- Cardiovascular Department, Infermi Hospital, Rivoli, Italy
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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Flore F, Scacciavillani R, Iannaccone G, Narducci ML, Pinnacchio G, Bencardino G, Perna F, Spera FR, Comerci G, Camilli M, Lombardo A, Lanza GA, Crea F, Pelargonio G. Mechanisms, prevalence and management of cardiac arrhythmias in cancer patients: a comprehensive review. Future Cardiol 2023; 19:707-718. [PMID: 37929680 DOI: 10.2217/fca-2023-0086] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Recently, prognosis and survival of cancer patients has improved due to progression and refinement of cancer therapies; however, cardiovascular sequelae in this population augmented and now represent the second cause of death in oncological patients. Initially, the main issue was represented by heart failure and coronary artery disease, but a growing body of evidence has now shed light on the increased arrhythmic risk of this population, atrial fibrillation being the most frequently encountered. Awareness of arrhythmic complications of cancer and its treatments may help oncologists and cardiologists to develop targeted approaches for the management of arrhythmias in this population. In this review, we provide an updated overview of the mechanisms triggering cardiac arrhythmias in cancer patients, their prevalence and management.
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Affiliation(s)
- Francesco Flore
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Roberto Scacciavillani
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giulia Iannaccone
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Maria Lucia Narducci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gaetano Pinnacchio
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gianluigi Bencardino
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Perna
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | | | - Gianluca Comerci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Massimiliano Camilli
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Antonella Lombardo
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gaetano Antonio Lanza
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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Pavone C, Pelargonio G. Reversible Causes of Atrioventricular Block. Cardiol Clin 2023; 41:411-418. [PMID: 37321691 DOI: 10.1016/j.ccl.2023.03.004] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Atrioventricular blocks may be caused by a variety of potentially reversible conditions, such as ischemic heart disease, electrolyte imbalances, medications, and infectious diseases. Such causes must be always ruled out to avoid unnecessary pacemaker implantation. Patient management and reversibility rates depend on the underlying cause. Careful patient history taking, monitoring of vital signs, electrocardiogram, and arterial blood gas analysis are crucial elements of the diagnostic workflow during the acute phase. Atrioventricular block recurrence after the reversal of the underlying cause may pose an indication for pacemaker implantation, because reversible conditions may actually unmask a preexistent conduction disorder.
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Affiliation(s)
- Chiara Pavone
- Cardiovascular Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome, Italy
| | - Gemma Pelargonio
- Cardiovascular Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome, Italy; Cardiology Institute, Catholic University of the Sacred Heart, Rome, Italy.
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Casella M, Conti S, Compagnucci P, Ribatti V, Narducci ML, Marcon L, Massara F, Valeri Y, De Francesco L, Martino AM, Ghiglieno C, Schiavone M, Balla C, Dell'Era G, Pelargonio G, Forleo GB, Iacopino S, Sgarito G, Calò L, Tondo C, Russo AD, Patti G. Reply by Casella et al. to letter regarding article, incidence of ventricular arrhythmias related to COVID infection and vaccination in patients with Brugada syndrome: Insights from a large Italian multicenter registry based on continuous rhythm monitoring. J Cardiovasc Electrophysiol 2023; 34:1791-1792. [PMID: 37393585 DOI: 10.1111/jce.15989] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Michela Casella
- Department of Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Sergio Conti
- Department of Electrophysiology, ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Paolo Compagnucci
- Department of Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
- Department of Biomedical Science and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Valentina Ribatti
- Department of Arrhythmology, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Maria Lucia Narducci
- Department of Cardiovascular Sciences, Arrhythmology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Lorenzo Marcon
- Department of Arrhythmology, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Francesca Massara
- Department of Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Yari Valeri
- Department of Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Luca De Francesco
- Department of Cardiovascular Sciences, Arrhythmology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Chiara Ghiglieno
- Division of Cardiology, University Hospital Maggiore della Carità, University of Eastern Piedmont, Novara, Italy
| | - Marco Schiavone
- Department of Arrhythmology, Luigi Sacco Hospital, Milan, Italy
| | - Cristina Balla
- Department of Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Gabriele Dell'Era
- Division of Cardiology, University Hospital Maggiore della Carità, University of Eastern Piedmont, Novara, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular Sciences, Arrhythmology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Saverio Iacopino
- Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giuseppe Sgarito
- Department of Electrophysiology, ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | - Claudio Tondo
- Department of Arrhythmology, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgery and Dental Sciences, University of Milan, Milan, Italy
| | - Antonio Dello Russo
- Department of Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
- Department of Biomedical Science and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Giuseppe Patti
- Division of Cardiology, University Hospital Maggiore della Carità, University of Eastern Piedmont, Novara, Italy
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Flore F, Scacciavillani R, Narducci ML, Pelargonio G, Crea F. Takotsubo syndrome and its linkage to neuroendocrinological disorders: a case report. Future Cardiol 2023. [PMID: 37378528 DOI: 10.2217/fca-2022-0115] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
Takotsubo syndrome (TTS) is an increasingly diagnosed entity, however the underlying pathophysiological mechanisms and their clinical implications are incompletely understood. An 82-year-old female, diagnosed with pituitary apoplexy, presented with ECG abnormalities and hsTnI levels consistent with an acute coronary syndrome and therefore underwent urgent coronary angiography that showed no significant stenosis and apical ballooning at left ventricle angiogram and therefore a TTS diagnosis was made. Moreover, during catheterization a 20 s Torsade de Pointes was registered. TTS is an entity that can be triggered by numerous conditions. This case of TTS was linked to many neuroendocrinological disorders.
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Affiliation(s)
- Francesco Flore
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome, 00168, Italy
| | - Roberto Scacciavillani
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome, 00168, Italy
| | - Maria Lucia Narducci
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome, 00168, Italy
| | - Gemma Pelargonio
- Istituto di Cardiologia Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, Rome, 00168, Italy
| | - Filippo Crea
- Istituto di Cardiologia Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, Rome, 00168, Italy
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Casella M, Conti S, Compagnucci P, Ribatti V, Narducci ML, Marcon L, Massara F, Valeri Y, De Francesco L, Martino AM, Ghiglieno C, Schiavone M, Balla C, Dell'Era G, Pelargonio G, Forleo GB, Iacopino S, Sgarito G, Calò L, Tondo C, Russo AD, Patti G. Incidence of ventricular arrhythmias related to COVID infection and vaccination in patients with Brugada syndrome: Insights from a large Italian multicenter registry based on continuous rhythm monitoring. J Cardiovasc Electrophysiol 2023; 34:1386-1394. [PMID: 37194742 DOI: 10.1111/jce.15929] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/04/2023] [Accepted: 05/03/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Brugada syndrome (BrS) has a dynamic ECG pattern that might be revealed by certain conditions such as fever. We evaluated the incidence and management of ventricular arrhythmias (VAs) related to COVID-19 infection and vaccination among BrS patients carriers of an implantable loop recorder (ILR) or implantable cardioverter-defibrillator (ICD) and followed by remote monitoring. METHODS This was a multicenter retrospective study. Patients were carriers of devices with remote monitoring follow-up. We recorded VAs 6 months before COVID-19 infection or vaccination, during infection, at each vaccination, and up to 6-month post-COVID-19 or 1 month after the last vaccination. In ICD carriers, we documented any device intervention. RESULTS We included 326 patients, 202 with an ICD and 124 with an ILR. One hundred and nine patients (33.4%) had COVID-19, 55% of whom developed fever. Hospitalization rate due to COVID-19 infection was 2.76%. After infection, we recorded only two ventricular tachycardias (VTs). After the first, second, and third vaccines, the incidence of non-sustained ventricular tachycardia (NSVT) was 1.5%, 2%, and 1%, respectively. The incidence of VT was 1% after the second dose. Six-month post-COVID-19 healing or 1 month after the last vaccine, we documented NSVT in 3.4%, VT in 0.5%, and ventricular fibrillation in 0.5% of patients. Overall, one patient received anti-tachycardia pacing and one a shock. ILR carriers had no VAs. No differences were found in VT before and after infection and before and after each vaccination. CONCLUSIONS From this large multicenter study conducted in BrS patients, followed by remote monitoring, the overall incidence of sustained VAs after COVID-19 infection and vaccination is relatively low.
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Affiliation(s)
- Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Sergio Conti
- Department of Electrophysiology, ARNAS Civico - Di Cristina - Benfratelli, Palermo, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
- Department of Biomedical Science and Public Health, Marche Polytechnic University, Ancona, Italy
| | | | | | | | - Francesca Massara
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Yari Valeri
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Luca De Francesco
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Chiara Ghiglieno
- Division of Cardiology, University Hospital Maggiore della Carità, University of Eastern Piedmont, Novara, Italy
| | | | - Cristina Balla
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy
| | - Gabriele Dell'Era
- Division of Cardiology, University Hospital Maggiore della Carità, University of Eastern Piedmont, Novara, Italy
| | - Gemma Pelargonio
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | | | - Giuseppe Sgarito
- Department of Electrophysiology, ARNAS Civico - Di Cristina - Benfratelli, Palermo, Italy
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | - Claudio Tondo
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgery and Dental Sciences, University of Milan, Milan, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
- Department of Biomedical Science and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Giuseppe Patti
- Division of Cardiology, University Hospital Maggiore della Carità, University of Eastern Piedmont, Novara, Italy
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Perna F, Telesca A, Scacciavillani R, Narducci ML, Bencardino G, Pinnacchio G, Spera FR, Sabarese R, Comerci G, Pelargonio G. Clinical Impact of Cardiac Fibrosis on Arrhythmia Recurrence after Ablation in Adults with Congenital Heart Disease. J Cardiovasc Dev Dis 2023; 10:jcdd10040168. [PMID: 37103047 PMCID: PMC10141040 DOI: 10.3390/jcdd10040168] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Adults with congenital heart disease (ACHD) are often affected by cardiac arrhythmias requiring catheter ablation. Catheter ablation in this setting represents the treatment of choice but is flawed by frequent recurrencies. Predictors of arrhythmia relapse have been identified, but the role of cardiac fibrosis in this setting has not been investigated. The aim of this study was to determine the role of the extension of cardiac fibrosis, detected by electroanatomical mapping, in predicting arrhythmia recurrencies after ablation in ACHD. MATERIALS AND METHODS Consecutive patients with congenital heart disease and atrial or ventricular arrhythmias undergoing catheter ablation were enrolled. An electroanatomical bipolar voltage map was performed during sinus rhythm in each patient and bipolar scar was assessed according to the current literature data. During follow-up, arrhythmia recurrences were recorded. The relationship between the extent of myocardial fibrosis and arrhythmia recurrence was assessed. RESULTS Twenty patients underwent successful catheter ablation of atrial (14) or ventricular (6) arrhythmias, with no inducible arrhythmia at the end of the procedure. During a median follow-up period of 207 weeks (IQR 80 weeks), eight patients (40%; five atrial and three ventricular arrhythmias) had arrhythmia recurrence. Of the five patients undergoing a second ablation, four showed a new reentrant circuit, while one patient had a conduction gap across a previous ablation line. The extension of the bipolar scar area (HR 1.049, CI 1.011-1.089, p = 0.011) and the presence of a bipolar scar area >20 cm2 (HR 6.101, CI 1.147-32.442, p = 0.034) were identified as predictors of arrhythmia relapse. CONCLUSION The extension of the bipolar scar area and the presence of a bipolar scar area >20 cm2 can predict arrhythmia relapse in ACHD undergoing catheter ablation of atrial and ventricular arrhythmias. Recurrent arrhythmias are often caused by circuits other than those previously ablated.
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Affiliation(s)
- Francesco Perna
- Cardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Alessandro Telesca
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Roberto Scacciavillani
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Maria Lucia Narducci
- Cardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gianluigi Bencardino
- Cardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Gaetano Pinnacchio
- Cardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Francesco Raffaele Spera
- Cardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Rocco Sabarese
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gianluca Comerci
- Cardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Gemma Pelargonio
- Cardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
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9
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Rosa GL, Pelargonio G, Narducci ML, Crea F. Nuevas vías de investigación para el valor pronóstico del intervalo onda Tpeak-Tend en pacientes con diferentes variantes morfológicas del síndrome de tako-tsubo Respuesta. Rev Esp Cardiol 2023. [DOI: 10.1016/j.recesp.2023.02.003] [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: 04/05/2023]
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10
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Rosa GL, Pelargonio G, Narducci ML, Pinnacchio G, Bencardino G, Perna F, Follesa F, Galiuto L, Crea F. Valor pronóstico del intervalo Tpeak-Tend en el desarrollo de arritmias ventriculares subagudas intrahospitalarias en el síndrome de tako-tsubo. Rev Esp Cardiol 2023. [DOI: 10.1016/j.recesp.2022.11.011] [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: 03/06/2023]
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11
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Bencardino G, Scacciavillani R, narducci ML, perna F, Comerci G, Gabrielli FA, Pinnacchio G, Spera FR, Pelargonio G. PROGNOSIS OF PATIENTS UNDERGOING CATHETER ABLATION OF ARRHYTHMIC STORM IN PATIENTS WITH AND WITHOUT HISTORY OF PREVIOUS ICD INTERVENTIONS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00623-x] [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: 03/06/2023]
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12
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La Rosa G, Pelargonio G, Narducci ML, Crea F. New research avenues for the prognostic value of the Tpeak-Tend interval in patients with different morphological variants of tako-tsubo syndrome. Response. Rev Esp Cardiol (Engl Ed) 2023; 76:491-492. [PMID: 36804555 DOI: 10.1016/j.rec.2023.02.004] [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] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/01/2023] [Indexed: 02/19/2023]
Affiliation(s)
- Giulio La Rosa
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Gemma Pelargonio
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Maria Lucia Narducci
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.
| | - Filippo Crea
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy
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13
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Narducci ML, Ruscio E, Nurchis MC, Domenico P, Scacciavillani R, Bencardino G, Perna F, Pelargonio G, Massetti M, Damiani G, Crea F. Mortality after transvenous lead extraction: A risk prediction model for sustainable care delivery. Eur J Clin Invest 2023; 53:e13969. [PMID: 36776121 DOI: 10.1111/eci.13969] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/14/2023] [Accepted: 01/24/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND AND AIMS Transvenous lead extraction (TLE) has become a pivotal part of a comprehensive lead management strategy, dealing with a continuously increasing demand. Nonetheless, the literature about the long-term impact of TLE on survivals is still lacking. Given these knowledge gaps, the aim of our study was to analyse very long-term mortality in patients undergoing TLE in public health perspective. METHODS This prospective, single-centre, observational study enrolled consecutive patients with cardiac implantable electronic device (CIED) who underwent TLE, from January 2005 to January 2021. The main goal was to establish the independent predictors of very long-term mortality after TLE. We also aimed at assessing procedural and hospitalization-related costs. RESULTS We enrolled 435 patients (mean age 70 ± 12 years, with mean lead dwelling time 6.8 ± 16.7 years), with prevalent infective indication to TLE (92%). Initial success of TLE was achieved in 98% of population. After a median follow-up of 4.5 years (range: 1 month-15.5 years), 150 of the 435 enrolled patients (34%) died. At multivariate analysis, death was predicted by: age (≥77 years, OR: 2.55, CI: 1.8-3.6, p < 0.001), chronic kidney disease (CKD) defined as severe reduction of estimated glomerular filtration rate (eGFR <30 mL/min/1.73 m2 , OR: 1.75, CI: 1.24-2.4, p = 0.001) and systolic dysfunction assessed before TLE defined as left ventricular ejection fraction (LVEF) <40%, OR: 1.78, CI 1.26-2.5, p = 0.001. Mean extraction cost was €5011 per patient without reimplantation and €6336 per patient with reimplantation respectively. CONCLUSIONS Our study identified three predictors of long-term mortality in a high-risk cohort of patients with a cardiac device infection, undergoing successful TLE. The future development of a mortality risk score before might impact on public health strategy.
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Affiliation(s)
- Maria Lucia Narducci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora Ruscio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mario Cesare Nurchis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,School of Economics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pascucci Domenico
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Health Sciences and Public Health Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberto Scacciavillani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gianluigi Bencardino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Perna
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Gianfranco Damiani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Health Sciences and Public Health Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Crea
- Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
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14
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Boriani G, Guerra F, De Ponti R, D'Onofrio A, Accogli M, Bertini M, Bisignani G, Forleo GB, Landolina M, Lavalle C, Notarstefano P, Ricci RP, Zanotto G, Palmisano P, De Bonis S, Pangallo A, Talarico A, Maglia G, Aspromonte V, Nigro G, Bianchi V, Rapacciuolo A, Ammendola E, Solimene F, Stabile G, Biffi M, Ziacchi M, Malpighi PSO, Saporito D, Casali E, Turco V, Malavasi VL, Vitolo M, Imberti JF, Bertini M, Anna AS, Zardini M, Placci A, Quartieri F, Bottoni N, Carinci V, Barbato G, De Maria E, Borghi A, Ramazzini OB, Bronzetti G, Tomasi C, Boggian G, Virzì S, Sassone B, Corzani A, Sabbatani P, Pastori P, Ciccaglioni A, Adamo F, Scaccia A, Spampinato A, Patruno N, Biscione F, Cinti C, Pignalberi C, Calò L, Tancredi M, Di Belardino N, Ricciardi D, Cauti F, Rossi P, Cardinale M, Ansalone G, Narducci ML, Pelargonio G, Silvetti M, Drago F, Santini L, Pentimalli F, Pepi P, Caravati F, Taravelli E, Belotti G, Rordorf R, Mazzone P, Bella PD, Rossi S, Canevese LF, Cilloni S, Doni LA, Vergara P, Baroni M, Perna E, Gardini A, Negro R, Perego GB, Curnis A, Arabia G, Russo AD, Marchese P, Dell’Era G, Occhetta E, Pizzetti F, Amellone C, Giammaria M, Devecchi C, Coppolino A, Tommasi S, Anselmino M, Coluccia G, Guido A, Rillo M, Palamà Z, Luzzi G, Pellegrino PL, Grimaldi M, Grandinetti G, Vilei E, Potenza D, Scicchitano P, Favale S, Santobuono VE, Sai R, Melissano D, Candida TR, Bonfantino VM, Di Canda D, Gianfrancesco D, Carretta D, Pisanò ECL, Medico A, Giaccari R, Aste R, Murgia C, Nissardi V, Sanna GD, Firetto G, Crea P, Ciotta E, Sgarito G, Caramanno G, Ciaramitaro G, Faraci A, Fasheri A, Di Gregorio L, Campsi G, Muscio G, Giannola G, Padeletti M, Del Rosso A, Notarstefano P, Nesti M, Miracapillo G, Giovannini T, Pieragnoli P, Rauhe W, Marini M, Guarracini F, Ridarelli M, Fedeli F, Mazza A, Zingarini G, Andreoli C, Carreras G, Zorzi A, Zanotto G, Rossillo A, Ignatuk B, Zerbo F, Molon G, Fantinel M, Zanon F, Marcantoni L, Zadro M, Bevilacqua M. Five waves of COVID-19 pandemic in Italy: results of a national survey evaluating the impact on activities related to arrhythmias, pacing, and electrophysiology promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing). Intern Emerg Med 2023; 18:137-149. [PMID: 36352300 PMCID: PMC9646282 DOI: 10.1007/s11739-022-03140-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The subsequent waves of the COVID-19 pandemic in Italy had a major impact on cardiac care. METHODS A survey to evaluate the dynamic changes in arrhythmia care during the first five waves of COVID-19 in Italy (first: March-May 2020; second: October 2020-January 2021; third: February-May 2021; fourth: June-October 2021; fifth: November 2021-February 2022) was launched. RESULTS A total of 127 physicians from arrhythmia centers (34% of Italian centers) took part in the survey. As compared to 2019, a reduction in 40% of elective pacemaker (PM), defibrillators (ICD), and cardiac resynchronization devices (CRT) implantations, with a 70% reduction for ablations, was reported during the first wave, with a progressive and gradual return to pre-pandemic volumes, generally during the third-fourth waves, slower for ablations. For emergency procedures (PM, ICD, CRT, and ablations), recovery from the initial 10% decline occurred in most cases during the second wave, with some variability. However, acute care for atrial fibrillation, electrical cardioversions, and evaluations for syncope showed a prolonged reduction of activity. The number of patients with devices which started remote monitoring increased by 40% during the first wave, but then the adoption of remote monitoring declined. CONCLUSIONS The dramatic and profound derangement in arrhythmia management that characterized the first wave of the COVID-19 pandemic was followed by a progressive return to the volume of activities of the pre-pandemic periods, even if with different temporal dynamics and some heterogeneity. Remote monitoring was largely implemented during the first wave, but full implementation is needed.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41121, Modena, Italy.
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo-University of Insubria, Varese, Italy
| | - Antonio D'Onofrio
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, Naples, Italy
| | | | - Matteo Bertini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara "Arcispedale S. Anna", Cona, Ferrara, Italy
| | - Giovanni Bisignani
- Cardiology Division, Castrovillari Hospital, ASP Cosenza, Castrovillari, Italy
| | | | | | - Carlo Lavalle
- Department of Cardiology, Policlinico Universitario Umberto I, Rome, Italy
| | | | | | - Gabriele Zanotto
- Department of Cardiology, Mater Salutis Hospital, Legnago, Verona, Italy
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15
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Rocco E, Angelini A, Simeone B, Grimaldi MC, Pinnacchio G, Narducci ML, Pelargonio G. The applications of Wearable Cardioverter Defibrillators in Heart Failure and beyond. Clin Ter 2023; 174:85-92. [PMID: 36655650 DOI: 10.7417/ct.2023.2502] [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] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Abstract Wearable cardioverter defibrillator has revealed a crucial device both in patients with a clear indication of ICD implantation but with temporary contraindications or in expectation of a diagnosis, considering that its use should be individualized.
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Affiliation(s)
- E Rocco
- Department of Medico-Surgical Sciences and Biotechnologies, Cardiology Unit, ICOT Hospital, Sapienza University of Rome, Latina, Italy
| | - A Angelini
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - B Simeone
- Department of Medico-Surgical Sciences and Biotechnologies, Cardiology Unit, ICOT Hospital, Sapienza University of Rome, Latina, Italy
| | - M C Grimaldi
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - G Pinnacchio
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - M L Narducci
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - G Pelargonio
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy
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16
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Cellini F, Narducci ML, Pavone C, Bencardino G, Perna F, Pinnacchio G, Chiesa S, Massaccesi M, Gambacorta MA, Manfrida S, Longo S, Mannocci A, Di Gregorio G, Boldrini L, Tagliaferri L, Indovina L, Placidi L, Stimato G, Spera FR, Scacciavillani R, Crea F, Valentini V, Pelargonio G. Ventricular tachycardia ablation through radiation therapy (VT-ART) consortium: Concept description of an observational multicentric trial via matched pair analysis. Front Cardiovasc Med 2023; 10:1020966. [PMID: 36923954 PMCID: PMC10008881 DOI: 10.3389/fcvm.2023.1020966] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/13/2023] [Indexed: 03/01/2023] Open
Abstract
Introduction Monomorphic ventricular tachycardia (VT) is a life-threatening condition often observed in patients with structural heart disease. Ventricular tachycardia ablation through radiation therapy (VT-ART) for sustained monomorphic ventricular tachycardia seems promising, effective, and safe. VT-ART delivers focused, high-dose radiation, usually in a single fraction of 25 Gy, allowing ablation of VT by inducing myocardial scars. The procedure is fully non-invasive; therefore, it can be easily performed in patients with contraindications to invasive ablation procedures. Definitive data are lacking, and no direct comparison with standard procedures is available. Discussion The aim of this multicenter observational study is to evaluate the efficacy and safety of VT-ART, comparing the clinical outcome of patients undergone to VT-ART to patients not having received such a procedure. The two groups will not be collected by direct, prospective accrual to avoid randomization among the innovative and traditional arm: A retrospective selection through matched pair analysis will collect patients presenting features similar to the ones undergone VT-ART within the consortium (in each center independently). Our trial will enroll patients with optimized medical therapy in whom endocardial and/or epicardial radiofrequency ablation (RFA), the gold standard for VT ablation, is either unfeasible or fails to control VT recurrence. Our primary outcome is investigating the difference in overall cardiovascular survival among the group undergoing VT-ART and the one not exposed to the innovative procedure. The secondary outcome is evaluating the difference in ventricular event-free survival after the last procedure (i.e., last RFA vs. VT-ART) between the two groups. An additional secondary aim is to evaluate the reduction in the number of VT episodes comparing the 3 months before the procedure to the ones recorded at 6 months (from the 4th to 6th month) following VT-ART and RFA, respectively. Other secondary objectives include identifying the benefits of VT-ART on cardiac function, as evaluated through an electrocardiogram, echocardiographic, biochemical variables, and on patient quality of life. We calculated the sample size (in a 2:1 ratio) upon enrolling 149 patients: 100 in the non-exposed control group and 49 in the VT-ART group. Progressively, on a multicentric basis supervised by the promoting center in the VT-ART consortium, for each VT-ART patient enrollment, a matched pair patient profile according to the predefined features will be shared with the consortium to enroll a patient that has not undergone VT-ART. Conclusion Our trial will provide insight into the efficacy and safety of VT-ART through a matched pair analysis, via an observational, multicentric study of two groups of patients with or without VT-ART in the multicentric consortium (with subgroup stratification into dynamic cohorts).
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Affiliation(s)
- Francesco Cellini
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Lucia Narducci
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Chiara Pavone
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gianluigi Bencardino
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Perna
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gaetano Pinnacchio
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Silvia Chiesa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mariangela Massaccesi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Stefania Manfrida
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Silvia Longo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alice Mannocci
- Faculty of Economics, Universitas Mercatorum, Rome, Italy
| | - Giuseppe Di Gregorio
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Indovina
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lorenzo Placidi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gerardina Stimato
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Raffaele Spera
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Scacciavillani
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Istituto di Cardiologia, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gemma Pelargonio
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Flore F, Narducci ML, Niccoli G, Ballacci F, Giordano F, Perna F, Bencardino G, Montone RA, Pelargonio G, Crea F. 578 LONG-TERM OUTCOME OF VENTRICULAR TACHYCARDIA CATHETER ABLATION IN PATIENTS WITH CHRONIC CORONARY TOTAL OCCLUSION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.045] [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: 12/23/2022]
Abstract
Abstract
Background
Chronic coronary total occlusions (CTO) are considered an emerging predictor of ventricular arrhythmias (VAs) but currently there are only few data on arrhythmic outcomes in patients affected by CTO undergoing radiofrequency catheter ablation of VAs.
Objective
This study sought to evaluate the impact of unrevascularized CTO on the recurrence of VAs after catheter ablation.
Methods
This was a single-center retrospective study that enrolled 120 patients, between 2015 and 2020. All patients were admitted for ventricular tachycardia (VT) or high premature ventricular contractions (PVCs) burden (>25% detected by Holter ECG), without evidence of acute coronary syndrome; they underwent coronary angiography, electrophysiology (EP) study and three-dimensional electroanatomic mapping (3D-EAM) followed by VAs ablation.
Results
Twenty-eight patients (23%) of 120 patients showed CTO at coronary angiography. At baseline, CTO group presented with higher prevalence of hypertension, chronic renal disease, systolic ventricular dysfunction, secondary prevention ICD implantation, higher rate of low abnormal activities by 3D-EAM compared to the non-CTO group. At a median follow-up of 15 months (range 1-96 months) after catheter ablation, the only independent predictor of VAs recurrence was the presence of moderate to severe left ventricular (LV) dysfunction (p=0.02).
Conclusion
The presence of CTO does not predict VAs recurrence after catheter ablation which is instead predicted by LV dysfunction.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Filippo Crea
- Fondazione Policlinico Universitario Agostino Gemelli
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Giordano F, Telesca A, Ballacci F, Flore F, Scacciavillani R, Bencardino G, Perna F, Pinnacchio G, Spera FR, Pelargonio G, Antonio Montone R, Niccoli G, Crea F, Lucia Narducci M. 610 EMERGING TRIGGERS OF ARRHYTHMIC EVENTS IN REMOTE MONITORED PATIENTS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.086] [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: 12/23/2022]
Abstract
Abstract
Background and aims
Worldwide, air pollution is the fourth leading cause of death. Both brief and long-term exposures to air pollution have been associated with marked increases in cardiovascular-related morbidity and mortality. Previous studies have focused on the short-term influence of particulate pollutants on ventricular arrhythmia (VA) development, primarily expressed as 24-hour Holter ECG monitoring arrhythmic burden or as presentation as life-threatening ventricular arrhythmias. The aim of our study was to investigate the association between air pollutant exposure and VA burden in remotely-monitored patients.
Methods
We enrolled retrospectively 86 patients carriers of implantable cardioverter-defibrillators (ICD), loop recorders (ILR) or pacemaker devices with remote monitoring via CarelinkTM Medtronic or Merlin.netTM PCN Abbott softwares. Intracavitary and ILR tracings were reviewed by EP personnel at our centre to define VA burden and the number of appropriate shocks and ATPs occurred in 2021. Demographic and clinical characteristics (e.g. cardiovascular history, ejection fraction, smoking, antiarrhythmic drugs (AADs)) were collected through telephone interviews. Each patient's residential and working address were used to obtain information on pollutant exposure in the years 2017-2021 in terms of annual mean concentrations of PM10, PM2.5, ozone, sulfur dioxide, carbon dioxide, carbon monoxide and benzene, as determined by European Environmental Agency air quality reports. The primary endpoint was a composite of ventricular fibrillation, sustained and nonsustained ventricular tachycardia, appropriate ATP or shocks in patients with various levels of air pollutants exposure.
Results
Of 86 patients (58 male, mean age 63.2±18.7 years) enrolled in this study, 44 (51.6%) had received an ICD, 32 of whom (37.2%) with a primary prevention indication. 31 patients (36.1%) had been receiving at least one AAD. History of coronary artery disease (CAD) was present in one third of the study population and baseline mean EF was 49.8±13.8%. VA events occurred in 17 patients (19.8%), all with a significantly lower baseline EF (40.3±12.2% vs 51.5±13.5% p=0.005). Average mean values of benzene concentration in the previous 4 years were significantly higher in patients suffering from a VA event (1.64±0.82 μg/m3 vs 1.12±0.48 μg/m3, p=0.001), as were PM2.5 values (11.64±1.98 vs 10.74±1.28 μg/m3, p=0.023). A weak but positive correlation was found between median PM2.5 concentration, benzene and VAs (p=0.023, p=0.001 respectively). A multivariate regression model was built, including long-term exposure to benzene and PM2.5 and baseline EF, and it would explain 29.8% of the variance in VAs, correctly classifying 78.1% of cases.
Conclusions
This study was the first to evaluate the relationship between long-term exposure to a wide array of air pollutants and VAs in a European population. In our sample, we found a weak but significant correlation between a higher chronic exposure to benzene and recorded VA events. Possible mechanisms may include oxidative stress and a direct, nonspecific membrane action due to benzene lipophilic properties. Hence, we highlighted the possible role of outdoor benzene exposure in ventricular arrhythmogenesis for the first time, a finding that requires validation through subsequent studies aimed at elucidating the role of air pollution as a ubiquitous, potentially modifiable, population-based risk factor.
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Affiliation(s)
- Federica Giordano
- Dipartimento Di Scienze Cardiovascolari E Pneumologiche - Università Cattolica Del Sacro Cuore
| | - Alessandro Telesca
- Dipartimento Di Scienze Cardiovascolari E Pneumologiche - Università Cattolica Del Sacro Cuore
| | - Federico Ballacci
- Dipartimento Di Scienze Cardiovascolari E Pneumologiche - Università Cattolica Del Sacro Cuore
| | - Francesco Flore
- Dipartimento Di Scienze Cardiovascolari E Pneumologiche - Università Cattolica Del Sacro Cuore
| | - Roberto Scacciavillani
- Dipartimento Di Scienze Cardiovascolari E Pneumologiche - Università Cattolica Del Sacro Cuore
| | - Gianluigi Bencardino
- Dipartimento Di Scienze Cardiovascolari E Pneumologiche - Fondazione Policlinico Universitario A. Gemelli Irccs
| | - Francesco Perna
- Dipartimento Di Scienze Cardiovascolari E Pneumologiche - Fondazione Policlinico Universitario A. Gemelli Irccs
| | - Gaetano Pinnacchio
- Dipartimento Di Scienze Cardiovascolari E Pneumologiche - Fondazione Policlinico Universitario A. Gemelli Irccs
| | - Francesco Raffaele Spera
- Dipartimento Di Scienze Cardiovascolari E Pneumologiche - Fondazione Policlinico Universitario A. Gemelli Irccs
| | - Gemma Pelargonio
- Dipartimento Di Scienze Cardiovascolari E Pneumologiche - Fondazione Policlinico Universitario A. Gemelli Irccs
| | - Rocco Antonio Montone
- Dipartimento Di Scienze Cardiovascolari E Pneumologiche - Fondazione Policlinico Universitario A. Gemelli Irccs
| | | | - Filippo Crea
- Dipartimento Di Scienze Cardiovascolari E Pneumologiche - Università Cattolica Del Sacro Cuore
- Dipartimento Di Scienze Cardiovascolari E Pneumologiche - Fondazione Policlinico Universitario A. Gemelli Irccs
| | - Maria Lucia Narducci
- Dipartimento Di Scienze Cardiovascolari E Pneumologiche - Fondazione Policlinico Universitario A. Gemelli Irccs
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La Rosa G, Pelargonio G, Narducci ML, Pinnacchio G, Bencardino G, Perna F, Follesa F, Galiuto L, Crea F. Prognostic value of the Tpeak-Tend interval for in-hospital subacute ventricular arrhythmias in tako-tsubo syndrome. Rev Esp Cardiol (Engl Ed) 2022; 76:353-361. [PMID: 36493957 DOI: 10.1016/j.rec.2022.12.001] [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] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND OBJECTIVES The clinical value of electrocardiogram (ECG) repolarization parameters associated with ventricular arrhythmias (VAs) in tako-tsubo syndrome is still under debate. We aimed to evaluate ECG predictors of subacute VAs, defined as those occurring after the first 48hours from admission. METHODS This single-center observational study enrolled patients admitted to the cardiology department between 2012 and 2018 with a confirmed diagnosis of tako-tsubo syndrome. Data collection included a 12-lead ECG on admission and at 48hours, continuous telemetry monitoring, blood testing, transthoracic echocardiography, and coronary angiography during hospitalization. VAs events were defined as: premature ventricular contractions ≥ 2000 within a 24-hour window of telemetry monitoring, ventricular fibrillation, sustained ventricular tachycardia (VT), polymorphic VT, and non-sustained VT. RESULTS A total of 87 patients (age 72±12 years) were enrolled. During a median of 8 days of hospitalization, subacute VAs were documented in 22 patients (25%) after a median of 91hours from admission. Subacute VAs were associated with an increase in mortality during hospitalization (P=.030). The corrected global (mean of the 12-lead ECG values) Tpeak-Tend interval at 48hours from admission was an independent predictor of subacute VAs and was statistically superior to the standard corrected QT interval (Z test, P=.040). A cut-off of 108 msec for the corrected global Tpeak-Tend yielded a 71% sensitivity and 72% specificity for subacute VAs. CONCLUSIONS In patients with tako-tsubo syndrome, subacute VAs are associated with repolarization alterations that can be identified on conventional ECG using the Tpeak-Tend interval.
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Affiliation(s)
- Giulio La Rosa
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Gemma Pelargonio
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Maria Lucia Narducci
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.
| | - Gaetano Pinnacchio
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Gianluigi Bencardino
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Francesco Perna
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Federico Follesa
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Leonarda Galiuto
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Filippo Crea
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy
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20
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Spera F, Narducci ML, Bencardino G, Perna F, Bisignani A, Pinnacchio G, Tondo C, Maggio R, Stabile G, Iacopino S, Tundo F, Ferraro A, De Simone A, Malacrida M, Pintus F, Crea F, Pelargonio G. Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation. Front Cardiovasc Med 2022; 9:985182. [DOI: 10.3389/fcvm.2022.985182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/14/2022] [Indexed: 11/10/2022] Open
Abstract
IntroductionUnrecognized incomplete pulmonary vein (PV) isolation during the index procedure, can be a major cause of clinical recurrences of atrial fibrillation (AF) after cryoballoon (CB) ablation. We aimed to characterize the extension of the lesions produced by CB ablation and to assess the value of using an ultra-high resolution electroanatomic mapping (UHDM) system to detect incomplete CB lesions.Materials and methodsTwenty-nine consecutive patients from the CHARISMA registry undergoing AF ablation at four Italian centers were prospectively evaluated. The Rhythmia™ mapping system and the Orion™ (Boston Scientific) mapping catheter were used to systematically map the left atrium and PVs before and after cryoablation.ResultsA total of 116 PVs were targeted and isolated. Quantitative assessment of the lesions revealed a significant reduction of the antral surface area of the PV, resulting in an ablated area of 5.7 ± 0.7 cm2 and 5.1 ± 0.8 cm2 for the left PV pair and right PV pair, respectively (p = 0.0068). The mean posterior wall (PW) area was 22.9 ± 2 cm2 and, following PV isolation, 44.8 ± 6% of the PW area was ablated. After CB ablation, complete isolation of each PV was documented by the POLARMap™ catheter in all patients. By contrast, confirmatory UHDM and the Lumipoint™ tool unveiled PV signals in 1 out of 114 of the PVs (0.9%). Over 30-day follow-up, no major procedure-related adverse events were reported. After a mean follow-up of 333 days, 89.7% of patients were free from arrhythmia recurrence.ConclusionThe lesion extension achieved by the new CB ablation system involved the PV antrum, with less than 50% of the PW remaining untouched. The new system, with short tip and circular mapping catheter, failed to achieve PV isolation in only 0.9% of all PVs treated.Clinical trial registration[http://clinicaltrials.gov/], identifier [NCT03793998].
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21
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Casella M, Gasperetti A, Compagnucci P, Narducci ML, Pelargonio G, Catto V, Carbucicchio C, Bencardino G, Conte E, Schicchi N, Andreini D, Pontone G, Giovagnoni A, Rizzo S, Inzani F, Basso C, Natale A, Tondo C, Russo AD, Crea F. Different Phases of Disease in Lymphocytic Myocarditis: Clinical and Electrophysiological Characteristics. JACC Clin Electrophysiol 2022; 9:314-326. [PMID: 36752480 DOI: 10.1016/j.jacep.2022.10.004] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/20/2022] [Accepted: 10/03/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Endomyocardial biopsy (EMB) is required to make a definite diagnosis of lymphocytic myocarditis (LM), to identify its etiology, and to classify LM into different phases. OBJECTIVES This study aims to characterize and compare clinical and electrophysiological characteristics of different biopsy-proven LM phases, namely acute myocarditis (AM), chronic active myocarditis (CAM), and healed myocarditis (HM). METHODS All patients with a diagnosis of LM at 3 Italian referral centers were prospectively enrolled. According to EMB findings, LM was classified as AM, CAM, or HM; per-group comparisons of clinical presentations, noninvasive, and invasive findings are reported. RESULTS Among the 122 enrolled patients (AM, n = 44; CAM, n = 42; HM, n = 36), complex ventricular arrhythmias were very common overall (n = 109, 89%), but ventricular fibrillation was slightly more prevalent in AM (P = 0.028). Cardiac magnetic resonance imaging showed late gadolinium enhancement in more patients with HM and CAM than AM (94.4% vs 92.9% vs 50%; P < 0.001), whereas edema was more common in AM than in CAM, being absent in HM (90.9% vs 50% vs 0%; P < 0.001). Accordingly, edema was the strongest independent clinical predictor of EMB-proven active inflammation. Electroanatomical mapping revealed a lower prevalence of low-voltage areas in AM than in CAM or HM. We observed a strong association between edema at a specific myocardial segment and normal voltages at that site (odds ratio: 0.24; 95% CI: 0.10-0.54; P < 0.01), as well as between late gadolinium enhancement and low-voltage areas (odds ratio: 2.86; 95% CI: 1.19-6.97; P = 0.019). CONCLUSIONS LM is a highly heterogeneous disease, and its different phases are characterized by diverse clinical, morphological, and electrophysiological features. Further research is required to identify electroanatomical markers of inflammation.
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Affiliation(s)
- Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti," Ancona, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Alessio Gasperetti
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti," Ancona, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy.
| | - Maria Lucia Narducci
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Gemma Pelargonio
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Valentina Catto
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Corrado Carbucicchio
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluigi Bencardino
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Edoardo Conte
- Cardiovascular Computed Tomography and Radiology Unit, Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Nicolò Schicchi
- Department of Radiology, University Hospital "Umberto I-Lancisi-Salesi," Ancona, Italy
| | - Daniele Andreini
- Cardiovascular Computed Tomography and Radiology Unit, Centro Cardiologico Monzino IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Cardiovascular Computed Tomography and Radiology Unit, Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy; Department of Radiology, University Hospital "Umberto I-Lancisi-Salesi," Ancona, Italy
| | - Stefania Rizzo
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedaliera-University of Padua, Padova, Italy
| | - Frediano Inzani
- Department of Woman, Child and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedaliera-University of Padua, Padova, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Claudio Tondo
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti," Ancona, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
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Montone RA, Rinaldi R, Del Buono MG, Gurgoglione F, La Vecchia G, Russo M, Caffè A, Burzotta F, Leone AM, Romagnoli E, Sanna T, Pelargonio G, Trani C, Lanza GA, Niccoli G, Crea F. Safety and prognostic relevance of acetylcholine testing in patients with stable myocardial ischaemia or myocardial infarction and non-obstructive coronary arteries. EUROINTERVENTION 2022; 18:e666-e676. [PMID: 35377315 PMCID: PMC10241282 DOI: 10.4244/eij-d-21-00971] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 11/08/2021] [Accepted: 02/07/2022] [Indexed: 07/25/2023]
Abstract
BACKGROUND Intracoronary provocation testing with acetylcholine (ACh) is crucial for the diagnosis of functional coronary alterations in patients with suspected myocardial ischaemia and non-obstructive coronary arteries. AIMS Our intention was to assess the safety and predictive value for major adverse cardiovascular and cerebrovascular events (MACCE) in patients presenting with ischaemia with non-obstructive coronary arteries (INOCA) or with myocardial infarction with non-obstructive coronary arteries (MINOCA). METHODS We prospectively enrolled consecutive INOCA or MINOCA patients undergoing intracoronary ACh provocation testing. RESULTS A total of 317 patients were enrolled: 174 (54.9%) with INOCA and 143 (45.1%) with MINOCA. Of these, 185 patients (58.4%) had a positive response to the ACh test. Complications during ACh provocative testing were all mild and transient and occurred in 29 (9.1%) patients, with no difference between patients with positive or negative responses to ACh testing, nor between INOCA and MINOCA patients. A history of paroxysmal atrial fibrillation, moderate/severe diastolic dysfunction and a higher QT dispersion at baseline electrocardiogram were independent predictors of complications. MACCE occurred in 30 patients (9.5%) during a median follow-up of 22 months. The incidence of MACCE was higher among patients with a positive ACh test (24 [13.0%] vs 6 [4.5%], p=0.017), and a positive ACh test was an independent predictor of MACCE. CONCLUSIONS ACh provocation testing is associated with a low risk of mild and transient complications, with a similar prevalence in both INOCA and MINOCA patients. Importantly, ACh provocation testing can help to identify patients at higher risk of future clinical events, suggesting a net clinical benefit derived from its use in this clinical setting.
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Affiliation(s)
- Rocco Antonio Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Rinaldi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Rome, Italy
| | - Marco Giuseppe Del Buono
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Rome, Italy
| | - Filippo Gurgoglione
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Rome, Italy
| | - Giulia La Vecchia
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Rome, Italy
| | - Michele Russo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Rome, Italy
| | - Andrea Caffè
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Maria Leone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Tommaso Sanna
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Rome, Italy
| | - Gaetano Antonio Lanza
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Rome, Italy
| | - Giampaolo Niccoli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Rome, Italy
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23
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Santurri M, Bonga J, Schmid M, Cauti FM, Solimene F, Polselli M, Bura M, Piccolo F, Malacrida M, Pelargonio G, Spera FR, Bianchi S, Rossi P. Automated conduction velocity estimation based on isochronal activation of heart chambers. J Interv Card Electrophysiol 2022; 66:647-660. [PMID: 36178554 PMCID: PMC10066170 DOI: 10.1007/s10840-022-01339-1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/09/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Spatial differences in conduction velocity (CV) are critical for cardiac arrhythmias induction. We propose a method for an automated CV calculation to identify areas of slower conduction during cardiac arrhythmias and sinus rhythm. METHODS Color-coded representations of the isochronal activation map using data coming from the RHYTHMIA™ Mapping System were reproduced by applying a temporal isochronal window at 20 ms. Geodesic distances of the 3D mesh were calculated using an algorithm selecting the minimum distance pathway (MDP). The CV estimation was performed considering points on the boundary of two spatially and temporally adjacent isochrones. For each of the boundary points of a given isochrone, the nearest boundary point of the consecutive isochrone was chosen, the MDP was evaluated, and a map of CV was created. The proposed method has been applied to a population of 29 patients. RESULTS In all cases of perimitral atrial flutter (16 pts out of 29 (55%)), areas with significantly low CV (< 30 cm/s) were found. Half of the cases present regions with low CV located in the anterior wall. No case with low CV at the so-called LA isthmus was observed. Right atrial maps during common atrial flutters showed low CV areas mainly located in the inferior inter-atrial septum. No areas of low CV were observed in subjects without a history of atrial arrhythmia while pts affected by paroxysmal AF showed areas with a limited extension of low CV. CONCLUSIONS The proposed software for automated CV estimation allows the identification of low CV areas, potentially helping electrophysiologists to plan the ablation strategy.
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Affiliation(s)
- Michela Santurri
- BioLab3, Biomedical Engineering Laboratory, Roma Tre University, Rome, Italy
| | - Jennifer Bonga
- BioLab3, Biomedical Engineering Laboratory, Roma Tre University, Rome, Italy
| | - Maurizio Schmid
- BioLab3, Biomedical Engineering Laboratory, Roma Tre University, Rome, Italy
| | - Filippo Maria Cauti
- Arrhythmology Unit, Hospital Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy
| | - Francesco Solimene
- Electrophysiology Unit, Clinica Montevergine, Mercogliano, Avellino, Italy
| | - Marco Polselli
- Arrhythmology Unit, Hospital Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy
| | | | | | | | - Gemma Pelargonio
- Cardiovascular Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Raffaele Spera
- Cardiovascular Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Stefano Bianchi
- Arrhythmology Unit, Hospital Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy
| | - Pietro Rossi
- Arrhythmology Unit, Hospital Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy.
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24
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Pinnacchio G, Ruscio E, Rocco E, Trani C, Burzotta F, Aurigemma C, Romagnoli E, Scacciavillani R, Narducci ML, Bencardino G, Perna F, Spera FR, Comerci G, Bisignani A, Pelargonio G. Short-Term Atrioventricular Dysfunction Recovery after Post-TAVI Pacemaker Implantation. J Cardiovasc Dev Dis 2022; 9:jcdd9100324. [PMID: 36286276 PMCID: PMC9604573 DOI: 10.3390/jcdd9100324] [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: 08/25/2022] [Revised: 09/04/2022] [Accepted: 09/09/2022] [Indexed: 11/24/2022] Open
Abstract
Permanent pacemaker implantation (PPI) represents a frequent complication after transcatheter aortic valve implantation (TAVI) due to atrio-ventricular (AV) node injury. Predictors of early AV function recovery were investigated. We analyzed 50 consecutive patients (82 ± 6 years, 58% males, EuroSCORE: 7.8 ± 3.3%, STS mortality score: 5 ± 2.8%). Pacemaker interrogations within 4−6 weeks from PPI were performed to collect data on AV conduction. The most common indication of PPI was persistent third-degree (44%)/high-degree (20%) AV block/atrial fibrillation (AF) with slow ventricular conduction (16%) after TAVI. At follow-up, 13 patients (26%) recovered AV conduction (i.e., sinus rhythm with stable 1:1 AV conduction/AF with a mean ventricular response >50 bpm, associated with a long-term ventricular pacing percentage < 5%). At multivariate analysis, complete atrio-ventricular block independently predicted pacemaker dependency at follow-up (p = 0.019). Patients with persistent AV dysfunction showed a significant AV conduction time prolongation after TAVI (PR interval from 207 ± 50 to 230 ± 51, p = 0.02; QRS interval from 124 ± 23 to 147 ± 16, p < 0.01) compared to patients with recovery, in whom AV conduction parameters remained unchanged. Several patients receiving PPI after TAVI have recovery of AV conduction within a few weeks. Longer observation periods prior to PPI might be justified, and algorithms to minimize ventricular pacing should be utilized whenever possible.
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Affiliation(s)
- Gaetano Pinnacchio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Correspondence:
| | - Eleonora Ruscio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Erica Rocco
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Cardiology Institute, Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Cardiology Institute, Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Roberto Scacciavillani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Maria Lucia Narducci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Gianluigi Bencardino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Francesco Perna
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Francesco Raffaele Spera
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Gianluca Comerci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Antonio Bisignani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Cardiology Institute, Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
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25
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Narducci ML, Scacciavillani R, Pelargonio G, Borro L, Secinaro A. Combining 3-Dimensional Electroanatomic Mapping and Cardiac Magnetic Resonance. JACC Case Rep 2022; 4:1200-1202. [PMID: 36213886 PMCID: PMC9537100 DOI: 10.1016/j.jaccas.2022.07.021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/07/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022]
Abstract
We present the case of a 17-year-old asymptomatic boy with a diagnosis of arrhythmogenic cardiomyopathy. Merging of cardiac magnetic resonance imaging and three-dimensional electroanatomic mapping provided striking visualization of the association between structural and electrical alterations and guided the decision to implant an implantable cardioverter defibrillator. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Maria Lucia Narducci
- Cardiovascular Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Address for correspondence: Dr Maria Lucia Narducci, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, Largo Agostino Gemelli, 8 Rome 00168, Italy.
| | - Roberto Scacciavillani
- Cardiovascular Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gemma Pelargonio
- Cardiovascular Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Borro
- Advanced Cardiothoracic Imaging Unit, Department of Imaging, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Department of Imaging, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
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26
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Pelargonio G, Scacciavillani R, Donisi L, Narducci ML, Aurigemma C, Pinnacchio G, Bencardino G, Perna F, Spera FR, Comerci G, Ruscio E, Romagnoli E, Crea F, Burzotta F, Trani C. Atrioventricular conduction in PM recipients after transcatheter aortic valve implantation: Implications using Wenckebach point measurement. Front Cardiovasc Med 2022; 9:904828. [PMID: 35935649 PMCID: PMC9353552 DOI: 10.3389/fcvm.2022.904828] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Atrioventricular (AV) conduction disturbances requiring permanent pacemaker implantation (PPI) are a common complication after transcatheter aortic valve implantation (TAVI). However, a significant proportion of patients might recover AV conduction at follow-up. Objectives The aim of our study was to evaluate the recovery of AV conduction by determination through Wenckebach point in patients with PPI and therefore identify patients who could benefit from device reprogramming to avoid unnecessary RV pacing. Methods We enrolled 43 patients that underwent PM implantation after TAVI at our Department from January 2018 to January 2021. PM interrogation was performed at follow-up and patients with native spontaneous rhythm were further assessed for AV conduction through WP determination. Results A total of 43 patients requiring a PM represented the final study population, divided in patients with severely impaired AV conduction (no spontaneous valid rhythm or WP < 100; 26) and patients with valid AV conduction (WP ≥ 100; 17). In the first group patients had a significantly higher number of intraprocedural atrioventricular block (AVB) (20 vs. 1, p < 0.005), showed a significant higher implantation depth in LVOT (7.7 ± 2.2 vs. 4.4 ± 1.1, p < 0.05) and lower ΔMSID (−0.28 ± 3 vs. −3.94 ± 2, p < 0.05). Conclusion AV conduction may recover in a significant proportion of patients. In our study, valve implantation depth in the LVOT and intraprocedural AV block are associated with severely impaired AV conduction. Regular PM interrogation and reprogramming are required to avoid unnecessary permanent right ventricular stimulation in patients with AV conduction recovery.
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Affiliation(s)
- Gemma Pelargonio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Roberto Scacciavillani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- *Correspondence: Roberto Scacciavillani,
| | - Luca Donisi
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Lucia Narducci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gaetano Pinnacchio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gianluigi Bencardino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Perna
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Raffaele Spera
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gianluca Comerci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Eleonora Ruscio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
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27
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Pavone C, Scacciavillani R, Narducci ML, Cellini F, Pelargonio G, Bencardino G, Perna F, Spera F, Pinnacchio G, Sanna T, Valentini V, Crea F. Successful ventricular tachycardia radioablation in a patient with previous chemical pleurodesis: A case report. Front Cardiovasc Med 2022; 9:937090. [PMID: 35924213 PMCID: PMC9339650 DOI: 10.3389/fcvm.2022.937090] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Stereotactic arrhythmia radioablation (STAR) is a novel technique for the ablation of ventricular tachycardia in patients with contraindications to standard procedures, i.e., radiofrequency ablation. Case presentation We report the case of a 73-year-old man with non-ischemic dilated cardiomyopathy and recurrent VT episodes. Electroanatomic mapping showed VT prevalently of epicardial origin, but direct epicardial access through subxyphoid puncture could not be performed due to pleuropericardial adhesions from a past history of chemical pleurodesis. STAR was performed, with no VT recurrence at 6 months follow-up. Conclusions Previous experiences with STAR have demonstrated its importance in the management of patients with refractory VT in whom other ablation strategies were not successful. Our case report highlights the use of STAR as a second choice in a patient with an unfavorable VT anatomical location and technical limitations to an optimal radiofrequency ablation. Moreover, it confirms STAR's effectiveness in the ablation of complex transmural lesions, which are more often associated with non-ischemic structural heart disease.
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Affiliation(s)
- Chiara Pavone
- Department of Cardiovascular Sciences, Agostino Gemelli University Polyclinic (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
- *Correspondence: Chiara Pavone
| | - Roberto Scacciavillani
- Department of Cardiovascular Sciences, Agostino Gemelli University Polyclinic (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Maria Lucia Narducci
- Department of Cardiovascular Sciences, Agostino Gemelli University Polyclinic (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
- Maria Lucia Narducci
| | - Francesco Cellini
- Unit of Oncological Radiotherapy, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Agostino Gemelli University Polyclinic (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular Sciences, Agostino Gemelli University Polyclinic (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Gianluigi Bencardino
- Department of Cardiovascular Sciences, Agostino Gemelli University Polyclinic (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Francesco Perna
- Department of Cardiovascular Sciences, Agostino Gemelli University Polyclinic (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Francesco Spera
- Department of Cardiovascular Sciences, Agostino Gemelli University Polyclinic (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Gaetano Pinnacchio
- Department of Cardiovascular Sciences, Agostino Gemelli University Polyclinic (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Tommaso Sanna
- Department of Cardiovascular Sciences, Agostino Gemelli University Polyclinic (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Vincenzo Valentini
- Unit of Oncological Radiotherapy, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Agostino Gemelli University Polyclinic (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Agostino Gemelli University Polyclinic (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
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28
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Burzotta F, Graziani F, Trani C, Aurigemma C, Bruno P, Lombardo A, Liuzzo G, Nesta M, Lanza GA, Romagnoli E, Locorotondo G, Leone AM, Pavone N, Spalletta C, Pelargonio G, Sanna T, Aspromonte N, Cavaliere F, Crea F, Massetti M. Clinical Impact of Heart Team Decisions for Patients With Complex Valvular Heart Disease: A Large, Single-Center Experience. J Am Heart Assoc 2022; 11:e024404. [PMID: 35621200 PMCID: PMC9238748 DOI: 10.1161/jaha.121.024404] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background A multidisciplinary approach might be pivotal for the management of patients with valvular heart disease (VHD), but clinical outcome data are lacking. Methods and Results At our institution, since 2014, internal guidelines recommended heart team consultations for patients with VHD. The clinical/echocardiographic characteristics, treatment recommendations, performed treatment, and early clinical outcomes of consecutive, hospitalized patients with VHD undergoing heart team evaluation were collected. Surgical risk was prospectively assessed by the EuroSCORE II and STS‐PROM. The primary end point of the study was early mortality. A total of 1004 patients with VHD with high clinical complexity (mean age, 75 years; mean EuroSCORE II, 9.4%; mean STS‐PROM, 5.6%; 48% ischemic heart disease; 29% chronic kidney disease, 9% oncologic/hematologic diseases) were enrolled. The heart team recommended an interventional treatment for 807 (80%) patients and conservative management for 197 (20%) patients. Management crossovers occurred in only 5% of patients. The recommended intervention was cardiac surgery for 230 (23%) patients, percutaneous treatment in 516 (51%) patients, and hybrid treatment in 61 (6%) patients. Early mortality occurred in 24 patients (2.4%) and was independently predicted by aortic stenosis, left ventricular ejection fraction, pulmonary artery systolic pressure, and conservative management recommendation. In patients referred to treatment, observed early mortality (1.7%) was significantly lower (P<0.001) than expected on the bases of both the STS‐PROM (5.2%) and EuroSCORE II (9.7%). Conclusions Within the limitations of its single‐center and observational design, the present study suggests that heart team–based management of patients with complex VHD is feasible and allows referral to a wide spectrum of interventions with promising early clinical results.
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Affiliation(s)
- Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | | | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | | | - Piergiorgio Bruno
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Antonella Lombardo
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Giovanna Liuzzo
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Marialisa Nesta
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
| | - Gaetano Antonio Lanza
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Enrico Romagnoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
| | | | | | - Natalia Pavone
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | | | - Gemma Pelargonio
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Tommaso Sanna
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Nadia Aspromonte
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Franco Cavaliere
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Massimo Massetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
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29
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Mantovan R, Solimene F, Pelargonio G, Cauti F, Marinigh R, Schillaci V, Narducci ML, Rossi P, Aloia A, Di Donna P, Grifoni G, Carbone A, Maglia G, Malacrida M, Allocca G. Detectable reentrant circuits in localized microreentrant tachycardias in the era of ultra high-density mapping. Europace 2022. [DOI: 10.1093/europace/euac053.120] [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
Optimal criteria in clinical practice differentiating microreentrant atrial tachycardias (mAT) from macroreentrant atrial arrhythmias (MAT) have not yet been clarified. The use of multielectrode catheters and the recent development of ultra high-density mapping (UHDM) with automated features has improved our knowledge of mAT circuits and foci location.
Purpose
In the present study, we systematically evaluated AT mechanisms in a large consecutive cohort of patients with MAT identifying the precise mAT circuits using the Rhythmia mapping system.
Methods
Consecutive patients indicated for MAT ablation from January 2021 to November 2021 at 33 centers were prospectively included. All MATs were completely mapped in the left or right atrium by means of the Rhythmia mapping system and the 64-poles Orion basket catheter. For study purpose, a mAT was defined as an AT with slow continuous low fragmented potentials covering at least 50% of tachycardia cycle length (CL) in a small area (set as a circuit within < 1 cm2) and in a couple of closed splines of the Orion catheter and a centrifugal activation pattern to the remainder of the atria. The Lumipoint tool was systematically used to confirm EGM fragmentation inside this area. Data are reported as mean±SD.
Results
One-hundred eighty-seven MATs were analyzed: 100 (53.7%) atypical left atrial flutter, 27 (14.3%) left AT and 60 (32%) right AT. A total of 7 MAT (prevalence of 3.7%) was identified as mATs (6 atypical left atrial flutter and 1 AT), with 5 out 7 with a previous history of AF ablation procedure. The percentage of atrial surface with a voltage level below 0.1 mV was 19±17%. The CL was 329±78ms. The electrical activity spanning the whole CL was detected by 2±0.6 pairs of close bipoles of the Orion catheter, and was actually confined to a region of 0.4±0.2cm2 with continuous highly fractionated potential covering 68±10% of the CL (longest component of fractionated EGM per spline=74±18% of the CL). Voltage level was 0.3±0.1mV at RF delivery site and 0.2±0.1mV at the site of longest duration of the fragmented potential, respectively. Targeted mAT activity was identified closer to PVs in three cases and at the mid portion of the anterior wall and at the roof in two cases each, respectively. In all cases a single shot RF delivery terminated each arrhythmia at targeted location. Consolidative RF ablations were then delivered in the adjacent area. No complication occurred. At three months follow-up all patients remained free from any AT recurrence.
Conclusions
In this standard of care clinical experience with UHDM system, the prevalence of mAT seems to be higher than previously reported in literature. A technique based on mAT identification through a novel automated algorithm and matched area of electrogram fractionation captured by the Orion catheter may limit the extent of ablation needed.
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Affiliation(s)
| | | | - G Pelargonio
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - F Cauti
- San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | | | | | - ML Narducci
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - P Rossi
- San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - A Aloia
- S.Luca Vallo Lucania Hospital, Vallo Della Lucania, Italy
| | | | - G Grifoni
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Carbone
- Maria SS. Addolorata Eboli Hospital, Eboli, Italy
| | - G Maglia
- Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | | | - G Allocca
- Conegliano Hospital, Conegliano, Italy
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30
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Giaccardi M, Strisciuglio T, Turreni F, Marinigh R, Carreras G, Pelargonio G, Bisceglia C. Gender differences in arrhythmias and psychological discomfort management. Europace 2022. [DOI: 10.1093/europace/euac053.091] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Palpitations and/or syncope are common in patients with psychoneurological disorders [1]. Arrhythmias may be associated to psychological discomfort as well [2]. Psychiatrics, epidemiology and commonplace agree that gender may lead to difference in symptom perception, and management [3-4]
Purpose
To investigate the abovementioned association we realized a retrospective multicentric registry including, after definite instrumental diagnosis, patients with previous mental disorder diagnosis, referring to arrhythmology ambulatories.
Results
64 pts (48 F, 75%), mean age 54±18y, were enrolled in 7 centers. Psychiatric diagnoses were: anxiety-depression disorder (N=50), panic attack (N=5), behavioural disorder (N=4), epilepsy (N=3), psychosis (N=1), diagnosed in 83% by General Practitioners and in 14% by Psychiatrists. 55 pts (86%) were on drug therapy: benzodiazepines (67%), SSRI (22%), neuroleptics (3%), antidepressants (2%), and natural products (5%). Among these, 89% reported no symptoms relief. 57 pts complained palpitations, 17 extrasystoles and 19 reported syncope. EPS study was performed in 48%, 24 h Holter ECG in 28%, and LR implantation in 5% of patients. We diagnosed AF (N=11), typical AFL (N=4), AT (N=8), AVNRT (N=16), AVRT (N=4), PAC (N=1), PVC (N=10), AV block (N=4), VT (N=3) and unspecified SVT (N=3). 44 pts underwent ablation. 62 pts (96,8) experienced strong symptoms reduction or resolution, and 42 psychiatric drugs withdrawal. One pt underwent PMK implantation.
Conclusions
In our series of cardiac symptoms ascribed to psychiatric disorders, women markedly prevailed. Psychologic discomfort could be caused by arrhythmias, as resolved or dramatically ameliorated by diagnosis and treatment. Further investigation in Psychiatric context is warranted.
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Affiliation(s)
- M Giaccardi
- Santa Maria Annunziata Hospital, Florence, Italy
| | - T Strisciuglio
- Federico II University Hospital, Cardiology, Naples, Italy
| | | | - R Marinigh
- Conegliano General Hospital, Conegliano, Italy
| | | | - G Pelargonio
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
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31
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Battaglia A, Calvanese R, Pandozi C, Tola G, Solimene F, Rossi L, Cauti F, Pedretti S, Mantovan R, Pelargonio G, Castro A, Gagliardi M, Izzo G, Malacrida M, Scaglione M. Ventricular tachycardia channels ablation incorporating automated high-density mapping guidance: data from the CHARISMA registry. Europace 2022. [DOI: 10.1093/europace/euac053.358] [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] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Ventricular tachycardia (VT) ablation targeting conducting channels (CC)s based on timing of late potentials (LPs) during sinus rhythm (dechanneling) may facilitate a scar homogenization strategy without the need for extensive ablation and possibly lead to higher successful rate.
Purpose
We evaluated the feasibility and safety of a CC identification and ablation approach by means of an ultra-high density mapping system with a novel automated algorithm in ischemic VT procedures.
Methods
Consecutive patients indicated for ischemic VT ablation were prospectively included. A complete map of the left ventricle was performed prior and after ablation through the Rhythmia mapping system. Channels were defined as any signal activity bounded by anatomic and functional barriers and characterized through the Lumipoint (LM) tool and continuous activation was used on the whole ventricular substrate. Procedural end point was the elimination of all identified CCs by ablation at the CC entrance and exit followed by abolition of any residual LPs inside the CC. The ablation endpoint was noninducibility. Data are reported as mean±SD.
Results
A total of 36 channels were identified through LM from 28 patients (1.2±0.5 per patient): 21 (75%) patients had 1 CC, 6 (21.4%) had 2 CCs and 1 (3.6%) had 3 CCs. LPs were identified inside CCs in 19 cases (67.9%). In 8 cases (28.6%) LPs were present both inside and outside and in 1 (3.6%) case LPs were present only outside the CC. LPs inside channels covered an area of 7.6±5 mm2 with a ratio between LPs area and CCs’ area of 67.4±31.8%. In 12 (43%) cases LPs area covered more than 90% of the CCs’ area. At voltage map analysis a total of 34 CC were identified: 1 CC was present in 75% of the cases, 2 CCs in 17.9% and 3 CCs in 3.6%. LPs were identified only inside CCs in 46.4% of the cases, both inside and outside in 42.9% and only outside in 10.7%. Healthy tissue (voltage level≥0.5mV) was prevalent (68.2±17%), followed by intermediate voltage areas (0.5-0.05 mV; 31.1±17%) and very low voltage areas (<0.05mV; 0.7±1%). LPs were found mostly at intermediate voltage areas (57.0±34% of the covered area; 39.1±33% at healthy tissue and 3.4±13% at very low voltage areas). LM was more accurate than traditional voltage mapping in identifying CCs: in 6 (21.4%) cases voltage map overestimated LPs areas, in 2 (7.1%) cases failed to fully identify LPs and only in 19 out 28 (67.8%) LM and voltage map had a complete agreement. All CCs’ entrance and exit were successfully ablated and abolition of any residual LPs inside the CC was achieved in all patients. No complication occurred. Noninducibility was achieved in all (100%) the cases.
Conclusions
In this experience, a channel identification approach through the advanced Lumipoint tool was more accurate than traditional voltage mapping and seems to be safe, feasible, and effective at least in the acute setting of ischemic VT ablation.
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Affiliation(s)
| | | | - C Pandozi
- San Filippo Neri Hospital, Rome, Italy
| | - G Tola
- AO Brotzu Hospital, Cagliari, Italy
| | | | - L Rossi
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - F Cauti
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | | | | | - G Pelargonio
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - A Castro
- Sandro Pertini Hospital, Rome, Italy
| | | | - G Izzo
- Ospedale Del Mare, Naples, Italy
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Zito A, Princi G, Lombardi M, D'Amario D, Vergallo R, Aurigemma C, Romagnoli E, Pelargonio G, Bruno P, Trani C, Burzotta F, Crea F. Long-term clinical impact of permanent pacemaker implantation in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis. Europace 2022; 24:1127-1136. [PMID: 35138367 PMCID: PMC9460982 DOI: 10.1093/europace/euac008] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [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: 10/23/2021] [Accepted: 01/27/2022] [Indexed: 11/12/2022] Open
Abstract
Aims The aims of this study is to assess by an updated meta-analysis the clinical outcomes related to permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) at long-term (≥12 months) follow-up (LTF). Methods and results A comprehensive literature research was performed on PubMed and EMBASE. The primary endpoint was all-cause death. Secondary endpoints were rehospitalization for heart failure, stroke, and myocardial infarction. A subgroup analysis was performed according to the Society of Thoracic Surgeon—Predicted Risk of Mortality (STS-PROM) score. This study is registered with PROSPERO (CRD42021243301). A total of 51 069 patients undergoing TAVI from 31 observational studies were included. The mean duration of follow-up was 22 months. At LTF, PPI post-TAVI was associated with a higher risk of all-cause death [risk ratio (RR) 1.18, 95% confidence interval (CI) 1.10–1.25; P < 0.001] and rehospitalization for heart failure (RR 1.32, 95% CI 1.13–1.52; P < 0.001). In contrast, the risks of stroke and myocardial infarction were not affected. Among the 20 studies that reported procedural risk, the association between PPI and all-cause death risk at LTF was statistically significant only in studies enrolling patients with high STS-PROM score (RR 1.25, 95% CI 1.12–1.40), although there was a similar tendency of the results in those at medium and low risk. Conclusion Patients necessitating PPI after TAVI have a higher long-term risk of all-cause death and rehospitalization for heart failure as compared to those who do not receive PPI.
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Affiliation(s)
- Andrea Zito
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
| | - Giuseppe Princi
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
| | - Marco Lombardi
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Zito A, Princi G, Lombardi M, Mario DD, Vergallo R, Aurigemma C, Romagnoli E, Pelargonio G, Bruno P, Trani C, Burzotta F, Crea F. 628 Long-term clinical impact of permanent pacemaker implantation in patients undergoing transcatheter aortic valve intervention: a systematic review and meta-analysis. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.057] [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
Aims
As compared with surgery, transcatheter aortic valve implantation (TAVI) is associated with increased need for permanent pacemaker implantation (PPMI). The clinical impact of PPMI post-TAVI has not been fully established. To assess by an updated meta-analysis the clinical outcomes related to PPMI after TAVI at long-term (≥12 months) follow-up (LTF).
Methods and results
A comprehensive literature research was performed on PubMed and EMBASE. The primary endpoint was all-cause death. Secondary endpoints were rehospitalization for heart failure, stroke, and myocardial infarction. A subgroup analysis was performed according to Society of Thoracic Surgeon—Predicted Risk of Mortality (STS-PROM) score. A total of 31 studies were identified, providing data on 51 069 patients. The mean duration of follow-up was 22 months. At LTF, PPMI post-TAVI was associated with a higher risk of all-cause death [22.9% vs. 19.6%; risk ratio (RR), 1.18, 95% confidence interval (CI), 1.10–1.25; P < 0.001] and rehospitalization for heart failure (16.6% vs. 15.1%; RR, 1.32; 95% CI, 1.13–1.52; P < 0.001). In contrast, risks of stroke and myocardial infarction were not affected. Among the 20 studies that reported surgical risk, the association between PPMI and LTF all-cause death risk was statistically significant only in studies enrolling patients with high STS-PROM score (RR, 1.25; 95% CI, 1.12–1.40), although there was a similar trend in those at medium and low-risk.
Conclusions
Patients necessitating PPMI after TAVI have higher long-term risk of all-cause death and rehospitalization for heart failure as compared to those who do not receive PPMI. Thus, strategies aimed at reducing need for PPMI might improve survival after TAVI.
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Affiliation(s)
- Andrea Zito
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Princi
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Lombardi
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Domenico D’A Mario
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rocco Vergallo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Narducci ML, Ruscio E, Nurchis MC, Pascucci D, Pelargonio G, Bencardino G, Perna F, Spera F, Pinnacchio G, Massetti M, Damiani G, Crea F. 500 The impact on healthcare of reimplantation and long-term mortality after transvenous lead extraction in patients with device related infection. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab137.001] [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
Aims
Transvenous lead extraction (TLE) has become a pivotal part of a comprehensive lead management strategy, dealing with a continuously increasing demand. Nonetheless, literature about long-term outcomes and the impact of a new device implantation on survival is still lacking. Given these knowledge gaps, the aim of our study was to analyse reimplantation and both early and long-term mortality in patients undergoing TLE, even in a public health perspective, specifically clarifying concerns about reimplantation.
Methods
This prospective, single-centre, observational, real-world registry consecutively enrolled patients (pts) with cardiac implantable electronic device who underwent TLE at our Hospital, from January 2005 to September 2020. The primary endpoint was to analyse major adverse cardiovascular events (MACEs) in both re-implanted (R Group) and non reimplanted (NR Group); secondary end-point was long-term (after discharge) mortality of the whole cohort, in order to investigate long-term mortality predictors.
Results
We enrolled high-risk cohort of 451 pts (mean population age 70 ± 12, with lead dwelling time 81.7 ± 201.2 months) at baseline findings: 92% of pts had an evidence of device infection, a generally impaired heart function with mean left ventricular ejection fraction (LVEF) 44 ± 13% and high rates of comorbidities (15% of pts with hypertension+ diabetes mellitus + renal failure). Three-hundred thirteen (72%) pts were reimplanted, using endocardiac leads in 86% and epicardial leads in 14%. Total MACEs rate was higher in R Group versus NR Group (64% versus 28%, P ≤ 0.001, CI 95%, respectively). In particular, rehospitalizations occurred more frequently in reimplanted population (R group 43% versus NR group 13%, P = 0.001, CI 95%). Long-term mortality rate was 34% (150 pts) at a mean follow up of 5.2 years. The leading contributor to long-term mortality was represented by multiple non-communicable chronic diseases (62%), being sepsis responsible for only 4% of long-term mortality, with a clear evidence of reduced infective burden after TLE and complete antibiotic therapy. At multivariate analysis, we found three independent predictors of long-term mortality: advanced age (> 77 years, OR 1.04, CI 1.02–1.06, P < 0.001), renal failure (eGFR<30 mL/min, OR 1.66, CI 1.15–2.39, P = 0.007) and left ventricular dysfunction before TLE (LVEF<45%, OR 1.58, CI 1.08–2.13, P = 0.017).
Conclusions
In patients undergoing TLE for infective indications, our study identified the reimplantation group as high risk group for adverse events before discharge. On the other hand, advanced age, renal failure and systolic dysfunction, as independent predictors of long-term mortality, could be evaluated as a predictive score to assess the mortality risk before the procedure of TLE.
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Affiliation(s)
| | - Eleonora Ruscio
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS Roma
| | | | | | - Gemma Pelargonio
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS Roma
- Universita’ Cattolica Del Sacro Cuore Roma
| | | | - Francesco Perna
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS Roma
| | - Francesco Spera
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS Roma
| | | | - Massimo Massetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS Roma
- Universita’ Cattolica Del Sacro Cuore Roma
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Perna F, Narducci ML, Sabarese R, Ruscio E, Scacciavillani R, Spera FR, Gianluigi B, Pinnacchio G, Pelargonio G, Crea F. 493 Prognostic value of myocardial scar and chamber enlargement at electroanatomical mapping during catheter ablation in adult congenital heart disease. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab127.030] [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
Aims
Atrial and ventricular tachyarrhythmias are common among patients with adult congenital heart disease (ACHD) and can impair quality of life and prognosis. Catheter ablation is often the main treatment option in this population, despite anatomical hurdles. Substrate mapping findings have not been thoroughly investigated as predictors of arrhythmia recurrence success and cardiovascular clinical outcome after ablation. We sought to determine the prognostic value of myocardial scar and chamber enlargement detected at electroanatomical mapping in ACHD patients undergoing catheter ablation of tachyarrhythmias.
Methods and results
Consecutive ACHD patients undergoing catheter ablation of atrial and ventricular tachycardias using different electroanatomical mapping systems were retrospectively identified from a hospital-based database. Scar extent detected at the electroanatomical mapping, as well as the total mapped area, was calculated. Arrhythmia recurrence, hospitalization for cardiovascular (CV) reasons, and a combined endpoint (arrhythmia recurrence and/or CV hospitalization) were evaluated during the follow-up. The relationship between the aforementioned electroanatomical findings and the patients’ outcome was assessed. Twenty patients (12 male, 60%; mean age 40 ± 11 years) undergoing atrial (n = 14; 70%) or ventricular (n = 6; 30%) tachyarrhythmia were included. Acute procedural success (arrhythmia termination and/or no reinduction) was achieved in all the patients. At a mean follow-up of 171 ± 135 weeks, eight patients (40%) had arrhythmia recurrence (4/6 in the ventricular tachycardia group, 67%, 4/14 in the atrial tachycardia group, 28%). Patients with arrhythmia recurrence had a more extensive bipolar scar (P = 0.029) and a larger total mapped area (P = 0.03) than patients without recurrence, and so did the patients with the composite endpoint (P = 0.029 and P = 0.03, respectively). Patients with subsequent CV hospitalization had a larger total mapped area than patients without CV hospitalization (P = 0.017). The presence of a bipolar scar ≥22.95 cm2 predicted arrhythmia relapse (0.039) at the multivariate analysis.
Conclusions
Patients with ACHD show a high recurrence rate after catheter ablation, especially for ventricular tachycardias. A large bipolar scar at the electroanatomical mapping and total mapped area predict arrhythmia recurrence, likely due to the presence of more extensive reentry circuits. A large total mapped area, which may reflect a greater disease severity, predicts both arrhythmia recurrence and CV hospitalizations. Early referral of ACHD patients for catheter ablation may be a sound strategy in order to perform the procedure in the setting of less advanced heart disease.
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Affiliation(s)
- Francesco Perna
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
| | - Maria Lucia Narducci
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Rocco Sabarese
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
| | - Eleonora Ruscio
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
| | - Roberto Scacciavillani
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
| | - Francesco Raffaele Spera
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
| | - Bencardino Gianluigi
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
| | - Gaetano Pinnacchio
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
| | - Gemma Pelargonio
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Filippo Crea
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
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Abstract
Atrioventricular blocks may be caused by a variety of potentially reversible conditions, such as ischemic heart disease, electrolyte imbalances, medications, and infectious diseases. Such causes must be always ruled out to avoid unnecessary pacemaker implantation. Patient management and reversibility rates depend on the underlying cause. Careful patient history taking, monitoring of vital signs, electrocardiogram, and arterial blood gas analysis are crucial elements of the diagnostic workflow during the acute phase. Atrioventricular block recurrence after the reversal of the underlying cause may pose an indication for pacemaker implantation, because reversible conditions may actually unmask a preexistent conduction disorder.
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Affiliation(s)
- Chiara Pavone
- Cardiovascular Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome, Italy
| | - Gemma Pelargonio
- Cardiovascular Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome, Italy; Cardiology Institute, Catholic University of the Sacred Heart, Rome, Italy.
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Solimene F, Giannotti Santoro M, Stabile G, Malacrida M, De Simone A, Pandozi C, Pelargonio G, Rossi P, Battaglia A, Pecora D, Bongiorni MG, Zucchelli G, Stocco C, Arestia A, Iuliano S, Russo M, Narducci ML, Segreti L. Early rhythm-control ablation therapy to prevent atrial fibrillation recurrences: Insights from the CHARISMA Registry. Pacing Clin Electrophysiol 2021; 44:2031-2040. [PMID: 34606098 DOI: 10.1111/pace.14374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/03/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND An early, comprehensive rhythm-control therapy is needed in order to treat atrial fibrillation (AF) effectively and to improve ablation outcomes. METHODS A total of 153 consecutive patients from the CHARISMA registry undergoing AF ablation at eight centers were included. Patients with de novo PVI were classified as having undergone early treatment (ET) if the procedure was performed within 6 months after the first AF episode, and as having undergone delayed treatment (DT) if ablation was performed over 6 months after the first AF episode. RESULTS One-hundred fifty-three patients were enrolled (69.9% male, 59 ± 10 years, 61.4% paroxysmal AF, 38.6% persistent AF). The time from the first AF episode to the ablation procedure was 1034 ± 1483 days. The ET group comprised 36 patients (25.3%), the DT group 60 (39.2%) and Redo cases were 57 (37.3%). During a mean follow-up of 366 ± 130 days, 18 patients (11.8%) suffered an AF/AT recurrence. More DT patients than ET patients suffered recurrences (15.7% vs. 2.2%, p = 0.0452) and the time to AT/AF recurrence was shorter in the group of patients who received an ablation treatment after 6 months (HR = 6.19, 95% CI: 1.7 to 21.9; p = 0.0474). On multivariate Cox analysis, only hypertension (HR = 4.86, 95% CI: 1.6 to 14.98, p = 0.0062) was independently associated with recurrences. Beyond the hypertension risk factor, ET was associated with a low risk of recurrence; recurrence rate ranged from 0% (ET patients without hypertension) to 25.0% (DT patients with hypertension). CONCLUSIONS An early rhythm-control ablation therapy in the absence of common risk factors was associated with the lowest rate of recurrences.
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Affiliation(s)
| | - Mario Giannotti Santoro
- Second Division of Cardiology, Cardiac, Thoracic, Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giuseppe Stabile
- Clinica Montevergine, Mercogliano, Avellino, Italy.,Anthea Hospital, Bari, Italy
| | | | - Antonio De Simone
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | - Claudio Pandozi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Pietro Rossi
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli, Isola Tiberina, Rome, Italy
| | | | - Domenico Pecora
- Electrophysiology Unit, Cardiovascular Department, Poliambulanza Institute Hospital Foundation, Brescia, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, Cardiac, Thoracic, Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardiac, Thoracic, Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | | | - Sara Iuliano
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | - Maurizio Russo
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Maria Lucia Narducci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardiac, Thoracic, Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Bencardino G, Vitulano N, Bisignani A, Gabrielli FA, Pelargonio G, Narducci ML, Perna F, Pinnacchio G, Comerci G, Lanza GA, Massetti M, Crea F. Severity of spleep apnea syndrome and life-threatening tachyarrhythmias in patients with implantable cardioverter defibrillator. Pacing Clin Electrophysiol 2021; 44:1657-1662. [PMID: 34314032 DOI: 10.1111/pace.14328] [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] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/15/2021] [Accepted: 07/25/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sleep apnea syndrome (SAS) has been reported to be associated with a higher incidence of ventricular arrhythmias. The aim of this study was twofold: (1) to investigate whether in SAS patients receiving an implantable cardioverter defibrillator (ICD) the severity of SAS was associated with the occurrence of ventricular arrhythmias; (2) to assess whether changes in nocturnal apnoic/hypopnoic episodes may favor the occurrence of life-threatening arrhythmias, that is, sustained ventricular tachycardia (VT)/fibrillation (VF), requiring ICD intervention. METHODS We enrolled 46 patients with documented SAS at polysomnography (apnea/hypopnea index [AHI] > 5) who also had a left ventricle ejection fraction (LVEF) < 35% and, according to primary prevention indications, implanted an ICD (Boston Scientific Incepta) able to daily monitor apnoic/hypopnoic episodes occurring during sleep. Patients were followed at 3-month intervals. RESULTS At a mean follow-up of 18 months, 21 episodes of sustained VT/FV requiring ICD intervention were documented in eight patients (17.4%). Baseline AHI was significantly higher in patients with compared to those without ICD intervention. ICD interventions, however, were not preceded by any worsening of apnoic/hypopnoic episodes. The respiratory disturbance index (RDI) of the week during the event, indeed, was not different from that recorded during the previous 2 weeks (25.4 ± 11, 25.6 ± 10 and 25.1 ± 10, respectively; p = .9). CONCLUSIONS In patients with SAS who received an ICD for primary prevention of sudden death, those with ICD interventions showed a more severe form of the disease at baseline. ICD interventions, however, were not preceded by any significant changes in SAS severity.
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Affiliation(s)
- Gianluigi Bencardino
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicola Vitulano
- Division of Cardiology, Miulli General Hospital, Acquaviva delle Fonti, Italy
| | - Antonio Bisignani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Augusta Gabrielli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Lucia Narducci
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Perna
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gaetano Pinnacchio
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gianluca Comerci
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gaetano Antonio Lanza
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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39
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Narducci M, Scacciavillani R, Pinnacchio G, Bencardino G, Perna F, Comerci G, Campisi M, Ceccarelli I, Pavone C, Spera F, Bisignani A, Crea F, Pelargonio G. The potential impact of acute coronary syndromes on automatic sensing system in Subcutaneous-ICDs. Int J Cardiol Heart Vasc 2021; 35:100841. [PMID: 34345651 PMCID: PMC8319739 DOI: 10.1016/j.ijcha.2021.100841] [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: 06/13/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022]
Abstract
75 patients with ACS or CCS underwent S-ICD screening upon arrival and after PCI. Before PCI, STEMI patients had lower screening pass rates than NSTE-ACS ones STEMI was the only predictor of screening failure at multivariate regression analysis. Patient selection and dynamic device programming are fundamental in ischemic subjects
Background The Subcutaneous-ICD (S-ICD) is emerging as a suitable option for most ICD candidates, however some open issues regarding the sensing algorithm still remain. Objectives We aimed to examine the performance of the S-ICD sensing algorithm in patients hospitalized for ST elevation myocardial infarction (STEMI), non ST elevation acute coronary syndrome (NSTE-ACS) or chronic coronary syndrome (CCS), before and after revascularization. Methods We performed a S-ICD automated screening on 75 patients, 21 hospitalized for STEMI, 23 for NSTE-ACS and 31 for CCS, before and after percutaneous revascularization, regardless their eligibility to ICD implantation. Results Patients did not differ in clinical, electrocardiographic and echocardiographic parameters. Rates of screening pass were significantly lower in STEMI patients compared to NSTE-ACS and CCS (5% vs 56.7% vs 81% respectively, p < .0001). The viability of the primary vector was lower in STEMI patients compared to NSTE-ACS and CCS (33% vs 56% vs 71%, p .027 respectively). After revascularization, there were no more significant differences between groups. Pairing subjects at baseline and after revascularization, STEMI subjects percentages of screening success were respectively 5% and 81% (p < .001) and the rates of primary vector viability were 33% and 81% (p .002). STEMI was the only independent predictor of screening failure at multivariate logistic regression analysis (odds ratio 10.68 confidence interval 2.77–41.38, p = .001) Conclusion The performance of the S-ICD and possible malfunction detections in the context of an acute ischemic event deserve further evaluation. Adequate patient selection and the development of dynamic device programming are warranted.
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Affiliation(s)
- M.L. Narducci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - R. Scacciavillani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - G. Pinnacchio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
- Corresponding authors at: Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Rome 00168, Italy.
| | - G. Bencardino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
- Corresponding authors at: Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Rome 00168, Italy.
| | - F. Perna
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - G. Comerci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - M. Campisi
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - I. Ceccarelli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - C. Pavone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - F. Spera
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - A. Bisignani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - F. Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
- Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - G. Pelargonio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
- Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
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40
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Segreti L, De Simone A, Schillaci V, Pandozi C, Bongiorni MG, Stabile G, Arestia A, Giannotti Santoro M, Pelargonio G, Scaglione M, Rossi P, Pecora D, Stocco C, Malacrida M, Solimene F. Early rhythm-control ablation therapy in preventing AF recurrences: insight from the CHARISMA Registry. Europace 2021. [DOI: 10.1093/europace/euab116.192] [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] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
An early and comprehensive rhythm-control therapy emerges as a need to treat AF in an effective way and to improve the ablation outcomes, in terms of arrhythmia-free survival.
Purpose
We aimed to investigate the importance of timing of ablation in preventing AF recurrences.
Methods
153 consecutive patients (pts) undergoing AF ablation from the CHARISMA registry at 8 Italian centres were included. Ablations were guided by a novel radiofrequency ablation catheter with local impedance (LI)-sensing capability through a dedicated algorithm (DirectSense, Boston Scientific). Pts were grouped as early treated (ET) if the procedure was performed within 1 year after the first AF episode and as delayed treated (DT) if admitted for ablation after more than 1 year. The ablation endpoint was PVI as assessed by entrance and exit block. Post-ablation follow-up was scheduled at 3, 6 and 12 months. AF and atrial tachycardia (AT) recurrences were considered as long-term endpoint.
Results
Of the 153 pts enrolled (69.9% male, 59 ± 10 years, 61.4% paroxysmal AF, 38.6% persistent AF), 123 (80.4%) met Class I indications, 23 (15%) Class IIa indications and 7 (4.6%) Class IIb indications according to current ESC AF guidelines. The mean time to ablation procedure from the first AF episode was 1034 ± 1483 days. Eighty pts (52.3%) were included in ET group, whereas 73 pts (47.7%) in DT group. No differences were found between AF type in terms of ablation strategy (53.3% of the cases -52 out 94- were classified as ET for paroxysmal AF vs 47.5% of the cases -28 out 59- were ET for persistent AF, p = 0.4346). At the end of the procedures, all PVs had been successfully isolated in all study pts. During a mean follow-up of 366 ± 130 days, 18 pts (11.8%) suffered an AF/AT recurrence after the 90-day blanking period. Recurrences occurred mostly in the DT group compared to the ET one (13 out 73 -17.8%- vs 5 out 80 -6.3%-, p = 0.042) and the time to AT/AF recurrence was longer in the ET group (HR = 0.2876, 95%CI: 0.1029 to 0.8038; p = 0.0181). On multivariate logistic analysis adjusted for baseline confounders, only hypertension (HR = 4.66, 95%CI: 1.5 to 14.48, p = 0.0081) was independently associated with recurrences. An early rhythm-control therapy was associated with a low risk of recurrences beyond the hypertension risk factor, ranging from 2% (no hypertension and an ET ablation therapy) to 30.3% (with hypertension and a DT procedure) (Figure 1).
Conclusion
A LI-guided ablation strategy for PVI proved to be safe and effective and resulted in a very high recurrence-free rate. An early rhythm-control therapy in the absence of common risk factors was associated with the lowest rate of recurrences. Abstract Figure. AT/AF Recurrence
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Affiliation(s)
- L Segreti
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - V Schillaci
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - C Pandozi
- San Filippo Neri Hospital, Rome, Italy
| | - MG Bongiorni
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - G Stabile
- Casa di cura San Michele, Maddaloni, Italy
| | - A Arestia
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | | | - G Pelargonio
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - P Rossi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - C Stocco
- Boston Scientific Italy, Milan, Italy
| | | | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
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Scaglione M, Calvanese R, Pandozi C, Pedretti S, Rossi L, Pelargonio G, Mantovan R, Solimene F, Canciello M, Fonte G, Biagi A, Caponi D, Cerrato N, Malacrida M, Battaglia A. Impact of channels identification and ablation in ventricular tachycardia patients through high-density mapping: preliminary experience from an Italian registry. Europace 2021. [DOI: 10.1093/europace/euab116.352] [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] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Ventricular tachycardia (VT) ablation techniques in ischemic cardiomyopathy have evolved during the recent years. However, the long-term success rate remains disappointing. A technique based on channel identification and ablation through a novel automated algorithm may limit the extent of ablation needed and possibly lead to higher successful rate.
Purpose
To report preliminary data on feasibility and safety of a channel identification approach and to characterize late potentials (LPs) features using an ultra-high density mapping system with a novel analysis tool in ischemic VT procedures.
Methods
Consecutive patients (pts) indicated for ischemic VT ablation were enrolled in the CHARISMA study. A complete map of the left ventricle was performed prior and after ablation through the Rhythmia mapping system. For our purpose channels were defined as any signal activity bounded by anatomic and functional barriers and characterized through a novel map analysis tool (Lumipoint-LM-) that automatically identifies fragmented late potentials (LPs) and continuous activation was used on the whole ventricular substrate. Procedural endpoint was the elimination of all identified conducting channels (CCs) by ablation at the CC entrance and exit followed by abolition of any residual LPs inside the CC. The ablation endpoint was noninducibility.
Results
A total of 18 channels were identified through LM from 14 pts: 71.4% of the pts had 1 CC, 28.6% had 2 CCs. In the majority of the cases LPs where identified only inside CCs (57.1%), whereas in 6 cases (42.9%) LPs were present both inside and outside. The mean conduction time inside CCs was 50.3 ± 30ms, the mean CC length was 32.6 ± 17mm and the conduction velocity was 0.8 ± 0.5 mm/ms. LPs covered a mean area of 7.0 ± 5mm2 (ratio between LPs area and CCs’ area = 52.4 ± 33.7%). At voltage map analysis 1 CC was present in 78.6% of the cases (2 CCs in 21.4%). LPs were identified only inside CCs in 42.9% of the cases, both inside and outside in 50% and only outside in 7.1%. Healthy tissue (voltage level≥0.5mV) was prevalent (61.2 ± 13.8%), followed by intermediate voltage areas (0.5-0.05mV; 37.5 ± 13.7%) and very low voltage areas (<0.05mV; 1.2 ± 2%). LPs were found mostly at intermediate voltage areas (54.1 ± 31.7% of the covered area; 39.1 ± 28.4% at healthy tissue and 6.8 ± 17.8% at very low voltage areas). Agreement in CCs identification between advanced analysis through LM and voltage map was fair (9/14 with complete agreement). In 3 cases voltage map overestimated LPs areas, in 2 cases failed to fully identify LPs. All CCs’ entrance and exit were successfully ablated and abolition of any residual LPs inside the CC was achieved in all pts. No complication occurred. Noninducibility was achieved in all the cases.
Conclusions
In our preliminary experience, a new channel identification approach through the advanced Lumipoint algorithm seems to be safe, feasible and effective at least in the acute setting of ischemic VT ablation.
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Affiliation(s)
| | | | - C Pandozi
- San Filippo Neri Hospital, Rome, Italy
| | | | - L Rossi
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - G Pelargonio
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - R Mantovan
- Conegliano General Hospital, Conegliano, Italy
| | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | | | - G Fonte
- Sant"Anna Hospital, Como, Italy
| | - A Biagi
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - D Caponi
- Cardinal Massaia Hospital, Asti, Italy
| | - N Cerrato
- Cardinal Massaia Hospital, Asti, Italy
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Solimene F, Giannotti Santoro M, De Simone A, Malacrida M, Stabile G, Pandozi C, Pelargonio G, Cauti FM, Scaglione M, Pecora D, Bongiorni MG, Arestia A, Grimaldi G, Russo M, Narducci ML, Segreti L. Pulmonary vein isolation in atrial fibrillation patients guided by a novel local impedance algorithm: 1-year outcome from the CHARISMA study. J Cardiovasc Electrophysiol 2021; 32:1540-1548. [PMID: 33851484 DOI: 10.1111/jce.15041] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 01/15/2021] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Highly localized impedance (LI) measurements during atrial fibrillation (AF) ablation have recently emerged as a viable real-time indicator of tissue characteristics and durability of the lesions created. We report the outcomes of acute and long-term clinical evaluation of the new DirectSense algorithm in AF ablation. METHODS Consecutive patients undergoing AF ablation were included in the CHARISMA registry. RF delivery was guided by the DirectSense algorithm, which records the magnitude and time-course of the impedance drop. The ablation endpoint was pulmonary vein isolation (PVI), as assessed by the entrance and exit block. RESULTS 3556 point-by-point first-pass RF applications of >10 s duration were analyzed in 153 patients (mean age=59 ± 10 years, 70% men, 61% paroxysmal AF, 39% persistent AF). The mean baseline LI was 105 ± 15 Ω before ablation and 92 ± 12 Ω after ablation (p < .0001). Both absolute drops in LI and the time to LI drop (LI drop/τ) were greater at successful ablation sites (n = 3122, 88%) than at ineffective ablation sites (n = 434, 12%) (14 ± 8 Ω vs 6 ± 4 Ω, p < .0001 for LI; 0.73 [0.41-1.25] Ω/s vs. 0.35[0.22-0.59 Ω/s, p < .0001 for LI drop/τ). No major complications occurred during or after the procedures. All PVs had been successfully isolated. During a mean follow-up of 366 ± 130 days, 18 patients (11.8%) suffered an AF/atrial tachycardia recurrence after the 90-day blanking period. CONCLUSION The magnitude and time-course of the LI drop during RF delivery were associated with effective lesion formation. This ablation strategy for PVI guided by LI technology proved safe and effective and resulted in a very low rate of AF recurrence over 1-year follow-up.
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Affiliation(s)
- Francesco Solimene
- Department of Electrophysiology, Clinica Montevergine, Mercogliano, Avellino, Italy
| | - Mario Giannotti Santoro
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Antonio De Simone
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | | | - Giuseppe Stabile
- Department of Electrophysiology, Clinica Montevergine, Mercogliano, Avellino, Italy.,Department of Electrophysiology, Anthea Hospital, Bari, Italy
| | - Claudio Pandozi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Gemma Pelargonio
- Cardiovascular Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Filippo Maria Cauti
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli, Isola Tiberina, Rome, Italy
| | - Marco Scaglione
- Department of Electrophysiology, Cardinal Massaia Hospital, Asti, Italy
| | - Domenico Pecora
- Electrophysiology Unit, Cardiovascular Department, Poliambulanza Institute Hospital Foundation, Brescia, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Alberto Arestia
- Department of Electrophysiology, Clinica Montevergine, Mercogliano, Avellino, Italy
| | - Gabriella Grimaldi
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | - Maurizio Russo
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Maria Lucia Narducci
- Cardiovascular Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Pelargonio G, La Rosa G, Di Stasio E, Narducci ML, Rocco E, Angelini A, Pinnacchio G, Bencardino G, Perna F, Comerci G, Catania F, Crea F. Ventricular arrhythmias in Takotsubo Syndrome: incidence, predictors and clinical outcomes. J Cardiovasc Med (Hagerstown) 2021; 22:180-189. [PMID: 32890232 DOI: 10.2459/jcm.0000000000001106] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS To investigate predictors of the occurrence of subacute ventricular arrhythmias (VAs), defined as any VAs presenting after 48 h from admission in patients with Takotsubo Syndrome (TTS), and to evaluate the related in-hospital mortality. METHODS This is a retrospective single-center study enrolling patients admitted between 2012 and 2017 with TTS according to International Takotsubo diagnostic criteria. Data collection included ECG on admission and at 48 h, telemetry monitoring and transthoracic echocardiogram. RESULTS We enrolled 93 patients; during in-hospital stay (mean 14 ± 16 days) subacute VAs occurred in 25% of patients (VAs group). Life-threatening VAs occurred in 6% of patients (3 sustained ventricular tachycardia, 1 torsade de pointes, 1 ventricular fibrillation) and not life-threatening VAs in 19% (6 non-sustained ventricular tachycardia and 12 premature ventricular contractions > 2000 in 24 h). Mortality was higher in the VAs than in the non-VAs group (P = 0.03), without differences in terms of life-threatening and not life-threatening subacute VAs (P = 0.65) and VAs on admission (P = 0.25). Logistic regression identified the following independent predictors of subacute VAs occurrence: VAs on admission {odds ratio [OR] 22.5 (3.9-131.8), P = 0.001]}, New York Heart Association (NYHA) class III-IV on admission [OR 6.7 (1.3- 34.0), P = 0.021] and QTc at 48 h [OR 1.01 (1.00-1.03), P = 0.046]. CONCLUSION TTS patients with VAs and NYHA class III-IV on admission and higher QTc at 48 h are at increased risk of subacute VAs occurrence, associated with higher in-hospital mortality. Awareness of this potential complication is critical for proper patients management.
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Affiliation(s)
- Gemma Pelargonio
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome, Italy.,Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulio La Rosa
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area. Madrid, Spain
| | - Enrico Di Stasio
- Dipartimento di Scienze di Laboratorio ed Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS.,Istituto di Biochimica e Biochimica Clinica, Università Cattolica del Sacro Cuore, Largo F. Vito 1, Rome, Italy
| | - Maria Lucia Narducci
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome, Italy
| | - Erica Rocco
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome, Italy
| | - Alessio Angelini
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome, Italy
| | - Gaetano Pinnacchio
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome, Italy
| | - Gianluigi Bencardino
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome, Italy
| | - Francesco Perna
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome, Italy
| | - Gianluca Comerci
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome, Italy
| | - Fiammetta Catania
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome, Italy
| | - Filippo Crea
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome, Italy.,Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy
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Cappannoli L, Scacciavillani R, Rocco E, Perna F, Narducci ML, Gabrielli FA, Vaccarella M, D'Amario D, Pelargonio G, Massetti M, Crea F, Aspromonte N. [Cardiac contractility modulation: a treatment option for patients with refractory heart failure]. G Ital Cardiol (Rome) 2021; 22:212-220. [PMID: 33687374 DOI: 10.1714/3557.35341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Heart failure is the cardiovascular epidemic of the 21st century, with poor prognosis and quality of life despite optimized medical treatment. In the past two decades, only two new drugs have been added to therapeutic strategies for patients with symptomatic heart failure and even less progresses have been made on devices, with the implantable defibrillator indicated for patients with ejection fraction ≤35% and cardiac resynchronization therapy for those with QRS >130 ms and evidence of left bundle branch block. Nevertheless, only a third of patients meet these criteria and a high percentage of patients are non-responders in terms of improving symptoms. Nowadays, in patients with symptomatic heart failure with ejection fraction between 25% and 45% and QRS <130 ms, not eligible for cardiac resynchronization therapy, cardiac contractility modulation represents a concrete treatment option, having proved to be safe and effective in reducing hospitalizations for heart failure and improving symptoms, functional capacity and quality of life.The aim of this review is therefore to summarize the pathophysiological mechanisms, the current indications and the recent developments regarding the new applications of cardiac contractility modulation for patients with chronic heart failure.
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Affiliation(s)
- Luigi Cappannoli
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma
| | - Roberto Scacciavillani
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma
| | - Erica Rocco
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma
| | - Francesco Perna
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma - Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma
| | - Maria Lucia Narducci
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma - Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma
| | - Francesca Augusta Gabrielli
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma - Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma
| | - Marcello Vaccarella
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma - Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma
| | - Domenico D'Amario
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma - Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma
| | - Gemma Pelargonio
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma - Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma
| | - Massimo Massetti
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma
| | - Filippo Crea
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma - Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma
| | - Nadia Aspromonte
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma - Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma
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Narducci ML, Cammarano M, Novelli V, Bisignani A, Pavone C, Perna F, Bencardino G, Pinnacchio G, Bianco M, Zeppilli P, Palmieri V, Pelargonio G. Diagnostic Workflow in Competitive Athletes with Ventricular Arrhythmias and Suspected Concealed Cardiomyopathies. Medicina (B Aires) 2021; 57:medicina57020182. [PMID: 33672601 PMCID: PMC7924041 DOI: 10.3390/medicina57020182] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 11/16/2022] Open
Abstract
The diagnosis of structural heart disease in athletes with ventricular arrhythmias (VAs) and an apparently normal heart can be very challenging. Several pieces of evidence demonstrate the importance of an extensive diagnostic work-up in apparently healthy young patients for the characterization of concealed cardiomyopathies. This study shows the various diagnostic levels and tools to help identify which athletes need deeper investigation in order to unmask possible underlying heart disease.
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Affiliation(s)
- Maria Lucia Narducci
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.P.); (G.B.); (G.P.); (G.P.)
- Correspondence:
| | - Michela Cammarano
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (M.B.); (P.Z.); (V.P.)
| | - Valeria Novelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Genetica Medica, 00168 Rome, Italy;
- Istituto di Medicina Genomica, Università del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Antonio Bisignani
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (A.B.); (C.P.)
| | - Chiara Pavone
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (A.B.); (C.P.)
| | - Francesco Perna
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.P.); (G.B.); (G.P.); (G.P.)
| | - Gianluigi Bencardino
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.P.); (G.B.); (G.P.); (G.P.)
| | - Gaetano Pinnacchio
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.P.); (G.B.); (G.P.); (G.P.)
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (A.B.); (C.P.)
| | - Massimiliano Bianco
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (M.B.); (P.Z.); (V.P.)
| | - Paolo Zeppilli
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (M.B.); (P.Z.); (V.P.)
| | - Vincenzo Palmieri
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (M.B.); (P.Z.); (V.P.)
| | - Gemma Pelargonio
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.P.); (G.B.); (G.P.); (G.P.)
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (A.B.); (C.P.)
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Pelargonio G, Di Monaco A, Guida P, Pellegrino PL, Vergara P, Grimaldi M, Narducci ML, Tritto M. Atrial fibrillation ablation: is common practice far from guidelines' world? The Italian experience from a national survey. J Interv Card Electrophysiol 2021; 63:125-132. [PMID: 33566236 DOI: 10.1007/s10840-021-00955-7] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, occurring in 1-2% of the general population. Catheter ablation has become an important treatment modality for patients with symptomatic drug-refractory AF. We report data regarding the AF ablation approaches and modalities in the Italian "real world." METHODS The survey was set-up to collect data on ablation procedure across Italy. All centers performing AF ablation were invited, regardless of the number of annual procedures, to complete a questionnaire regarding their ablation approaches. All centers reported data regarding procedures performed during the year 2017. RESULTS A total of 3260 procedures were reported from 49 participating hospitals. Most of Italian regions were included in the study. The majority of the centers performed "Always" pulmonary vein isolation (PVI) in paroxysmal and persistent AF catheter ablation, while adjunctive lesions in persistent AF ablation were planned in most of them but not all, and 16% never performed lesions other than PVI. During ablation procedure, vitamin k inhibitors were uninterrupted in 55% of centers, while direct oral anticoagulant in 44% of centers was used uninterruptedly. No relationship was observed between patient data and the number of procedures performed at each center. CONCLUSIONS This survey suggests that the adherence of Italian centers to the most recent European Society of Cardiology guidelines for AF ablation is reasonably high.
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Affiliation(s)
- Gemma Pelargonio
- Dipartimento di Scienze Cardiovascolari Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Di Monaco
- Dipartimento di Cardiologia. Ospedale Generale Regionale "F. Miulli", Acquaviva delle Fonti (Bari), Italy.
| | - Pietro Guida
- Dipartimento di Cardiologia. Ospedale Generale Regionale "F. Miulli", Acquaviva delle Fonti (Bari), Italy
| | - Pier Luigi Pellegrino
- Dipartimento di Cardiologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Foggia, Foggia, Italy
| | - Pasquale Vergara
- Unità Operativa di Aritmologia, Ospedale San Raffaele di Milano, Segrate, Italy
| | - Massimo Grimaldi
- Dipartimento di Cardiologia. Ospedale Generale Regionale "F. Miulli", Acquaviva delle Fonti (Bari), Italy
| | - Maria Lucia Narducci
- Dipartimento di Scienze Cardiovascolari Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Massimo Tritto
- Unità operativa di Elettrofisiolgia ed Elettrostimolazione, Humanitas Mater Domini, Castellanza (Varese), Italy
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47
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Narducci ML, La Rosa G, Pinnacchio G, Inzani F, d'Amati G, Perna F, Bencardino G, D'Amario D, Pieroni M, Dello Russo A, Casella M, Pelargonio G, Crea F. Assessment of patients presenting with life-threatening ventricular arrhythmias and suspected myocarditis: The key role of endomyocardial biopsy. Heart Rhythm 2021; 18:907-915. [PMID: 33516948 DOI: 10.1016/j.hrthm.2021.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/25/2020] [Revised: 01/03/2021] [Accepted: 01/19/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Life-threatening ventricular tachyarrhythmias (VAs) represent a significant cause of death in myocarditis. OBJECTIVE The purpose of this study was to identify predictors of sustained VAs in patients with myocarditis and ventricular phenotype diagnosed by workflow including endomyocardial biopsy (EMB) guided by 3D electroanatomic mapping (3D-EAM). METHODS We prospectively enrolled patients with suspected myocarditis and VAs, undergoing cardiac magnetic resonance imaging, coronary angiography, 3D-EAM, and EMB guided by 3D-EAM. At follow-up, sustained VAs were detected by device interrogation and 24-hour electrocardiographic Holter monitoring. RESULTS We enrolled 54 consecutive patients (mean age 41 ± 14 years; 32(59%) men) with normal ventricular function; left ventricular and right ventricular (RV) late gadolinium enhancement was present, respectively, in 21 (46%) and 6 (13%) of the 46 patients who underwent cardiac magnetic resonance. In 31 patients, the histological diagnosis was myocarditis, while in 14 patients, focal replacement myocardial fibrosis (FRMF); in 9 patients, specimens were inadequate (diagnostic yield of EMB 83%). 3D-EAM showed a larger endocardial scar area for both ventricles in myocarditis than in FRMF (RV bipolar mean scar area 22 ± 16 cm2 vs 3 ± 2 cm2; P = .02; left ventricular bipolar mean scar area 13 ± 5 cm2 vs 4 ± 2 cm2; P = .02, respectively). At a follow-up of 21 months, freedom from sustained VAs was 58% in myocarditis and 92% in FRMF (log-rank, P = .008). Histological diagnosis of myocarditis and RV endocardial scar were independent predictors of sustained VAs (P = .02 for both). CONCLUSION Our data highlight the need for 3D-EAM-guided EMB in apparently healthy young patients with suspected myocarditis and VAs.
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Affiliation(s)
- Maria Lucia Narducci
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Giulio La Rosa
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gaetano Pinnacchio
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Frediano Inzani
- Istituto di Anatomia Patologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblicata, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Giulia d'Amati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesco Perna
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gianluigi Bencardino
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico D'Amario
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Department of Biomedical Science and Public Health, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, Department of Clinical Special and Dental Sciences, "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
| | - Gemma Pelargonio
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Crea
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy
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48
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Sollazzo F, Palmieri V, Gervasi SF, Cuccaro F, Modica G, Narducci ML, Pelargonio G, Zeppilli P, Bianco M. Sudden Cardiac Death in Athletes in Italy during 2019: Internet-Based Epidemiological Research. ACTA ACUST UNITED AC 2021; 57:medicina57010061. [PMID: 33445447 PMCID: PMC7827560 DOI: 10.3390/medicina57010061] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 02/02/2023]
Abstract
Background and objectives: An Italian nationwide pre-participation screening approach for prevention of sudden cardiac death in athletes (SCD-A) in competitive sportspeople showed promising results but did not achieve international consensus, due to cost-effectiveness and the shortfall of a monitoring plan. From this perspective, we tried to provide an epidemiological update of SCD-A in Italy through a year-long internet-based search. Materials and Methods: One year-long Google search was performed using mandatory and non-mandatory keywords. Data were collected according to prevalent SCD-A definition and matched with sport-related figures from Italian National Institute of Statistics (ISTAT) and Italian National Olympic Committee (CONI). Results: Ninety-eight cases of SCD-A in 2019 were identified (48.0% competitive, 52.0% non-competitive athletes). Male/female ratio was 13:1. The most common sports were soccer (33.7%), athletics (15.3%) and fitness (13.3%). A conclusive diagnosis was achieved only in 37 cases (33 of cardiac origin), with the leading diagnosis being coronary artery disease in 27 and a notably higher occurrence among master athletes. Combining these findings with ISTAT and CONI data, the SCD-A incidence rate in the whole Italian sport population was found to be 0.47/100,000 persons per year (1.00/100,000 in the competitive and 0.32/100,000 in the non-competitive population). The relative risk of SCD-A is 3.1 (CI 2.1–4.7; p < 0.0001) for competitive compared to non-competitive athletes; 9.9 for male (CI 4.6–21.4; p < 0.0001) with respect to female. Conclusions: We provided an updated incidence rate of SCD-A in both competitive and non-competitive sport in Italy. A higher risk of SCD-A among competitive and male athletes was confirmed, thus corroborating the value of Italian pre-participation screening in this population.
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Affiliation(s)
- Fabrizio Sollazzo
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (S.F.G.); (F.C.); (G.M.); (P.Z.); (M.B.)
| | - Vincenzo Palmieri
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (S.F.G.); (F.C.); (G.M.); (P.Z.); (M.B.)
- Correspondence: ; Tel.: +39-06-3015-4078; Fax: +39-06-3015-6656
| | - Salvatore Francesco Gervasi
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (S.F.G.); (F.C.); (G.M.); (P.Z.); (M.B.)
| | - Francesco Cuccaro
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (S.F.G.); (F.C.); (G.M.); (P.Z.); (M.B.)
| | - Gloria Modica
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (S.F.G.); (F.C.); (G.M.); (P.Z.); (M.B.)
| | - Maria Lucia Narducci
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Istituto di Cardiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.L.N.); (G.P.)
| | - Gemma Pelargonio
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Istituto di Cardiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.L.N.); (G.P.)
| | - Paolo Zeppilli
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (S.F.G.); (F.C.); (G.M.); (P.Z.); (M.B.)
| | - Massimiliano Bianco
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (S.F.G.); (F.C.); (G.M.); (P.Z.); (M.B.)
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49
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Casella M, Bergonti M, Narducci ML, Persampieri S, Gasperetti A, Conte E, Catto V, Carbucicchio C, Guerra F, Pontone G, Andreini D, Basso C, Di Biase L, Santangeli P, Natale A, Pelargonio G, Russo AD, Tondo C. Prior myocarditis and ventricular arrhythmias: The importance of scar pattern. Heart Rhythm 2020; 18:589-596. [PMID: 33348060 DOI: 10.1016/j.hrthm.2020.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/05/2020] [Revised: 12/01/2020] [Accepted: 12/15/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Multiple studies have addressed the importance of anteroseptal scar in patients with nonischemic cardiomyopathy. However, this pattern has never been fully evaluated in patients with prior myocarditis. OBJECTIVE The purpose of this study was to evaluate whether anteroseptal scar is associated with worse outcome in patients with prior myocarditis and how it affects the efficacy of catheter ablation (CA). METHODS This was a retrospective study of consecutive patients with prior myocarditis and arrhythmic presentation. Cardiac magnetic resonance and electroanatomic voltage mapping were used to identify the scar pattern. Patients were referred for either CA or escalated antiarrhythmic drug (AAD) therapy. The main outcome was ventricular arrhythmia (VA)-free survival according to the presence of anteroseptal scar. RESULTS A total of 144 consecutive patients with prior myocarditis were included. Mean age was 42.1 ± 14.9 years, and 58% were men. Ejection fraction was normal in 73% of patients. Anteroseptal scar was present in 44% of cases. Sixty-one patients (42%) underwent CA. Overall, at 2-year follow-up, VA-free survival was 77% in the CA group. After CA, the mean number of AADs taken by each patient decreased from 1.8 to 0.9 per day (p<0.001). The presence of anteroseptal scar was found to be an independent predictor of VA relapse both in patients treated with CA (hazard ratio [HR] 3.6; 95% confidence interval [CI] 1.1-11.4; P = .03) and in the overall population (HR 2.0; 95% CI 1.2-3.5; P = .02) . CONCLUSION In patients with prior myocarditis and VA, the presence of anteroseptal scar negatively predicts outcomes irrespective of treatment strategy.
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Affiliation(s)
- Michela Casella
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I-Lancisi-Salesi", Ancona, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Marco Bergonti
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy.
| | | | | | - Alessio Gasperetti
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; University Heart Center, University Hospital Zurich, Zürich, Switzerland
| | | | | | | | - Federico Guerra
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I-Lancisi-Salesi", Ancona, Italy; Department of Biomedical Science and Public Health, Marche Polytechnic University, Ancona, Italy
| | | | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedaliera-University of Padua, Padova, Italy
| | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore Hospital, Bronx, New York
| | - Pasquale Santangeli
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Hospital, Austin, Texas
| | - Gemma Pelargonio
- Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I-Lancisi-Salesi", Ancona, Italy; Department of Biomedical Science and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Claudio Tondo
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy
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50
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Narducci ML, Cellini F, Placidi L, Boldrini L, Perna F, Bencardino G, Pinnacchio G, Bertolini R, Cannelli G, Frascino V, Tagliaferri L, Chiesa S, Mattiucci GC, Balducci M, Gambacorta MA, Rossi M, Indovina L, Pelargonio G, Valentini V, Crea F. Case Report: A Case Report of Stereotactic Ventricular Arrhythmia Radioablation (STAR) on Large Cardiac Target Volume by Highly Personalized Inter- and Intra-fractional Image Guidance. Front Cardiovasc Med 2020; 7:565471. [PMID: 33330640 PMCID: PMC7719630 DOI: 10.3389/fcvm.2020.565471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/25/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction: Although catheter ablation is the current gold standard treatment for refractory ventricular arrhythmias, sometimes its efficacy is not optimal and it's associated with high risks of procedural complication and death. Stereotactic arrhythmia radioablation (STAR) is increasingly being adopted for such clinical presentation, considering its efficacy and safety.Case Presentation: We do report our experience managing a case of high volume of left ventricle for refractory ventricular tachycardia in advanced heart failure patient, by delivering a single fraction of STAR through an highly personalization of dose delivery applying repeated inter- and continuous intra-fraction image guidance.Conclusion: According to the literature reports, we recommend considering increasing as much as possible the personalization features and safety technical procedure as long as that is not significantly affecting the STAR duration. Moreover, the duration in itself shouldn't be the main parameter, but balanced into the frame of possibly obtainable outcome improvement. At best of our knowledge, this is the first report applying such specific technology onto this clinical setting. Future studies will clarify these issues.
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Affiliation(s)
- Maria Lucia Narducci
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lorenzo Placidi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Perna
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gianluigi Bencardino
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gaetano Pinnacchio
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberta Bertolini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Cannelli
- Department of Anesthesiology, Intensive Care and Pain Therapy, Fondazione Policlinico A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Vincenzo Frascino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Chiesa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gian Carlo Mattiucci
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mario Balducci
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Antonietta Gambacorta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Rossi
- Department of Anesthesiology, Intensive Care and Pain Therapy, Fondazione Policlinico A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Indovina
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gemma Pelargonio
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy
- *Correspondence: Gemma Pelargonio
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Crea
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy
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