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Bisignani G, Cheung JW, Rordorf R, Kutyifa V, Hofer D, Berti D, Di Biase L, Martens E, Russo V, Vitillo P, Zoutendijk M, Deneke T, Köhler I, Schrader J, Upadhyay G. Implantable cardiac monitors: artificial intelligence and signal processing reduce remote ECG review workload and preserve arrhythmia detection sensitivity. Front Cardiovasc Med 2024; 11:1343424. [PMID: 38322767 PMCID: PMC10844377 DOI: 10.3389/fcvm.2024.1343424] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/05/2024] [Indexed: 02/08/2024] Open
Abstract
Introduction Implantable cardiac monitors (ICMs) provide long-term arrhythmia monitoring, but high rates of false detections increase the review burden. The new "SmartECG" algorithm filters false detections. Using large real-world data sets, we aimed to quantify the reduction in workload and any loss in sensitivity from this new algorithm. Methods Patients with a BioMonitor IIIm and any device indication were included from three clinical projects. All subcutaneous ECGs (sECGs) transmitted via remote monitoring were classified by the algorithm as "true" or "false." We quantified the relative reduction in workload assuming "false" sECGs were ignored. The remote monitoring workload from five hospitals with established remote monitoring routines was evaluated. Loss in sensitivity was estimated by testing a sample of 2000 sECGs against a clinical board of three physicians. Results Of our population of 368 patients, 42% had an indication for syncope or pre-syncope and 31% for cryptogenic stroke. Within 418.5 patient-years of follow-up, 143,096 remote monitoring transmissions contained 61,517 sECGs. SmartECG filtered 42.8% of all sECGs as "false," reducing the number per patient-year from 147 to 84. In five hospitals, nine trained reviewers inspected on average 105 sECGs per working hour. This results in an annual working time per patient of 83 min without SmartECG, and 48 min with SmartECG. The loss of sensitivity is estimated as 2.6%. In the majority of cases where true arrhythmias were rejected, SmartECG classified the same type of arrhythmia as "true" before or within 3 days of the falsely rejected sECG. Conclusion SmartECG increases efficiency in long-term arrhythmia monitoring using ICMs. The reduction of workload by SmartECG is meaningful and the risk of missing a relevant arrhythmia due to incorrect filtering by the algorithm is limited.
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Affiliation(s)
| | - Jim W. Cheung
- Division of Cardiology, Weill Cornell Medicine, New York, NY, United States
| | - Roberto Rordorf
- Department of Cardiology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Kutyifa
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, NY, United States
| | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Dana Berti
- Department of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Luigi Di Biase
- Arrhythmia Services, Albert Einstein College of Medicine at Montefiore Health System, New York, NY, United States
| | - Eimo Martens
- Department of Cardiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Vincenzo Russo
- Department of Cardiology, University Vanvitelli, Monaldi Hospital, Napoli, Italy
| | - Paolo Vitillo
- Department of Cardiology, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità San Giuseppe Moscati, Avellino, Italy
| | - Marlies Zoutendijk
- Department of Cardiology, Admiraal de Ruyter Ziekenhuis, Goes, Netherlands
| | - Thomas Deneke
- Department of Cardiology, Rhön Clinic Campus Bad Neustadt, Bad Neustadt a. d. Saale, Germany
| | | | | | - Gaurav Upadhyay
- Center for Arrhythmia Care, University of Chicago Medicine, Chicago, IL, United States
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2
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Lucà F, Andreassi MG, Gulizia MM, Borghini A, Colombo PE, Benedetto FA, Bernelli C, Bisceglia I, Bisignani G, Caldarola P, Canale ML, Caporale R, Caretta G, Ceravolo R, Ciconte VA, Corda M, Cornara S, De Bonis S, De Luca L, Di Fusco SA, Di Matteo I, Di Nora C, Favilli S, Gelsomino S, Geraci G, Giubilato S, Matteucci A, Nardi F, Navazio A, Parrini I, Pilleri A, Pozzi A, Rao CM, Riccio C, Rossini R, Turazza FM, Grimaldi M, Gabrielli D, Picano E, Colivicchi F, Oliva F. [ANMCO Position paper: Ionizing radiation exposure and radioprotection in the cath-lab]. G Ital Cardiol (Rome) 2023; 24:915-932. [PMID: 37901982 DOI: 10.1714/4129.41234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
In the last decades, because of the improvements in the percutaneous treatment of coronary heart disease, valvular heart disease, congenital heart defects, and the increasing number of cardiac resynchronization therapy and cardioverter-defibrillator implantations, the interventional cardiologists' radio-exposure has importantly risen, causing concerns for ionizing radiation-associated diseases such as cancer and neurodegenerative disorders. Consequently, the radiation exposure issue importantly affects operators' safety. However, our knowledge of this field is poor and most operators are unaware to be at risk, especially because of the absence of effective preventive measures. The aim of this ANMCO position paper is to improve the awareness of operators and identify new ways of reducing operator ionizing radiation dose and minimizing the risk.
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Affiliation(s)
- Fabiana Lucà
- Divisione di Cardiologia, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria
| | | | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | | | - Paola Enrica Colombo
- Fisica Sanitaria, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | | | - Chiara Bernelli
- Unità Complessa di Cardiologia, Ospedale Santa Corona, Pietra Ligure (SV)
| | - Irma Bisceglia
- Servizi Cardiologici Integrati, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma
| | - Giovanni Bisignani
- U.O.C. Cardiologia-UTIC-Emodinamica, Ospedale Castrovillari, ASP Cosenza
| | | | | | - Roberto Caporale
- U.O.C. Cardiologia Interventistica, Ospedale Annunziata, Cosenza
| | - Giorgio Caretta
- S.C. Cardiologia, Ospedale Sant'Andrea, La Spezia, ASL5 Liguria
| | - Roberto Ceravolo
- U.O. Cardiologia e UTIC, Ospedale Giovanni Paolo II, Lamezia Terme (CZ)
| | | | - Marco Corda
- Cardiologia con UTIC, Azienda di Rilievo Nazionale e Alta Specializzazione "G. Brotzu", Cagliari
| | - Stefano Cornara
- S.C. Cardiologia Levante, P.O. Levante - Ospedale San Paolo, Savona
| | - Silvana De Bonis
- U.O. Cardiologia e UTIC, Ospedale Civile N. Giannettasio, Rossano (CS)
| | - Leonardo De Luca
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma
| | - Stefania Angela Di Fusco
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Irene Di Matteo
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Concetta Di Nora
- S.O.C. Cardiochirurgia, A.O.U. Santa Maria della Misericordia, Udine
| | - Silvia Favilli
- S.O.C. Cardiologia Pediatrica e della Transizione, IRCSS Azienda Ospedaliero-Universitaria Meyer, Firenze
| | - Sandro Gelsomino
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht - CARIM, University of Maastricht, Maastricht, Olanda
| | - Giovanna Geraci
- U.O. Cardiologia, P.O. Sant'Antonio Abate, ASP Trapani, Erice (TP)
| | - Simona Giubilato
- U.O.C. Cardiologia con UTIC ed Emodinamica, Azienda Ospedaliera Cannizzaro, Catania
| | - Andrea Matteucci
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Federico Nardi
- Dipartimento di Cardiologia, Ospedale Santo Spirito, Casale Monferrato (AL)
| | - Alessandro Navazio
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia
| | | | - Annarita Pilleri
- S.S.D. Consulenza e Valutazione Cardiologica, Azienda di Rilievo Nazionale e Alta Specializzazione "G. Brotzu", Cagliari
| | - Andrea Pozzi
- U.O.C. Cardiologia 1, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | - Carmelo Massimiliano Rao
- Divisione di Cardiologia, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria
| | - Carmine Riccio
- U.O.S.D. Follow-up del Paziente Post-Acuto, Dipartimento Cardio-Vascolare, AORN Sant'Anna e San Sebastiano, Caserta
| | - Roberta Rossini
- S.C. Cardiologia, Azienda Ospedaliera S. Croce e Carle, Cuneo
| | | | - Massimo Grimaldi
- U.O.C. Cardiologia-UTIC, Ospedale Miulli, Acquaviva delle Fonti (BA)
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma - Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
| | | | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
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Lucà F, Gulizia MM, Abrignani MG, Benedetto FA, Bisceglia I, Bisignani G, Bobbio MC, Caldarola P, Canale ML, Caretta G, Ceravolo R, Chimenti C, Ciconte VA, Corda M, Cornara S, Di Fusco SA, Di Matteo I, Di Nora C, Favilli S, Francese GM, Gelsomino S, Gensini GF, Giubilato S, Grimaldi M, Nardi F, Navazio A, Parrini I, Pilleri A, Pozzi A, Rao CM, Riccio C, Rossini R, Vernero S, Gabrielli D, Oliva F, Colivicchi F. [ANMCO Position paper: Choosing Wisely - ANMCO proposals for 2023]. G Ital Cardiol (Rome) 2023; 24:754-765. [PMID: 37642128 DOI: 10.1714/4084.40686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Nowadays, a progressive and exponential increase in the use of invasive and non-invasive instrumental diagnostics and therapeutic services has been shown. Although unnecessary, instrumental examinations are often largely prescribed, replacing clinical evaluation. Their correct use, on the contrary, would address precise epidemiological and clinical contexts. Therefore identifying whether a test or procedure is appropriate or not plays a crucial role in clinical practice. Several documents from scientific societies and expert groups indicate the most appropriate cardiovascular diagnostic and therapeutic procedures. The international Choosing Wisely campaign invited the main scientific societies to identify five techniques or treatments used in their field that are often unnecessary and may potentially damage patients. The Italian Association of Hospital Cardiologists (ANMCO) joined the project identifying the five cardiological practices in our country at greater risk of inappropriateness in 2014. This list has recently been updated. Moreover, possible solutions to this problem have been proposed.
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Affiliation(s)
| | | | | | | | - Irma Bisceglia
- Servizi Cardiologici Integrati, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma
| | - Giovanni Bisignani
- U.O.C. Cardiologia-UTIC-Emodinamica, Ospedale Castrovillari, ASP Cosenza, Cosenza
| | - Marco Carlo Bobbio
- Segretario Generale Slow Medicine ETS, già Direttore S.C. Cardiologia, A.O. Santa Croce e Carle, Cuneo
| | | | | | - Giorgio Caretta
- S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia
| | - Roberto Ceravolo
- U.O. Cardiologia e UTIC, Ospedale Giovanni Paolo II, Lamezia Terme (CZ)
| | - Cristina Chimenti
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Azienda Ospedaliera Policlinico Umberto I, Sapienza Università di Roma, Roma
| | | | - Marco Corda
- Cardiologia con UTIC, Azienda di Rilievo Nazionale e Alta Specializzazione "G. Brotzu", Cagliari
| | - Stefano Cornara
- S.C. Cardiologia Levante, P.O. Levante - Ospedale San Paolo, Savona
| | - Stefania Angela Di Fusco
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Irene Di Matteo
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Concetta Di Nora
- S.O.C. Cardiochirurgia, A.O.U. Santa Maria della Misericordia, Udine
| | - Silvia Favilli
- S.O.C. Cardiologia Pediatrica e della Transizione, IRCSS Azienda Ospedaliero-Universitaria Meyer, Firenze
| | - Giuseppina Maura Francese
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | - Sandro Gelsomino
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht - CARIM, University of Maastricht, Maastricht, Olanda
| | | | - Simona Giubilato
- U.O.C. Cardiologia con UTIC ed Emodinamica, Azienda Ospedaliera Cannizzaro, Catania
| | - Massimo Grimaldi
- U.O.C. Cardiologia-UTIC, Ospedale Miulli, Acquaviva delle Fonti (BA)
| | - Federico Nardi
- Dipartimento di Cardiologia, Ospedale Santo Spirito, Casale Monferrato (AL)
| | - Alessandro Navazio
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia
| | | | - Annarita Pilleri
- S.S.D. Consulenza e Valutazione Cardiologica, Azienda di Rilievo Nazionale e Alta Specializzazione "G. Brotzu", Cagliari
| | - Andrea Pozzi
- U.O.C. Cardiologia 1, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | - Carmelo Massimiliano Rao
- Divisione di Cardiologia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria
| | - Carmine Riccio
- U.O.S.D. Follow-up del Paziente Post-Acuto, Dipartimento Cardio-Vascolare, AORN Sant'Anna e San Sebastiano, Caserta
| | - Roberta Rossini
- S.C. Cardiologia, Azienda Ospedaliera S. Croce e Carle, Cuneo
| | | | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma - Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
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4
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Migliore F, Biffi M, Viani S, Pittorru R, Francia P, Pieragnoli P, De Filippo P, Bisignani G, Nigro G, Dello Russo A, Pisanò E, Palmisano P, Rapacciuolo A, Silvetti MS, Lavalle C, Curcio A, Rordorf R, Lovecchio M, Valsecchi S, D’Onofrio A, Botto GL. Modern subcutaneous implantable defibrillator therapy in patients with cardiomyopathies and channelopathies: data from a large multicentre registry. Europace 2023; 25:euad239. [PMID: 37536671 PMCID: PMC10438213 DOI: 10.1093/europace/euad239] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 06/07/2023] [Accepted: 08/01/2023] [Indexed: 08/05/2023] Open
Abstract
AIMS Patients with cardiomyopathies and channelopathies are usually younger and have a predominantly arrhythmia-related prognosis; they have nearly normal life expectancy thanks to the protection against sudden cardiac death provided by the implantable cardioverter defibrillator (ICD). The subcutaneous ICD (S-ICD) is an effective alternative to the transvenous ICD and has evolved over the years. This study aimed to evaluate the rate of inappropriate shocks (IS), appropriate therapies, and device-related complications in patients with cardiomyopathies and channelopathies who underwent modern S-ICD implantation. METHODS AND RESULTS We enrolled consecutive patients with cardiomyopathies and channelopathies who had undergone implantation of a modern S-ICD from January 2016 to December 2020 and who were followed up until December 2022. A total of 1338 S-ICD implantations were performed within the observation period. Of these patients, 628 had cardiomyopathies or channelopathies. The rate of IS at 12 months was 4.6% [95% confidence interval (CI): 2.8-6.9] in patients with cardiomyopathies and 1.1% (95% CI: 0.1-3.8) in patients with channelopathies (P = 0.032). No significant differences were noted over a median follow-up of 43 months [hazard ratio (HR): 0.76; 95% CI: 0.45-1.31; P = 0.351]. The rate of appropriate shocks at 12 months was 2.3% (95% CI: 1.1-4.1) in patients with cardiomyopathies and 2.1% (95% CI: 0.6-5.3) in patients with channelopathies (P = 1.0). The rate of device-related complications was 0.9% (95% CI: 0.3-2.3) and 3.2% (95% CI: 1.2-6.8), respectively (P = 0.074). No significant differences were noted over the entire follow-up. The need for pacing was low, occurring in 0.8% of patients. CONCLUSION Modern S-ICDs may be a valuable alternative to transvenous ICDs in patients with cardiomyopathies and channelopathies. Our findings suggest that modern S-ICD therapy carries a low rate of IS. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov/Identifier: NCT02275637.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Mauro Biffi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Stefano Viani
- Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Raimondo Pittorru
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Pietro Francia
- Cardiology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University Sapienza, Rome, Italy
| | - Paolo Pieragnoli
- Arrhythmic Disease Unit, University of Florence, Florence, Italy
| | - Paolo De Filippo
- Cardiac Electrophysiology and Pacing Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Gerardo Nigro
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Università Politecnica delle Marche, Ancona, Italy
| | - Ennio Pisanò
- Cardiology Unit, ‘Vito Fazzi’ Hospital, Lecce, Italy
| | | | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Massimo Stefano Silvetti
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Carlo Lavalle
- Cardiology Department, Policlinico Umberto I - La Sapienza University, Rome, Italy
| | - Antonio Curcio
- Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi Magna Graecia, Campus di Germaneto, Catanzaro, Italy
| | - Roberto Rordorf
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | | | - Sergio Valsecchi
- Cardiac Rhythm Management Division, Boston Scientific, Milan, Italy
| | - Antonio D’Onofrio
- ‘Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie’, Monaldi Hospital, Naples, Italy
| | - Giovanni Luca Botto
- Department of Clinical cardiology and Electrophysiology ASST Rhodense, Rho and Garbagnate M.se, Milan, Italy
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5
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Rodio G, Iacopino S, Pisanò EC, Calvi V, Rovaris G, Marini M, Giammaria M, Caravati F, Maglia G, Zanotto G, Della Bella P, Biffi M, Curnis A, Maines M, Orsida D, Santamaria M, Bisignani G, Baroni M, Lissoni F, Duca A, Forleo GB, Piemontese C, De Salvia A, Miracapillo G, Celentano E, Zecchin M, Luzzi G, Giacopelli D, Gargaro A, D'Onofrio A. Temporal association between drops in thoracic impedance and malignant ventricular arrhythmia: A longitudinal analysis of remote monitoring trends. J Cardiovasc Electrophysiol 2023; 34:947-956. [PMID: 36709469 DOI: 10.1111/jce.15834] [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: 06/03/2022] [Revised: 12/23/2022] [Accepted: 01/22/2023] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Thoracic impedance (TI) drops measured by implantable cardioverter-defibrillators (ICDs) have been reported to correlate with ventricular tachycardia/fibrillation (VT/VF). The aim of our study was to assess the temporal association of decreasing TI trends with VT/VF episodes through a longitudinal analysis of daily remote monitoring data from ICDs and cardiac resynchronization therapy defibrillators (CRT-Ds). METHODS AND RESULTS Retrospective data from 2384 patients were randomized 1:1 into a derivation or validation cohort. The TI decrease rate was defined as the percentage of rolling weeks with a continuously decreasing TI trend. The derivation cohort was used to determine a TI decrease rate threshold for a ≥99% specificity of arrhythmia prediction. The associated risk of VT/VF episodes was estimated in the validation cohort by dividing the available follow-up into 60-day assessment intervals. Analyses were performed separately for 1354 ICD and 1030 CRT-D patients. During a median follow-up of 2.0 years, 727 patients (30.4%) experienced 3298 confirmed VT/VF episodes. In the ICD group, a TI decrease rate of >60% was associated with a higher risk of VT/VF episode in a 60-day assessment interval (stratified hazard ratio, 1.42; 95% confidence interval (CI), 1.05-1.92; p = .023). The TI decrease preceded (40.8%) or followed (59.2%) the VT/VF episodes. In the CRT-D group, no association between TI decrease and VT/VF episodes was observed (p = .84). CONCLUSION In our longitudinal analysis, TI decrease was associated with VT/VF episodes only in ICD patients. Preventive interventions may be difficult since episodes can occur before or after TI decrease.
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Affiliation(s)
- Giovanna Rodio
- Division of Cardiology, Ospedale Santissima Annunziata, Taranto, Italy
| | | | | | - Valeria Calvi
- Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco", Catania, Italy
| | | | | | | | | | | | | | | | - Mauro Biffi
- Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | | | | | - Matteo Baroni
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | | | | | | | | | | | | | | | - Giovanni Luzzi
- Division of Cardiology, Ospedale Santissima Annunziata, Taranto, Italy
| | - Daniele Giacopelli
- Biotronik Italia S.P.A., Vimodrone, Italy
- University of Padova, Padua, Italy
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6
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Pino PG, Madeo A, Lucà F, Ceravolo R, di Fusco SA, Benedetto FA, Bisignani G, Oliva F, Colivicchi F, Gulizia MM, Gelsomino S. Clinical Utility of Three-Dimensional Echocardiography in the Evaluation of Mitral Valve Disease: Tips and Tricks. J Clin Med 2023; 12:jcm12072522. [PMID: 37048605 PMCID: PMC10094963 DOI: 10.3390/jcm12072522] [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] [Received: 12/31/2022] [Revised: 02/22/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
Although real-time 3D echocardiography (RT3DE) has only been introduced in the last decades, its use still needs to be improved since it is a time-consuming and operator-dependent technique and acquiring a good quality data can be difficult. Moreover, the additive value of this important diagnostic tool still needs to be wholly appreciated in clinical practice. This review aims at explaining how, why, and when performing RT3DE is useful in clinical practice.
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Affiliation(s)
- Paolo G. Pino
- Former Cardiology Department, San Camillo Forlanini Hospital, 00151 Roma, Italy
| | - Andrea Madeo
- Cardiology Department, Ferrari Hospital, 87012 Castrovillari, Italy
| | - Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
| | - Roberto Ceravolo
- Cardiology Unit, Giovanni Paolo II Hospital, 88046 Lamezia, Italy
| | | | - Francesco Antonio Benedetto
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
| | | | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
| | - Furio Colivicchi
- Cardiology Department, San Filippo Neri Hospital, 00135 Rome, Italy
| | | | - Sandro Gelsomino
- Cardiothoracic Department, Maastricht University, 6211 LK Maastrich, The Netherlands
- Correspondence:
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Stabile G, Guerra F, Tola G, Vergara P, Accogli M, Bertini M, Bisignani G, Forleo GB, Lavalle C, Notarstefano P, Zanotto G, Landolina M, Boriani G, Ricci RP, D'Onofrio A, De Ponti R. [2020 Catheter Ablation Registry of the Italian Association of Arrhythmology and Cardiac Pacing]. G Ital Cardiol (Rome) 2023; 24:241-244. [PMID: 36853162 DOI: 10.1714/3980.39628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND This report describes the findings of the 2020 Italian Catheter Ablation Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC). METHODS Data collection was retrospective. A standardized questionnaire was completed by each of the participating centers. RESULTS A total of 10 378 ablation procedures were performed by 66 institutions. Most centers (70%) have an electrophysiology laboratory, and 23% a hybrid cardiac surgery laboratory. All centers have a 3D mapping system. The median number of electrophysiologists and nurses involved in the electrophysiology laboratory was 3.5 and 3, respectively. An electrophysiology technician was involved in 35% of all centers. In 88.2% of cases, catheter ablation was performed for supraventricular arrhythmias; the most frequently treated arrhythmia was atrial fibrillation (39.4%), followed by atrioventricular nodal reentrant tachycardia (18.6%), and common atrial flutter (10.6%). In 72.9% of patients, catheter ablation was performed using a 3D mapping system, with a "near-zero" fluoroscopic approach in 37.7% of all patients. CONCLUSIONS The 2020 Italian Catheter Ablation Registry confirmed that the electrophysiology activity was markedly affected by the COVID-19 pandemic; atrial fibrillation is the most frequently treated arrhythmia with an increasing number of procedures performed with a 3D mapping system and a "near-zero" approach.
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Affiliation(s)
- Giuseppe Stabile
- Mediterranea Cardiocentro, Napoli - Anthea Hospital, Bari - Clinica Montevergine, Mercogliano (AV) - Casa di Cura San Michele, Maddaloni (CE)
| | - Federico Guerra
- Università Politecnica delle Marche, Ospedali Riuniti, Ancona
| | | | | | | | | | | | | | | | | | | | | | - Giuseppe Boriani
- AOU Policlinico di Modena, Università degli Studi di Modena e Reggio Emilia, Modena
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8
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Botto GL, Ziacchi M, Nigro G, D'Onofrio A, Dello Russo A, Francia P, Viani S, Pisanò E, Bisignani G, Caravati F, Migliore F, De Filippo P, Ottaviano L, Rordorf R, Manzo M, Canevese FL, Lovecchio M, Valsecchi S, Checchi L. Intermuscular technique for implantation of the subcutaneous implantable defibrillator: a propensity-matched case-control study. Europace 2023; 25:1423-1431. [PMID: 36794691 PMCID: PMC10105850 DOI: 10.1093/europace/euad028] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 11/07/2022] [Accepted: 12/09/2023] [Indexed: 02/17/2023] Open
Abstract
AIMS A previous randomized study demonstrated that the subcutaneous implantable cardioverter defibrillator (S-ICD) was noninferior to transvenous ICD with respect to device-related complications and inappropriate shocks. However, that was performed prior to the widespread adoption of pulse generator implantation in the intermuscular (IM) space instead of the traditional subcutaneous (SC) pocket. The aim of this analysis was to compare survival from device-related complications and inappropriate shocks between patients who underwent S-ICD implantation with the generator positioned in an IM position in comparison with an SC pocket. METHODS AND RESULTS We analysed 1577 consecutive patients who had undergone S-ICD implantation from 2013 to 2021 and were followed up until December 2021. Subcutaneous patients (n = 290) were propensity matched with patients of the IM group (n = 290), and their outcomes were compared. : During a median follow-up of 28 months, device-related complications were reported in 28 (4.8%) patients and inappropriate shocks were reported in 37 (6.4%) patients. The risk of complication was lower in the matched IM group than in the SC group [hazard ratio 0.41, 95% confidence interval (CI) 0.17-0.99, P = 0.041], as well as the composite of complications and inappropriate shocks (hazard ratio 0.50, 95% CI 0.30-0.86, P = 0.013). The risk of appropriate shocks was similar between groups (hazard ratio 0.90, 95% CI 0.50-1.61, P = 0.721). There was no significant interaction between generator positioning and variables such as gender, age, body mass index, and ejection fraction. CONCLUSION Our data showed the superiority of the IM S-ICD generator positioning in reducing device-related complications and inappropriate shocks. CLINICAL TRIAL REGISTRATION Clinical Trial Registration: ClinicalTrials.gov; NCT02275637.
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Affiliation(s)
- Giovanni Luca Botto
- U.O. Electrophysiology, ASST Rhodense, Viale Carlo Forlanini 95, 20024 Garbagnate Milanese (MI), Italy
| | - Matteo Ziacchi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Gerardo Nigro
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli,' Monaldi Hospital, Naples, Italy
| | - Antonio D'Onofrio
- 'Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie', Monaldi Hospital, Naples, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Università Politecnica delle Marche, Ancona, Italy
| | - Pietro Francia
- Cardiology, Department of Clinical and Molecular Medicine, Sapienza University, St Andrea Hospital, Rome, Italy
| | - Stefano Viani
- Second Cardiology Division, Department of Cardio-Thoracic and Vascular, University Hospital of Pisa, Pisa, Italy
| | - Ennio Pisanò
- Cardiology Division, 'Vito Fazzi' Hospital, Lecce, Italy
| | | | - Fabrizio Caravati
- Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic Vascular Sciences and Public Health University of Padova, Padua, Italy
| | - Paolo De Filippo
- Cardiac Electrophysiology and Pacing Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luca Ottaviano
- Arrhythmia and Electrophysiology Unit, Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Roberto Rordorf
- Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico 'S. Matteo', Pavia, Italy
| | - Michele Manzo
- Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Fabio Lorenzo Canevese
- U.O. Electrophysiology, ASST Rhodense, Viale Carlo Forlanini 95, 20024 Garbagnate Milanese (MI), Italy
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9
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Lau DH, Pierre B, Cabanas P, Martens E, Bisignani G, Hofer D, Berruezo A, Eschalier R, Mansourati J, Gaspar T, Sanfins VM, Erglis A, Hain A, Papaioannou G, Cuneo A, Tscholl V, Schrader J, Deneke T. Diagnostic yield of an insertable cardiac monitor in a large patient population. Heart Rhythm O2 2023; 4:97-102. [PMID: 36873314 PMCID: PMC9975005 DOI: 10.1016/j.hroo.2022.11.005] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Insertable cardiac monitors (ICMs) are increasingly used for cardiac rhythm diagnosis with expanding indications. Little has been reported about their use and efficacy. Objective The study sought to evaluate the clinical utility of a novel ICM (Biotronik BIOMONITOR III) including the time to diagnosis in unselected patients with different ICM indications. Methods Patients from 2 prospective clinical studies were included to determine the diagnostic yield of the ICM. The primary endpoint was time to clinical diagnosis per implant indication or to the first change in atrial fibrillation (AF) therapy. Results A total of 632 patients were included with a mean follow-up of 233 ± 168 days. Of 384 patients with (pre)syncope, 34.2% had a diagnosis at 1 year. The most frequent therapy was permanent pacemaker implantation. Of 133 patients with cryptogenic stroke, 16.6% had an AF diagnosis at 1 year, resulting in oral anticoagulation. Of 49 patients with an indication for AF monitoring, 41.0% had a relevant change in AF therapy based on ICM data at 1 year. Of 66 patients with other indications, 35.4% received a rhythm diagnosis at 1 year. Moreover, 6.5% of the cohort had additional diagnoses: 26 of 384 patients with syncope, 8 of 133 patients with cryptogenic stroke, and 7 of 49 patients with AF monitoring. Conclusion In a large unselected patient population with heterogeneous ICM indications, the primary endpoint of rhythm diagnosis was achieved in ∼1 in 4, and additional clinically relevant findings was achieved in 6.5% of patients at short-term follow-up.
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Affiliation(s)
- Dennis H Lau
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, Australia
| | - Bertrand Pierre
- Department of Cardiology, Tours University Hospital, Chambray-lès-Tours, France
| | - Pilar Cabanas
- Department of Cardiology, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Eimo Martens
- Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | | | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Antonio Berruezo
- Department of Cardiology, Teknon Heart Institute, Barcelona, Spain
| | - Romain Eschalier
- Department of Cardiology, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | | | - Thomas Gaspar
- Heart Center, University of Dresden, Dresden, Germany
| | - Victor Manuel Sanfins
- Department of Cardiology, Hospital Senhora da Oliveira - Guimarães, Guimarães, Portugal
| | - Andrejs Erglis
- Department of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Andreas Hain
- Department of Cardiology, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
| | | | - Alessandro Cuneo
- Department of Cardiology, Krankenhaus Maria-Hilf Stadtlohn, Stadtlohn, Germany
| | - Verena Tscholl
- Department of Cardiology, Charité Universitaetsmedizin, Campus Mitte, Berlin, Germany
| | - Jürgen Schrader
- Department of Cardiology, Biotronik SE & Co.KG, Berlin, Germany
| | - Thomas Deneke
- Department of Cardiology, Rhön Clinic Campus Bad Neustadt, Saale, Germany
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10
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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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11
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Bisignani G, De Bonis S, Pierre B, Lau DH, Hofer D, Sanfins VM, Hain A, Cabanas P, Martens E, Berruezo A, Eschalier R, Milliez P, Lüsebrink U, Mansourati J, Papaioannou G, Giacopelli D, Gargaro A, Ploux S. Insertable cardiac monitor with a long sensing vector: Impact of obesity on sensing quality and safety. Front Cardiovasc Med 2023; 10:1148052. [PMID: 37025684 PMCID: PMC10071510 DOI: 10.3389/fcvm.2023.1148052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/07/2023] [Indexed: 04/08/2023] Open
Abstract
Background Fat layers in obese patients can impair R-wave detection and diagnostic performance of a subcutaneous insertable cardiac monitor (ICM). We compared safety and ICM sensing quality between obese patients [body mass index (BMI) ≥ 30 kg/m2] and normal-weight controls (BMI <30 kg/m2) in terms of R-wave amplitude and time in noise mode (noise burden) detected by a long-sensing-vector ICM. Materials and methods Patients from two multicentre, non-randomized clinical registries are included in the present analysis on January 31, 2022 (data freeze), if the follow-up period was at least 90 days after ICM insertion, including daily remote monitoring. The R-wave amplitudes and daily noise burden averaged intraindividually for days 61-90 and days 1-90, respectively, were compared between obese patients (n = 104) and unmatched (n = 268) and a nearest-neighbour propensity score (PS) matched (n = 69) normal-weight controls. Results The average R-wave amplitude was significantly lower in obese (median 0.46 mV) than in normal-weight unmatched (0.70 mV, P < 0.0001) or PS-matched (0.60 mV, P = 0.003) patients. The median noise burden was 1.0% in obese patients, which was not significantly higher than in unmatched (0.7%; P = 0.056) or PS-matched (0.8%; P = 0.133) controls. The rate of adverse device effects during the first 90 days did not differ significantly between groups. Conclusion Although increased BMI was associated with reduced signal amplitude, also in obese patients the median R-wave amplitude was >0.3 mV, a value which is generally accepted as the minimum level for adequate R-wave detection. The noise burden and adverse event rates did not differ significantly between obese and normal-weight patients.Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04075084 and NCT04198220.
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Affiliation(s)
- Giovanni Bisignani
- Department of Cardiology, Ospedale Civile Ferrari, Castrovillari, Italy
- Correspondence: Giovanni Bisignani
| | - Silvana De Bonis
- Department of Cardiology, Ospedale Civile Ferrari, Castrovillari, Italy
| | | | - Dennis H. Lau
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Daniel Hofer
- Department of Cardiology, UniversitätsspitalZürich, Zurich, Switzerland
| | - Victor Manuel Sanfins
- Department of Cardiology, Hospital Senhora da Oliveira—Guimarães, Guimarães, Portugal
| | - Andreas Hain
- Department of Cardiology, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
| | - Pilar Cabanas
- Department of Cardiology, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Eimo Martens
- Department of Cardiology, Klinikum Rechts der Isar der Technischen Universität München, München, Germany
| | - Antonio Berruezo
- Department of Cardiology, Centro Médico Teknon, Barcelona, Spain
| | - Romain Eschalier
- Department of Cardiology, Hôpital Gabriel Montpied, Clermont Ferrand, France
| | - Paul Milliez
- Department of Cardiology, Le Centre Hospitalier Universitaire de Caen CHRU Caen, Caen, France
| | - Ulrich Lüsebrink
- Department of Cardiology, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Germany
| | | | | | - Daniele Giacopelli
- Clinical Unit, Biotronik Italia, Milano, Italy
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Padova, Italy
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12
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Schiavone M, Gasperetti A, Laredo M, Breitenstein A, Vogler J, Palmisano P, Gulletta S, Pignalberi C, Lavalle C, Pisanò E, Ricciardi D, Curnis A, Dello Russo A, Tondo C, Badenco N, Di Biase L, Kuschyk J, Biffi M, Tilz R, Forleo GB, Arosio R, Ruggiero D, Viecca M, Ziacchi M, Diemberger I, Angeletti A, Fierro N, Della Bella P, Mitacchione G, Compagnucci P, Casella M, Santini L, Piro A, Picarelli F, Bressi E, Calò L, Montemerlo E, Rovaris G, De Bonis S, Bisignani A, Bisignani G, Russo G, Guarracini F, Vitali F, Bertini M, Fink T, Fastenrath F, Kaiser L, Hakmi S, Waintraub X, Gandjbakhch E, Saguner A. Inappropriate Shock Rates and Long-Term Complications due to Subcutaneous Implantable Cardioverter Defibrillators in Patients With and Without Heart Failure: Results From a Multicenter, International Registry. Circ Arrhythm Electrophysiol 2023; 16:e011404. [PMID: 36595631 DOI: 10.1161/circep.122.011404] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Marco Schiavone
- Luigi Sacco University Hospital, Milan (M.S., A.G., G.B.F.).,Department of Systems Medicine, University of Rome Tor Vergata, Italy (M.S.)
| | - Alessio Gasperetti
- Luigi Sacco University Hospital, Milan (M.S., A.G., G.B.F.).,Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.G., N.B.)
| | - Mikael Laredo
- APHP, Hôpital Pitié Salpêtrière, Paris, France (M.L.)
| | | | - Julia Vogler
- Department of Elctrophysiology, Herzzentrum Lubeck, Germany (J.V., R.T.)
| | - Pietro Palmisano
- Cardiology Unit, "Card. G. Panico" Hospital, Tricase, Italy (P.P.)
| | - Simone Gulletta
- Arrhythmology & Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan (S.G.)
| | | | | | - Ennio Pisanò
- U.O.S.V.D. Cardiac Electrophysiology - "V. Fazzi" Hospital, Lecce (E.P.)
| | | | | | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi," Ancona (A.D.R.)
| | - Claudio Tondo
- Heart Rhythm Centre, Monzino Cardiology Centre, IRCCS, Milan, Italy (C.T.)
| | - Nicolas Badenco
- Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.G., N.B.)
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology at Montefiore-Einstein Center, Bronx, NY (L.D.B.)
| | - Jürgen Kuschyk
- Cardiology Unit, University Medical Center Mannheim, Germany (J.K.)
| | - Mauro Biffi
- Cardiology, IRCCS, Department of Experimental, Diagnostic & Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy (M.B.)
| | - Roland Tilz
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany (R.T.)
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13
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Rodio G, Iacopino S, Pisanò EC, Calvi V, Rovaris G, Marini M, Giammaria M, Caravati F, Maglia G, Maines M, Orsida D, Santamaria M, Bisignani G, Baroni M, Lissoni F, Duca A, Luzzi G, Giacopelli D, Gargaro A, D´onofrio A. 336 TEMPORAL CONNECTION BETWEEN HOME MONITORING TRENDS OF THORACIC IMPEDANCE AND SUSTAINED VENTRICULAR ARRHYTHMIAS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.075] [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
Introduction
Implantable cardioverter defibrillators (ICDs) provide daily values of thoracic impedance (TI) that are inversely correlated with fluid accumulation in the lungs. Since sustained ventricular arrhythmias (SVA) are known to have a short-term relationship with heart failure exacerbations, our objective was to assess TI trends temporally related to SVA episodes.
Methods
This study analyzed data daily transmitted from patients with ICD or cardiac resynchronization therapy defibrillator (CRT-D) of the nationwide Home Monitoring Expert Alliance network. Device-detected SVAs were adjudicated for appropriateness. Patients were randomly split into a derivation and validation cohort. To identify the most significant TI trend (TI-index), several numerical TI transformations were tested in a cross-sectional analysis of the derivation cohort modelling the odds of first SVA with univariate logistic regressions. In the same cohort, the threshold of the selected transformation was identified to maximize the projected specificity. The relative risk of SVA for TI-index above threshold was estimated in the validation cohort by applying Cox proportional hazard models stratified by individual patients to 60-day duration windows. Analyses were performed separately in the ICD and CRT-D groups.
Results
The study cohort included 2,384 patients with 69 years of age (interquartile range: 60, 77); 19% were women, 42% had coronary artery disease, and 43% had a CRT-D. After a median follow-up of 2.0 (1.0, 3.4) years, there were 3,298 appropriate SVA episodes in 727 patients (30%).
The derived IT-index consisted of the percentage of 6-day intervals of the rolling average of TI values showing monotone decrease in the last 82 days. The increase in the risk of SVA was 3% (p<0.0001) per unit of percentage. The threshold of 60% of intervals with monotone decrease was associated with 99.9% projected specificity and 70.3% accuracy.
In the validation cohort, the TI-Index was associated with a 42% increased risk of SVA episodes in the ICD group (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.05-1.92, p=0.023). The TI-index exceeded the 60% threshold before the episode in 38% of the detected episodes. The association was not significant in the CRT-D group (HR 0.96, 95% CI 0.62-1.47, p=0.84).
Conclusions
In our analysis of remote monitoring data, a specific monotonic decreasing trend of TI was temporally associated with SVA in patients with ICD. Careful monitoring of TI can identify a period of susceptibility to ventricular arrhythmias that deserves more intensive attention.
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Affiliation(s)
| | | | | | - Valeria Calvi
- Azienda O.U. Policlinico G. Rodolico-San Marco Catania
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14
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Maglia G, Giammaria M, Zanotto G, D'Onofrio A, Della Bella P, Marini M, Rovaris G, Iacopino S, Calvi V, Pisanò EC, Ziacchi M, Curnis A, Senatore G, Caravati F, Saporito D, Forleo GB, Pedretti S, Santobuono VE, Pepi P, De Salvia A, Balestri G, Maines M, Orsida D, Bisignani G, Baroni M, Lissoni F, Bertini M, Giacopelli D, Gargaro A, Biffi M. Ventricular Arrhythmias and Implantable Cardioverter-Defibrillator Therapy in Women: A Propensity Score-Matched Analysis. JACC Clin Electrophysiol 2022; 8:1553-1562. [PMID: 36543505 DOI: 10.1016/j.jacep.2022.08.002] [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: 03/23/2022] [Revised: 07/13/2022] [Accepted: 08/05/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Causes of sex differences in incidence of sustained ventricular arrhythmias (SVAs) are poorly understood. OBJECTIVES This study aims to investigate sex-specific risk of SVAs and device therapies by balancing sex groups in relation to several baseline characteristics with the propensity score (PS). METHODS We used a large remote monitoring dataset from implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds). Study endpoints were time to the first appropriate SVA, time to the first device therapy for SVA, and time to the first ICD shock. Results were compared between females and a PS-matched male subgroup. RESULTS In a cohort of 2,532 patients with an ICD or CRT-D (median age, 70 years), 488 patients (19.3%) were women. After selecting 488 men PS-matched for 19 variables relative to baseline demographics, implant indications, principal comorbidities, and concomitant therapy, yet the SVA rate at the 2.1-year median follow-up was significantly lower in women than in man (adjusted HR: 0.65; 95% CI: 0.51-0.81; P < 0.001). Women also showed a reduced risk of any device therapy (HR: 0.59; 95% CI: 0.45-0.76; P < 0.001) and shocks (HR: 0.66; 95% CI: 0.47-0.94; P = 0.021). Differences in sex-specific SVA risk profile were not confirmed in CRT-D patients (HR: 0.78; 95% CI: 0.55-1.09; P = 0.14) nor in those with an ejection fraction <30% (HR: 0.80; 95% CI: 0.52-1.23; P = 0.31). CONCLUSIONS After matching demographics, indications, principal comorbidities, and concomitant therapy, women still exhibited a lower SVA risk profile than men, except in the subgroups of CRT-D or/and ejection fraction <30%.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Valeria Calvi
- Azienda O.U. Policlinico G. Rodolico - San Marco, Catania, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Matteo Baroni
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | | | - Daniele Giacopelli
- Biotronik Italia S.p.a., Vimodrone (MI), Italy; University of Padova, Padova, Italy
| | | | - Mauro Biffi
- Policlinico Sant'Orsola-Malpighi, Bologna, Italy
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15
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Rordorf R, Viani S, Biffi M, Pieragnoli P, Nigro G, Migliore F, Francia P, De Filippo P, Dello Russo A, D'Onofrio A, Bisignani G, Ottaviano L, Caravati F, Valsecchi S, Vicentini A. Subcutaneous Implantable Defibrillator programming: an analysis of Italian clinical practice and its evolution. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The UNTOUCHED study (designed in 2017 and published in 2021) demonstrated high success rate for termination of ventricular arrhythmias, and very low inappropriate shock rate in subcutaneous implantable cardioverter-defibrillator (S-ICD) recipients. The prescribed device programming included a conditional zone between 200 and 250 beats per minute (bpm) with discrimination algorithms employed to avoid delivering inappropriate shocks in this range, and a shock zone based on the rate alone for arrhythmias >250 bpm. Whether these results influenced clinical practice is unknown.
Methods
We assessed the programming at implantation and changes in programmed parameters at follow-up (≥1 year) in a cohort of S-ICD recipients enrolled in the Rhythm Detect registry at 56 centers.
Results
From 2013 to 2021, 1521 consecutive patients (aged 49±15 years; 79% male, 52% dilated cardiomyopathy, 31% arrhythmic syndromes, 16% hypertrophic cardiomyopathy) were analyzed. At implantation, the programmed sensing vector was the Primary in 59% of patients, the Secondary in 35%, the Alternate in 6%. At follow-up, the sensed vector was changed in 13% of patients. The programmed conditional zone cutoff was set to 200 [200–220] bpm (median [25–75 percentile]), and the shock zone cutoff to 230 [210–250] bpm. At follow-up, the conditional zone cutoff was reprogrammed in 13% of patients, but the median value in the overall population did not change (200 [200–220] bpm; p>0.05). The shock zone cutoff was reprogrammed in 43% of cases, and the overall median value was 250 [230–250] bpm (p<0.001 versus implantation). Sorting patients by implantation date, we observed that in the first 764 patients (implanted ≤2017) the shock zone cutoff was set to 210 [210–230] bpm at implantation and to 240 [230–250] bpm at follow-up (reprogrammed in 66% of cases). While in patients implanted >2017, it was already set to 250 [230–250] bpm at implantation and to 250 [240–250] bpm at follow-up (reprogrammed in 20% of cases, p<0.001 versus ≤2017).
Conclusions
S-ICD programming parameters are rarely changed during follow-up (approximately 13% of patients). The only exception in clinical practice was the shock zone cutoff. Centers have begun to program high cutoffs in recent years. This happened at the time of implantation for new S-ICD recipients and at follow-up for pre-existing implants. This behavior is consistent with a substantial adoption of published trial findings and could contribute to reduce the incidence of inappropriate shocks in clinical practice.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Rordorf
- Foundation IRCCS Polyclinic San Matteo - University of Pavia , Pavia , Italy
| | - S Viani
- Cisanello Hospital , Pisa , Italy
| | - M Biffi
- S. Orsola-Malpighi Policlinic , Bologna , Italy
| | | | - G Nigro
- Luigi Vanvitelli University Hospital , Naples , Italy
| | - F Migliore
- University Hospital of Padova , Padua , Italy
| | | | - P De Filippo
- ASST Papa Giovanni XXIII Bergamo , Bergamo , Italy
| | - A Dello Russo
- Marche Polytechnic University of Ancona , Ancona , Italy
| | - A D'Onofrio
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - G Bisignani
- Civil Hospital Ferrari - Castrovillari , Castrovillari , Italy
| | - L Ottaviano
- Clinical Institute Saint Ambrogio , Milan , Italy
| | - F Caravati
- Circolo Hospital and Macchi Foundation of Varese , Varese , Italy
| | | | - A Vicentini
- Foundation IRCCS Polyclinic San Matteo - University of Pavia , Pavia , Italy
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16
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Botto GL, Ziacchi M, Nigro G, D'Onofrio A, Dello Russo A, Francia P, Viani S, Pisano' E, Bisignani G, Caravati F, Migliore F, De Filippo P, Ottaviano L, Valsecchi S, Checchi L. Intermuscular technique for implantation of the subcutaneous implantable defibrillator: a propensity-matched case-control study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
A previous randomized study (PRAETORIAN) demonstrated that the subcutaneous implantable cardioverter–defibrillator (S-ICD) was noninferior to transvenous ICD with respect to device-related complications and inappropriate shocks. However, that was performed prior to the widespread adoption of pulse generator implantation in the intermuscular (IM) space instead of the traditional subcutaneous (SC) pocket.
Purpose
To compare survival from device-related complications and inappropriate shocks between patients who underwent S-ICD implantation with the generator positioned in an IM position in comparison with a SC pocket.
Methods
We analyzed 1577 consecutive patients who had undergone S-ICD implantation from 2013 to 2021 and were followed up until December 2021. SC patients were propensity-matched with patients of the IM group, and their outcomes were compared.
Results
SC implantations were performed in 367 (23%) patients. These patients were propensity-matched with 367 IM patients. Intra-procedural complications were reported in 9 (2.5%) patients in the SC Group and 7 (1.9%) in the IM Group. During a median follow-up of 29 months, device-related complications were reported in 55 (7.5%) patients and inappropriate shocks were reported in 54 (7.4%) patients. The risk of the composite primary endpoint was lower in the matched IM Group than in the SC Group (unadjusted hazard ratio 0.67, 95% CI 0.45–0.99, p=0.042), while the risk of appropriate shocks was similar between groups (unadjusted hazard ratio 0.99, 95% CI 0.60–1.64, p=0.976). There was no significant interaction between generator positioning and variables such as gender, age, body mass index, ejection fraction and generation of the device.
Conclusions
In this experience, IM S-ICD generator positioning was superior to SC positioning in reducing device-related complications and inappropriate shocks.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G L Botto
- ASST Rhodense , Garbagnate Milanese , Italy
| | - M Ziacchi
- S. Orsola-Malpighi Policlinic , Bologna , Italy
| | - G Nigro
- Luigi Vanvitelli University Hospital , Naples , Italy
| | - A D'Onofrio
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - A Dello Russo
- Marche Polytechnic University of Ancona , Ancona , Italy
| | | | - S Viani
- Cisanello Hospital , Pisa , Italy
| | | | - G Bisignani
- Civil Hospital Ferrari - Castrovillari , Castrovillari , Italy
| | - F Caravati
- Circolo Hospital and Macchi Foundation of Varese , Varese , Italy
| | - F Migliore
- University Hospital of Padova , Padua , Italy
| | - P De Filippo
- ASST Papa Giovanni XXIII Bergamo , Bergamo , Italy
| | - L Ottaviano
- Clinical Institute Saint Ambrogio , Milan , Italy
| | | | - L Checchi
- Careggi University Hospital , Florence , Italy
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17
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Bisignani A, De Bonis S, Cavaliere AL, Lovecchio M, Valsecchi S, Bisignani G. Stability of the subcutaneous defibrillator implanted with the intermuscular two-incision technique: 1-year follow-up. J Cardiovasc Med (Hagerstown) 2022; 23:484-486. [PMID: 35763773 DOI: 10.2459/jcm.0000000000001311] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Antonio Bisignani
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome
| | - Silvana De Bonis
- Department of Cardiology, Ospedale 'Ferrari', Castrovillari, Cosenza
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18
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Viani S, Segreti L, Ottaviano L, Biffi M, Nigro G, Ricciardi G, Francia P, D’onofrio A, Bisignani G, Dello Russo A, De Filippo P, Solimene F, Scalone A, Botto G, Migliore F. Real-world survival of model-3501 subcutaneous implantable defibrillator lead. Europace 2022. [DOI: 10.1093/europace/euac053.451] [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
In December 2020, the subcutaneous implantable cardioverter-defibrillator (S-ICD) lead model-3501 was subject to a safety notification because of increased risk of fracture at a location just distal to the proximal sense ring. The manufacturer’s product performance report currently reports a lead survival probability of 98.8% at 45 months. However, no multicenter long-term performance information exists for this lead.
Purpose
Our aim was to assess the longevity of model-3501 leads and to compare it with that of the previous model-3401.
Methods
This analysis included consecutive patients who received an S-ICD with a model-3501 or a model-3401 lead at 66 Italian participating centers of the Rhythm Detect registry. A lead failed if it required extraction/replacement because of abnormalities suggestive of a structural defect, e.g. out-of-range impedance, nonphysiological electrical noise or ineffective therapy.
Results
From January 2013 to July 2021, 2403 patients were implanted and followed up (78% male, age 49±15years, ejection fraction 45±16%, body mass index 26±4Kg/m2). A 3501-model lead was used in 1697 patients and a 3401-model in 706 patients. During a median follow-up of 38 months [25th–75th percentile: 24-55], we detected 4 malfunctioning model-3501 leads and 2 model-3401 leads. After analysis of the returned leads by the manufacturer’s technical services, a single model-3501 lead failure was a fracture distal to the proximal ring electrode, as described in the manufacturer’s advisory letter. No deaths or permanent injuries occurred as a result of lead failures. The survival of 3501-model leads at 4 years was 99.5% (95% confidence interval, 99.0 to 99.9) compared with 99.9% (95% confidence interval, 99.6 to 100.0) of 3401-model leads (p=0.110). The cumulative occurrence rate of the 3501-model safety notification fracture was 0.1% (95% confidence interval, 0.0 to 0.3).
Conclusions
In this large multicenter analysis, the survival probability of model-3501 S-ICD leads was in line with that reported by the manufacturer, was not significantly lower than that of 3401-model leads (not affected by a safety notification), and still higher than that reported with transvenous leads. Although an enhanced electrode is now available, which addresses the potential for electrode body fracture, the present findings are reassuring and may have significant implications for the management of patients who have affected leads.
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Affiliation(s)
- S Viani
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Segreti
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Ottaviano
- Clinical Institute Saint Ambrogio, Milan, Italy
| | - M Biffi
- S. Orsola-Malpighi Policlinic, Bologna, Italy
| | - G Nigro
- University of Campania Luigi Vanvitell, Naples, Italy
| | - G Ricciardi
- Careggi University Hospital, Florence, Italy
| | | | | | - G Bisignani
- Civil Hospital Ferrari - Castrovillari, Castrovillari, Italy
| | | | | | | | | | - G Botto
- ASST Rhodense, Garbagnate Milanese, Italy
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19
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VIANI STEFANO, Segreti L, Ottaviano L, Biffi M, Nigro G, Ricciardi G, Francia P, D'Onofrio A, Bisignani G, Russo AD, FILIPPO PAOLODE, Solimene F, Scalone A, Migliore F. PO-618-04 LONGEVITY OF MODEL-3501 SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR LEAD IN CLINICAL PRACTICE. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Viani S, Migliore F, Ottaviano L, Biffi M, Ammendola E, Ricciardi G, Francia P, D’Onofrio A, Bisignani G, Russo AD, De Filippo P, Solimene F, Scalone A, Caravati F, Rordorf R, Calvi VI, Botto GL, Bongiorni MG. Longevity of model-3501 subcutaneous implantable defibrillator leads in clinical practice. Viani: Longevity of S-ICD leads. Heart Rhythm 2022; 19:1206-1207. [DOI: 10.1016/j.hrthm.2022.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/21/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022]
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21
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Deneke T, Cabanas P, Hofer D, Gaspar T, Pierre B, Bisignani G, Pathak RK, Sanfins VM, Martens E, Mansourati J, Berruezo-Sanchez A, Wiemer M, Hain A, Pezawas T, Wenzel B, Lau D. New Generation Miniaturized Insertable Cardiac Monitor with a Long Sensing Vector: Insertion Procedure, Sensing Performance, and Home Monitoring Transmission Success in a Real-World Population. Heart Rhythm O2 2022; 3:152-159. [PMID: 35496450 PMCID: PMC9043386 DOI: 10.1016/j.hroo.2022.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Indexed: 12/27/2022] Open
Abstract
Background Objective Methods Results Conclusion
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Affiliation(s)
- Thomas Deneke
- Rhön Clinic Campus Bad Neustadt, Bad Neustadt a. d. Saale, Germany
- Address reprint requests and correspondence: Prof Dr Thomas Deneke, RHÖN-KLINIKUM Campus Bad Neustadt, Von-Guttenberg-Strasse 11, 97616 Bad Neustadt a.d. Saale, Germany.
| | | | | | - Thomas Gaspar
- Heart Center, University of Dresden, Dresden, Germany
| | | | | | | | | | - Eimo Martens
- Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | | | | | | | | | | | | | - Dennis Lau
- Royal Adelaide Hospital, Adelaide, Australia
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22
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Bisignani A, De Bonis S, Cavaliere AL, Bisignani G. Reply to S-ICD: Is it time for radiological follow-ups? J Cardiovasc Electrophysiol 2021; 33:324. [PMID: 34910344 DOI: 10.1111/jce.15324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Antonio Bisignani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
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23
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De Luca E, Madeo A, Pasquale GS, Ponturo G, Rosselli F, De Bonis S, Bisignani G. 773 Correlation between high troponin levels and left atrial strain as biomarker of incremented atrial fibrillation rate in patients with acute myocardial infarction. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab140.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Heart rhythm disorders, both bradyarrhythmias and tachyarrhythmias, are the most frequently observed complication in the acute phase and after primary angioplasty in patients with acute myocardial infarction (AMI). New onset atrial fibrillation (Afib) represents the most frequent arrhythmia found between 6% and 21% in patients with AMI and its onset increases the thromboembolic and mortality risk of all causes of those patients. Troponin levels measured with modern assays represent today the most specific cardiac biomarker of myocardial injury and its measurement represents the cornerstone for the diagnosis of AMI in accordance with the ESC Guidelines 2018; however, also Afib itself causes an increase in troponin values (troponinopathy). Therefore, the single biohumoral value cannot assume prognostic value in helping the clinician to recognize patients with AMI who are more predisposed to encounter Afib. So, the object of our evaluation was to support the elevated troponin values with echocardiographic biomarkers, such as the evaluation of the left atrial strain (LAS), to perform a more accurate stratification of the arrhythmic risk in patients with AMI.
Methods and results
A prospective multiparametric study was carried out at our Interventional Cardiology Hub Center. 240 patients with ACS-STEMI diagnosed were recruited over one year from March 2020 to March 2021. Patients included were all ≥18 (55 ± 23 y), predominantly male (88% male, 12% female). Exclusion criteria were: permanent atrial fibrillation; valvular heart disease (moderate or severe heart valve stenosis or valve replacement); implantation of a pacemaker or defibrillator; (4) poor image quality. Emergency coronary angiography (CAG) was carried out to execute primary percutaneous intervention (primary PCI with DES) on the culprit vessel. All patients underwent echocardiography by GE Vivid 80 (GE Ultrasound, Horten, Norway) in order to evaluate changes in segmental kinetics, left ventricular ejection fraction (LVEF). The ratio of peak early filling velocity of mitral inflow to early diastolic annulus velocity (E′) of the medial annulus (E/E′) was calculated. Left atrial volumes (LAVi, ml/m2) and diameter were obtained through standard apical 4 and 2 chamber views with a frame-rate range of 40–71 frames/s; then, offline analysis of images was performed using EchoPAC version 201 (GE Vingmed Ultrasound) (VSSLV) software in order to calculate LAS for each one. Patients were subjected to serial sampling to evaluate temporally troponin values and the possible Afib appearance was recognized by telemetry monitoring. Statistical analysis was performed using SPSS version 20 (IBM, Armonk, New York), continuous variables were expressed as mean ± standard deviation (SD). Pearson’s correlation coefficient was used to assess the correlation between strain value, baseline characteristics and troponin levels. All statistical tests are two-sided, and a P-value < 0.05 is considered statistically significant. Two groups were recognized: high troponin levels with pathological LAS and new Afib (N = 47); medium-high troponin levels with normal LAS and no Afib (N = 143). Respectively, LAS were 8.4 ± 4.0% vs. 16 ± 4.5%, P < 0.001, LAVi 44 ± 5 ml/m2 vs. 30 ± 3.2, P = 0.001, and peak of troponin levels (3.45 ± 0.46 ng/ml vs. 2.34 ± 0.22 ng/ml, P = 0.002). Multivariate analysis identified that peak troponin levels alone wasn’t a prognostic index of increased arrhythmic burden, while the correlation between high peak levels and altered LAS were independent predictors of new AFib in AMI.
Conclusions
The evaluation of atrial dysfunction by new echo-derived parameters and its correlation with troponin values allows a more accurate stratification of arrhythmic risk in patients with ACS. The applicability of the obtained data would allow a more careful evaluation of the clinical trend and the prognostic outcome in the subcategory analysed. Therefore, the association between biohumoral and instrumental parameters could become new biomarkers capable of predicting an increase in thromboembolic risk in AMI patients. The creation of an app that takes into account the parameters listed could be a possible future support that can help the clinician calculate the increased risk rate of new Afib in patients with ACS.
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Affiliation(s)
- Emilia De Luca
- Cardiology Department, Interventional Cardiology, ‘P. Ferrari’ Hospital, Castrovillari, ASP Cosenza, Italy
- PhD Biomarkers of Chronic and Complex Diseases, Magna Graecia University, Catanzaro, UK
| | - Andrea Madeo
- Cardiology Department, Interventional Cardiology, ‘P. Ferrari’ Hospital, Castrovillari, ASP Cosenza, Italy
| | - Giovanni San Pasquale
- Cardiology Department, Interventional Cardiology, ‘P. Ferrari’ Hospital, Castrovillari, ASP Cosenza, Italy
| | - Gianluca Ponturo
- Cardiology Department, Interventional Cardiology, ‘P. Ferrari’ Hospital, Castrovillari, ASP Cosenza, Italy
| | - Francescantonio Rosselli
- Cardiology Department, Interventional Cardiology, ‘P. Ferrari’ Hospital, Castrovillari, ASP Cosenza, Italy
| | - Silvana De Bonis
- Cardiology Department, Interventional Cardiology, ‘P. Ferrari’ Hospital, Castrovillari, ASP Cosenza, Italy
| | - Giovanni Bisignani
- Cardiology Department, Interventional Cardiology, ‘P. Ferrari’ Hospital, Castrovillari, ASP Cosenza, Italy
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24
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Bianchi V, Bisignani G, Migliore F, Biffi M, Nigro G, Viani S, Caravati F, Checchi L, Francia P, De Filippo P, Pecora D, Lavalle C, Scalone A, Rossi P, Palmisano P, Licciardello G, Ospizio R, Lovecchio M, Valsecchi S, D'Onofrio A. Safety of Omitting Defibrillation Efficacy Testing With Subcutaneous Defibrillators: A Propensity-Matched Case-Control Study. Circ Arrhythm Electrophysiol 2021; 14:e010381. [PMID: 34852635 DOI: 10.1161/circep.121.010381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Valter Bianchi
- "Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie", Monaldi Hospital, Naples, Italy (V.B., A.D.)
| | | | - Federico Migliore
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (F.M.)
| | - Mauro Biffi
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S.Orsola-Malpighi, Italy (M.B.)
| | - Gerardo Nigro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Monaldi Hospital, Naples, Italy (G.N.)
| | - Stefano Viani
- Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (S.V.)
| | | | | | - Pietro Francia
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University, St. Andrea Hospital, Rome, Italy (P.F.)
| | | | - Domenico Pecora
- Unità di Elettrofisiologia, Dipartimento Cardiovascolare, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (D.P.)
| | - Carlo Lavalle
- Department of Cardiovascular Disease, Policlinico Umberto I Hospital, Rome, Italy (C.L.)
| | | | | | | | | | | | | | | | - Antonio D'Onofrio
- "Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie", Monaldi Hospital, Naples, Italy (V.B., A.D.)
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25
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Stabile G, Guerra F, Tola G, Bertaglia E, Palmisano P, Berisso MZ, Soldati E, Bisignani G, Forleo GB, Zanotto G, Landolina M, Boriani G, D'Onofrio A, De Ponti R, Ricci RP. [2019 Catheter Ablation Registry of the Italian Association of Arrhythmology and Cardiac Pacing]. G Ital Cardiol (Rome) 2021; 22:1034-1037. [PMID: 34845406 DOI: 10.1714/3698.36883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND This report describes the findings of the 2019 Italian Catheter Ablation Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC). METHODS Data collection was retrospective. A standardized questionnaire was completed by each of the participating centers. RESULTS A total of 15 201 ablation procedures were performed by 91 institutions. Most (78%) of the centers has one electrophysiology laboratory, and 17% of them has a hybrid cardiac surgery laboratory. Almost all (98%) centers have a 3D mapping system. The median number of electrophysiologists and nurses involved in the electrophysiology laboratory was 3 and an electrophysiology technician was involved in 30% of all centers. In 88.4% of cases, ablations were performed for supraventricular arrhythmias, and among these the most frequently treated arrhythmia was atrial fibrillation (32.9%), followed by atrioventricular nodal reentrant tachycardia (23.9%), and common atrial flutter (11.7%). In 10 256 (67.4%) patients catheter ablation was performed by means of a 3D mapping system, with a "near-zero" fluoroscopic approach in 4626 (30.4%) of all patients. CONCLUSIONS The 2019 Italian Catheter Ablation Registry confirmed that atrial fibrillation is the most commonly treated arrhythmia in the ablation centers with an increasing number of procedures performed with a 3D mapping system and a "near-zero" approach.
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Affiliation(s)
- Giuseppe Stabile
- Anthea Hospital, Bari - Clinica Montevergine, Mercogliano (AV) - Clinica San Michele, Maddaloni (CE)
| | - Federico Guerra
- Università Politecnica delle Marche, Ospedali Riuniti, Ancona
| | | | | | | | | | | | | | | | | | | | - Giuseppe Boriani
- Università di Modena e Reggio Emilia, Policlinico di Modena, Modena
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26
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Vicentini A, Bisignani G, De Vivo S, Viani S, Savarese G, Francia P, Celentano E, Checchi L, Carreras G, Santini L, Lamberti F, Ottaviano L, Scalone A, Giorgi D, Lovecchio M, Valsecchi S, Rordorf R. Patient acceptance of subcutaneous versus transvenous defibrillator systems: A multi-center experience. J Cardiovasc Electrophysiol 2021; 33:81-89. [PMID: 34797012 DOI: 10.1111/jce.15297] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 06/01/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an effective alternative to the transvenous ICD. No study has yet compared S-ICD and transvenous ICD by assessing patient acceptance as a patient-centered outcome. OBJECTIVE To evaluate the patient acceptance of the S-ICD and to investigate its association with clinical and implantation variables. In patients with symptomatic heart failure and reduced ejection fraction (HFrEF), the acceptance of the S-ICD was compared with a control group of patients who received a transvenous ICD. METHODS Patient acceptance was calculated with the Florida Patient Acceptance Survey (FPAS) which measures four factors: return to function (RTF), device-related distress (DRD), positive appraisal (PA), and body image concerns (BIC). The survey was administered 12 months after implantation. RESULTS 176 patients underwent S-ICD implantation. The total FPAS and the single factors did not differ according to gender, body habitus, or generator positioning. Patients with HFrEF had lower FPAS and RTF. Younger patients showed better RTF (75 [56-94] vs. 56 [50-81], p = .029). Patients who experienced device complications or device therapies showed higher DRD (40 [35-60] vs. 25 [10-50], p = .019). Patients with HFrEF receiving the S-ICD had comparable FPAS, RTF, DRD, and BIC to HFrEF patients implanted with the transvenous ICD while exhibited significantly better PA (88 [75-100] vs. 81 [63-94], p = .02). CONCLUSIONS Our analysis revealed positive patient acceptance of the S-ICD, even in groups at risk of more distress such as women or patients with thinner body habitus, and regardless of the generator positioning. Among patients receiving ICDs for HFrEF, S-ICD was associated with better PA versus transvenous ICD.
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Affiliation(s)
- Alessandro Vicentini
- Department of Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico 'S. Matteo', Pavia, Italy
| | | | - Stefano De Vivo
- Unità Operativa di Elettrofisiologia, 'Studio e Terapia delle Aritmie', Monaldi Hospital, Naples, Italy
| | - Stefano Viani
- Division of Second Cardiology, Department of Cardio-Thoracic and Vascular, University Hospital of Pisa, Pisa, Italy
| | - Gianluca Savarese
- Department of Cardiology, 'San Giovanni Battista' Hospital, Foligno, Italy
| | - Pietro Francia
- Cardiology, Department of Clinical and Molecular Medicine, 'St. Andrea' Hospital, Sapienza University, Rome, Italy
| | - Eduardo Celentano
- Department of Cardiology, 'Santa Maria della Pietà' Hospital, Casoria, Napoli, Italy
| | | | | | - Luca Santini
- Division of Cardiology, Divisiono of Hospital Cardiology, 'Giovan Battista Grassi' Hospital, Rome, Italy
| | - Filippo Lamberti
- Department of Medicine, Cardiovascular Section, 'San Eugenio' Hospital, Rome, Italy
| | - Luca Ottaviano
- Department of Cardiology, Istituto Clinico 'Sant'Ambrogio', Milan, Italy
| | | | - Davide Giorgi
- Division of Cardiology, 'San Luca' Hospital, Lucca, Italy
| | | | | | - Roberto Rordorf
- Department of Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico 'S. Matteo', Pavia, Italy
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27
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Palmisano P, Ziacchi M, Angeletti A, Guerra F, Forleo GB, Bertini M, Notarstefano P, Accogli M, Lavalle C, Bisignani G, Landolina M, Zanotto G, D’Onofrio A, Ricci RP, De Ponti R, Boriani G. The Practice of Deep Sedation in Electrophysiology and Cardiac Pacing Laboratories: Results of an Italian Survey Promoted by the AIAC (Italian Association of Arrhythmology and Cardiac Pacing). J Clin Med 2021; 10:jcm10215035. [PMID: 34768557 PMCID: PMC8584354 DOI: 10.3390/jcm10215035] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 01/23/2023] Open
Abstract
The aim of this survey, which was open to all Italian cardiologists involved in arrhythmia, was to assess common practice regarding sedation and analgesia in interventional electrophysiology procedures in Italy. The survey consisted of 28 questions regarding the approach to sedation used for elective direct-current cardioversion (DCC), subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation, atrial fibrillation (AF) ablation, ventricular tachycardia (VT) ablation, and transvenous lead extraction procedures. A total of 105 cardiologists from 92 Italian centres took part in the survey. The rate of centres where DCC, S-ICD implantation, AF ablation, VT ablation and lead extraction procedures were performed without anaesthesiologic assistance was 60.9%, 23.6%, 51.2%, 37.3%, and 66.7%, respectively. When these procedures were performed without anaesthesiologic assistance, the drugs (in addition to local anaesthetics) commonly administered were benzodiazepines (from 64.3% to 79.6%), opioids (from 74.4% to 88.1%), and general anaesthetics (from 7.1% to 30.4%). Twenty-three (21.9%) of the 105 cardiologists declared that they routinely administered propofol, without the supervision of an anaesthesiologist, in at least one of the above-mentioned procedures. In current Italian clinical practice, there is a lack of uniformity in the sedation/analgesia approach used in interventional electrophysiology procedures.
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Affiliation(s)
- Pietro Palmisano
- Cardiology Unit, “Card. G. Panico” Hospital, 73039 Tricase, Italy;
- Correspondence:
| | - Matteo Ziacchi
- Institute of Cardiology, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (M.Z.); (A.A.)
| | - Andrea Angeletti
- Institute of Cardiology, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (M.Z.); (A.A.)
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I-Lancisi-Salesi, 60126 Ancona, Italy;
| | | | - Matteo Bertini
- Cardiology Unit, Azienda Ospedaliero-Universitaria Di Ferrara “Arcispedale S. Anna”, 44124 Cona, Ferrara, Italy;
| | | | - Michele Accogli
- Cardiology Unit, “Card. G. Panico” Hospital, 73039 Tricase, Italy;
| | - Carlo Lavalle
- Department of Cardiology, Policlinico Universitario Umberto I, 00161 Roma, Italy;
| | - Giovanni Bisignani
- Cardiology Division, Castrovillari Hospital, ASP Cosenza, 87012 Castrovillari, Italy;
| | | | - Gabriele Zanotto
- Department of Cardiology, Mater Salutis Hospital, 37045 Legnago, Verona, Italy;
| | - Antonio D’Onofrio
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, 80131 Naples, Italy;
| | | | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale Di Circolo-University of Insubria, 21100 Varese, Italy;
| | - Giuseppe Boriani
- Department of Biomedical, Metabolic and Neural Sciences, Cardiology Division, University of Modena and Reggio Emilia, Policlinico Di Modena, 41121 Modena, Italy;
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28
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Migliore F, Viani S, Ziacchi M, Ottaviano L, Checchi L, Francia P, D'Onofrio A, Bisignani G, Dello Russo A, De Filippo P, Solimene F, Pisano E, Palmisano P, Manzo M, Botto GL. Defibrillation testing of subcutaneous versus transvenous defibrillators in the clinical practice: a nationwide survey in Italy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
According to current guidelines, defibrillation testing (DT) for efficacy can be omitted in patients undergoing transvenous implantable cardioverter–defibrillator (T-ICD) implantation. DT is still recommended for patients at risk for a high defibrillation threshold (e.g. hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, right-sided implantations) and for ICD generator changes. Moreover, a class I recommendation remains to perform DT during the implantation of subcutaneous ICD (S-ICD). The aim of the present survey was to analyze the current practice of DT during T-ICD and S-ICD implantations in Italy.
Methods
In March 2021, an ad hoc questionnaire on the current performance of DT and the standard practice adopted during testing was completed by 72 operators at Italian centers implanting S-ICD and T-ICD.
Results
48 (67%) operators reported never performing DT during de-novo T-ICD implantations, while no operators perform it systematically. The remaining respondents perform it in specific cases: right sided implantations (54%), poor signal sensing (46%), secondary prevention patients (42%), arrhythmic syndromes (13%), hypertrophic cardiomyopathy (8%). DT is never performed at T-ICD generator change. At the time of de-novo S-ICD implantation, DT is never performed by 9 (13%) operators and performed systematically by 48 (66%). The remaining operators perform DT in cases of: secondary prevention patients (73%), sub-optimal S-ICD placement (33%), non-compromised ejection fraction (33%) or obese patients (7%). DT is not performed at S-ICD generator change by 92% of operators. DT is conducted by delivering a first shock energy of 65J by 60% of operators, while the remaining 40% test lower energy values. The most frequently reported conditions for revising the system at the end of de- novo implantation procedure is high shock impedance (54%) and sub-optimal S-ICD placement or high PRAETORIAN score (50%). With adequately low shock impedance and optimal system placement, 37% of operators would accept a defibrillation margin <15J.
Conclusion
In current clinical practice, the vast majority of operators omit DT at T-ICD implantation, even when still recommended in the guidelines. DT is also frequently omitted at S-ICD implantation. We also report a wide variability among operators in the procedures followed during DT and in the criteria applied for defining the procedural success.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Migliore
- Departement of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - S Viani
- University Hospital, Pisa, Italy
| | - M Ziacchi
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - L Ottaviano
- Clinical Institute Saint Ambrogio, Milan, Italy
| | - L Checchi
- Careggi University Hospital, Florence, Italy
| | - P Francia
- Sapienza University Sant'Andrea Hospital, Rome, Italy
| | - A D'Onofrio
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | | | - A Dello Russo
- Marche Polytechnic University of Ancona, Ancona, Italy
| | | | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - E Pisano
- Vito Fazzi Hospital, Lecce, Italy
| | - P Palmisano
- Cardinale G. Panico Hospital, Tricase, Italy
| | - M Manzo
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
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29
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Rapacciuolo A, Iacopino S, D'Onofrio A, Curnis A, Pisanò EC, Biffi M, Della Bella P, Dello Russo A, Caravati F, Zanotto G, Calvi V, Rovaris G, Senatore G, Nicolis D, Santamaria M, Giammaria M, Maglia G, Duca A, Ammirati G, Romano SA, Piacenti M, Celentano E, Bisignani G, Vaccaro P, Miracapillo G, Bertini M, Nigro G, Giacopelli D, Gargaro A, Bisceglia C. Cardiac resynchronization therapy defibrillators in patients with permanent atrial fibrillation. ESC Heart Fail 2021; 8:5204-5212. [PMID: 34514741 PMCID: PMC8712818 DOI: 10.1002/ehf2.13599] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/22/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022] Open
Abstract
Aims There are conflicting data on the benefit of cardiac resynchronization therapy (CRT) in heart failure (HF) patients with permanent atrial fibrillation (AF). We aimed to compare patient outcomes according to the presence or absence of permanent AF at device implantation. Methods and results We retrospectively analysed remote monitoring data from 1141 CRT defibrillators. Propensity score with inverse‐probability weighting method was used to balance AF and sinus rhythm (SR) groups. Analysis endpoints included total mortality, appropriate defibrillation shocks, and CRT percentage. There were 229 patients (20.1%) in the AF group and 912 patients (79.9%) in the SR group. Compared with SR patients, AF patients were older (median age, 77 vs. 72 years, P < 0.001), more frequently male (82.5% vs. 75.5%, P = 0.02), and had higher heart rate (75.7 vs. 71.0 b.p.m., P < 0.001). Of the 229 AF patients, 162 (70.7%) received suboptimal CRT (<98%) and 67 (29.3%) had adequate CRT (≥98%). During a median follow‐up of 24 months, total mortality did not differ between AF and SR groups (propensity‐score‐weighted hazard ratio, HR 1.32 [95% confidence interval, 0.82–2.15], P = 0.25). The risk of appropriate shocks was significantly higher in the AF group with <98% CRT than in the SR group (weighted‐HR, 1.99 [1.21–3.26], P = 0.006) and was similar in the AF group with ≥98% CRT versus the SR group (1.29 [0.66–2.53], P = 0.45). During follow‐up, sinus rhythm was recovered in 23 patients in the AF group (10%) after a median time of 106 (42–256) days. The rate of sinus rhythm recovery in the AF group was 4.5 (95% CI, 2.8–6.7) per 100 patient‐years; the rate of permanent AF occurrence in the SR group was 2.5 (95% CI, 1.9–3.3) per 100 patient‐years. Conclusions Although mortality was similar across patient groups, patients with permanent AF and suboptimal CRT had twofold higher risk of appropriate shocks than SR patients or AF patients with CRT ≥ 98%.
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Affiliation(s)
- Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Corso Umberto I, 40, Naples, 80138, Italy
| | | | | | | | | | - Mauro Biffi
- Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | | | - Valeria Calvi
- Policlinico G. Rodolico, Az. O.U. Policlinico - V. Emanuele, Catania, Italy
| | | | | | | | | | | | | | - Antonio Duca
- IRCCS Neurolesi-Ospedale Piemonte, Messina, Italy
| | - Giuseppe Ammirati
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Corso Umberto I, 40, Naples, 80138, Italy
| | | | | | | | | | - Paola Vaccaro
- AOR Villa Sofia-Cervello P.O. Cervello, Palermo, Italy
| | | | | | - Gerardo Nigro
- University of Campania "Luigi Vanvitelli," Monaldi Hospital, Naples, Italy
| | - Daniele Giacopelli
- Biotronik Italia S.p.a., Vimodrone, Italy.,University of Padova, Padova, Italy
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30
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Bianchi V, Bisignani G, Nigro G, Migliore F, Tola G, Viani S, Rossi P, Biffi M, Palmisano P, Checchi L, Licciardello G, Francia P, Leidi C, Lovecchio M, D'Onofrio A. B-AB11-03 OMISSION OF DEFIBRILLATION TESTING DURING S-ICD IMPLANTATION IN CLINICAL PRACTICE: FOLLOW UP ANALYSIS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.066] [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: 10/20/2022]
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31
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Russo V, Viani S, Migliore F, Nigro G, Biffi M, Tola G, Bisignani G, Dello Russo A, Sartori P, Rordorf R, Ottaviano L, Perego GB, Checchi L, Segreti L, Bertaglia E, Lovecchio M, Valsecchi S, Bongiorni MG. Lead Abandonment and Subcutaneous Implantable Cardioverter-Defibrillator (S-ICD) Implantation in a Cohort of Patients With ICD Lead Malfunction. Front Cardiovasc Med 2021; 8:692943. [PMID: 34395560 PMCID: PMC8356671 DOI: 10.3389/fcvm.2021.692943] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background: When an implantable-cardioverter defibrillator (ICD) lead becomes non-functional, a recommendation currently exists for either lead abandonment or removal. Lead abandonment and subcutaneous ICD (S-ICD) implantation may represent an additional option for patients who do not require pacing. The aim of this study was to investigate the outcomes of a strategy of lead abandonment and S-ICD implantation in the setting of lead malfunction. Methods: We analyzed all consecutive patients who underwent S-ICD implantation after abandonment of malfunctioning leads and compared their outcomes with those of patients who underwent extraction and subsequent reimplantation of a single-chamber transvenous ICD (T-ICD). Results: Forty-three patients underwent S-ICD implantation after abandonment of malfunctioning leads, while 62 patients underwent extraction and subsequent reimplantation of a new T-ICD. The two groups were comparable. In the extraction group, no major complications occurred during extraction, while the procedure failed and an S-ICD was implanted in 4 patients. During a median follow-up of 21 months, 3 major complications or deaths occurred in the S-ICD group and 11 in the T-ICD group (HR 1.07; 95% CI 0.29–3.94; P = 0.912). Minor complications were 4 in the S-ICD group and 5 in the T-ICD group (HR 2.13; 95% CI 0.49–9.24; P = 0.238). Conclusions: In the event of ICD lead malfunction, extraction avoids the potential long-term risks of abandoned leads. Nonetheless the strategy of lead abandonment and S-ICD implantation was feasible and safe, with no significant increase in adverse outcomes, and may represent an option in selected clinical settings. Further studies are needed to fully understand the potential risks of lead abandonment. Clinical Trial Registration: URL: ClinicalTrials.gov Identifier: NCT02275637
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Affiliation(s)
- Vincenzo Russo
- Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Stefano Viani
- Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Gerardo Nigro
- Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Mauro Biffi
- Institute of Cardiology, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | | | | | - Antonio Dello Russo
- Clinica di Cardiologia e Aritmologia, Università Politecnica delle Marche, Ancona, Italy
| | - Paolo Sartori
- Cardiology Division, Hospital IRCCS San Martino, Genoa, Italy
| | - Roberto Rordorf
- Department of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Luca Ottaviano
- Cardiology Division, Istituto Clinico S. Ambrogio, Milan, Italy
| | | | - Luca Checchi
- Cardiology Division, University of Florence, Florence, Italy
| | - Luca Segreti
- Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | | | | | - Maria Grazia Bongiorni
- Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
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32
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Guerra F, Palmisano P, Bisignani G, Forleo G, Landolina M, Soldati E, Stabile G, Zanotto G, Berisso MZ, Boriani G, De Ponti R, Ricci RP. [The unmet needs of sudden cardiac death. The role of the wearable cardioverter defibrillator when the risk is transient or uncertain]. G Ital Cardiol (Rome) 2021; 21:764-767. [PMID: 32968313 DOI: 10.1714/3431.34202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sudden cardiac death is defined as a natural death due to termination of cardiac activity associated with loss of consciousness, spontaneous breathing and circulation. Nowadays, the prevention of sudden cardiac death represents a major issue and many areas of uncertainty are not met by current evidences. Among those, reliable tools for risk stratification are still lacking, as well as solution for patients in which the risk of sudden cardiac death is due to a transient or correctable condition.The concept of the wearable cardioverter defibrillator is based on a potential solution for such grey areas. It merges long-term monitoring capabilities, shockable rhythm discrimination and shock delivery without the need for bystander assistance or invasive procedures. The present review aims to summarize current problems in dealing with this insidious condition, and to discuss potential options for patients in whom sudden cardiac death could be prevented more safely and cost-effectively.
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Affiliation(s)
- Federico Guerra
- Ospedali Riuniti "Umberto I-Lancisi-Salesi", Università Politecnica delle Marche, Ancona
| | | | | | | | | | | | - Giuseppe Stabile
- Clinica Montevergine, Mercogliano (AV), Clinica San Michele, Maddaloni (CE)
| | | | | | - Giuseppe Boriani
- Università di Modena e Reggio Emilia, Policlinico di Modena, Modena
| | - Roberto De Ponti
- Ospedale di Circolo, Università degli Studi dell'Insubria, Varese
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33
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Bianchi V, Bisignani G, Russo V, Migliore F, Tola G, Viani S, Rossi P, Biffi M, Palmisano P, Checchi L, Licciardello G, Francia P, Leidi C, Ospizio R, D"onofrio A. Safety of omitting defibrillation efficacy testing with subcutaneous defibrillators: a propensity matched case-control study. Europace 2021. [DOI: 10.1093/europace/euab116.404] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Defibrillation efficacy testing (DT) is recommended at implantation of subcutaneous implantable cardioverter–defibrillators (S-ICD). However, prior works found that adherence to this recommendation is declining in clinical practice.
Purpose
To compare survival from all-cause death and first ineffective shock (primary endpoint) and the composite of all-cause death, ineffective shock, inappropriate shock and device-related complication (secondary endpoint) between patients who underwent DT and those with omitted DT.
Methods
We analyzed 1652 consecutive patients who underwent S-ICD implantation in 60 Italian centers from 2013 to 2019.
Results
DT was not performed in 325 (20%) patients (no-DT patients). As compared with the DT group, these patients were older (51 ± 16 vs. 48 ± 15 years; p < 0.01) and had lower ejection fraction (37 ± 16% vs. 46 ± 16%; p < 0.01). The 325 no-DT patients were propensity matched with 325 patients of the DT group. During a median follow up of 19 months, 27 (4.2%) patients died for any-cause. During follow-up, 34 (5.2%) patients received appropriate shocks to treat discrete episodes of VT/VF. The first shock was effective in 30 out of 34 patients (88%), whereas a second shock was required to terminate VT/VF in 3 patients and a third shock in the last one. The primary endpoint occurred in 31 (4.8%) patients, and the risk was not significantly increased in the no-DT cohort (HR = 1.26, 95%CI:0.62-2.55, p = 0.522). Inappropriate shocks were reported in 36 (5.5%) patients and device-related complications in 25 (3.8%) patients during follow-up. Survival from the composite secondary endpoint was comparable between groups (HR = 0.86, 95%CI:0.57-1.32, p = 0.500).
Conclusions
Our data confirmed that DT is frequently omitted in current clinical practice, especially in older patients with worse systolic function. A strategy that omits DT did not appear to compromise the effectiveness of the S-ICD and no additional risk seems associated with DT omission at a mid-term follow-up. These data suggest that routine DT at S-ICD implant might not be necessary. Randomized trials are needed to confirm this finding.
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Affiliation(s)
| | | | - V Russo
- Second University of Naples, Naples, Italy
| | - F Migliore
- Azienda Ospedaliera di Padova, Padova, Italy
| | - G Tola
- AO Brotzu Hospital, Cagliari, Italy
| | - S Viani
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - P Rossi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - M Biffi
- Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - P Palmisano
- Cardinale G. Panico Hospital, Tricase, Italy
| | - L Checchi
- Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | | | | | - C Leidi
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - R Ospizio
- Boston Scientific Italy, Milan, Italy
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Bisignani G, Bisignani A, Cavaliere AL, Lovecchio M, Valsecchi S, De Bonis S. Long term stability of the subcutaneous cardioverter defibrillator implanted by means of the intermuscular two incision technique. Europace 2021. [DOI: 10.1093/europace/euab116.403] [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 To ensure effective defibrillation with the subcutaneous implantable cardioverter defibrillator (S-ICD), both the lead and the generator must be adequately positioned extrathoracically. We assessed the long-term adequacy of the S-ICD system position and its stability in a group of patients who received the S-ICD by means of the two-incision intermuscular technique.
Methods The PRAETORIAN score uses chest radiography to provide feedback on S-ICD positioning, and identifies patients with high defibrillation thresholds. We compared radiographs taken immediately after implantation and on 12-month follow-up examination.
Results We analyzed data from 38 patients with the S-ICD generator positioned in an intermuscular pocket. The median PRAETORIAN score was 38 [25th to 75th percentile: 30 to 60]. Two (5%) patients had a score of 90 (intermediate risk of conversion failure). The thickness of the adipose tissue between the coil and the sternum was ≤1 coil width in 72% of patients, the generator was on, or posterior to, the midline in 94% of patients, and the amount of fat tissue between the generator and the thoracic wall was less than the generator width in 78% of patients. No generator or electrode dislodgments were detected on analyzing radiographs collected at the 12-month visit. In all patients, assessment of the PRAETORIAN score confirmed the values calculated on post-implantation analysis. During follow-up, no ineffective therapies, sudden cardiac or device-related deaths occurred.
Conclusions The position of the S-ICD system implanted using the two-incision intermuscular technique was adequate at the time of implantation and remained stable after 12 months.
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Affiliation(s)
- G Bisignani
- Hospital Ferrari, Department of Cardiology, Castrovillari, Italy
| | - A Bisignani
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - AL Cavaliere
- Hospital Ferrari, Department of Cardiology, Castrovillari, Italy
| | | | | | - S De Bonis
- Hospital Ferrari, Department of Cardiology, Castrovillari, Italy
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Deneke T, Mariani J, Cabanas P, Lau D, Gaspar T, Steffel J, Pierre B, Martens E, Sanfins VM, Schrader J, Bisignani G. Real-world experience with the insertion of a new implantable cardiac monitor. Europace 2021. [DOI: 10.1093/europace/euab116.029] [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: Private company. Main funding source(s): Biotronik SE & Co.KG
OnBehalf
BIO|CONCEPT.BIOMONITOR III study group, BIO|MASTER.BIOMONITOR III study group, BIO|STREAM-ICM study group
Background
Implantable Cardiac Monitors (ICM) provide continuous long-term heart rhythm monitoring. The new ICM BIOMONITOR III / IIIm (BM III) is provided with a single-step insertion tool.
Purpose
To report on the insertion procedure of the BM III in a large real-world patient population.
Methods
The BM III combines a low cross-section (4.5 x 8.5 mm) with an extended ICM length (77 mm, including flexible antenna). It is inserted into subcutaneous tissue with an ‘injection’ tool that forms the pocket and delivers the device in a single step. We report results of the insertion procedure from a pooled data set from the BIO|CONCEPT BM III (completed) and the BIO|MASTER BM III and BIO|STREAM-ICM (ongoing) studies.
Results
From 54 investigational sites in 11 countries, 455 insertions were reported (including 39 BM IIIm). The patients were 63 ± 16 years old, had a BMI of 27.6 ± 5.4, and 43% were women. The indications were syncope or pre-syncope (57%), cryptogenic stroke (23%), management of AF (11%) or other (9%). Insertions took 1.7 ± 1.8 minutes until removal of the insertion tool, 4.7 ± 3.4 minutes until wound closure, and 7.1 ± 5.6 minutes including wound cleaning. The wound was sutured (79%) or closed with staples (10%) or adhesive strips (10%). General anaesthesia was used in 8% of the patients and antibiotic prophylaxis in 50% (44% systemic and 6% local). Insertions took place in the catheter laboratory (62%), operating theatre (22%) or in a consultation room (16%) without specific precautional equipment.
The insertion site was parallel to the heart"s long axis (56%), parasternal (39%), in the 2nd/3rd intercostal space (3.5%), axillary (0.9%) or at the clavicula (0.7%). The device was repositioned in one case (0.2%). 13 adverse events were reported in connection to the insertion procedure. 5 cases of device pocket bleeding or hematoma occurred. In 5 further cases, the device migrated, posing the risk of extrusion, or actually extruded. Three of these cases used only adhesive strips or no wound closure at all. In two cases, an incorrect usage of the incision tool and substantial subcutaneous fatty tissue may have contributed. One device was damaged by a 200 J defibrillation shock with a shock electrode placed over the device. One patient suffered from dyspnoea, possibly due to psychogenic hyperventilation. One patient had a vasovagal syncope due to pain after an insertion with insufficient local anaesthesia. No infections were reported until the day of analysis, which was more than 30 days after insertion in 92% of all cases.
Conclusion
The new BM III was inserted in typically less than 5 minutes until wound closure. A relevant number of insertions took place in a consultation room. Prophylactic antibiotics may be unnecessary, because no pocket infections were reported, although no antibiotic prophylaxis was used in one half of all cases (N = 229). In summary, the insertion with the new tool is fast and has a low risk of complications.
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Affiliation(s)
- T Deneke
- Heart Center Bad Neustadt, Bad Neustadt a. d. Saale, Germany
| | - J Mariani
- The Alfred Hospital, Melbourne, Australia
| | - P Cabanas
- University Hospital Alvaro Cunqueiro, Vigo, Spain
| | - D Lau
- Royal Adelaide Hospital, Adelaide, Australia
| | - T Gaspar
- University Hospital Dresden, Dresden, Germany
| | - J Steffel
- University Hospital Zurich, Zurich, Switzerland
| | - B Pierre
- University Hospital of Tours, Tours, France
| | - E Martens
- Klinikum rechts der Isar, Munich, Germany
| | - VM Sanfins
- Hospital Senhora da Oliveira - Guimaraes, Guimaraes, Portugal
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Stabile G, Bertaglia E, Guerra F, Palmisano P, Zoni Berisso M, Soldati E, Bisignani G, Forleo GB, Zanotto G, Landolina M, Boriani G, D'Onofrio A, De Ponti R, Ricci RP. Organization and procedures in contemporary catheter ablation centres: data from the 2018 Italian Catheter Ablation Registry. J Cardiovasc Med (Hagerstown) 2021; 22:631-636. [PMID: 34009836 DOI: 10.2459/jcm.0000000000001183] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This report describes the findings of the 2018 Italian Catheter Ablation Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC). METHODS The Italian Catheter Ablation Registry systematically collects data on the ablation procedures performed in Italy. Data collection was retrospective. A standardized questionnaire was completed by participating centres. RESULTS We collected data on 15 714 catheter ablation procedures performed in Italy during 2018 in 94 electrophysiology centres. In most centres (75/94, 80%), a single electrophysiology laboratory was available, and a hybrid electrophysiology laboratory was available in 15% (14/94) of centres. In most (93%) centres, at least two electrophysiologists were involved in the catheter ablation procedures. In only 13 out of 94 (14%) electrophysiology laboratories, an anaesthesiologist assists every electrophysiology procedure; in most cases (74/94, 79%), an on-demand anaesthesiology service was available. On-site cardiothoracic surgery was reported in 43 out of 94 (46%) centres.Nonfluoroscopic navigation systems were available in most centres (88/94, 93%). Intracardiac echocardiography was used in 59 out of 94 (63%) electrophysiology laboratories. Atrial fibrillation (31%) was the most frequently treated ablation target, followed by atrioventricular nodal re-entrant tachycardia (20%) and cavo-tricuspid isthmus (15%). In 61.7% of all procedures, a 3D mapping system was used. In about one-third of procedures, a near-zero approach was performed. CONCLUSION In most Italian electrophysiology centres, a single electrophysiology laboratory was available and at least two electrophysiologists were involved in the ablation procedures. An increasing number of procedures were performed by means of a nonfluoroscopic mapping system with a near-zero approach.
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Affiliation(s)
- Giuseppe Stabile
- Anthea Hospital, Bari.,Clinica Montevergine, Mercogliano.,Clinica San Michele, Maddaloni (CE)
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Ospedali Riuniti, Ancona
| | | | | | | | | | | | | | | | - Giuseppe Boriani
- Università di Modena e Reggio Emilia, Policlinico di Modena, Modena
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De Bonis S, Salerno N, Bisignani A, Capristo A, Sosto G, Verta A, Borselli R, Capristo C, Bisignani G. Cardiology emergency management and telecardiology within territorial hospital network. Four years activity results. Am J Emerg Med 2021; 48:347-350. [PMID: 33526347 DOI: 10.1016/j.ajem.2021.01.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Silvana De Bonis
- Department of Cardiology, Ospedale "Ferrari", Castrovillari, CS, Italy
| | - Nadia Salerno
- Department of Cardiology, Ospedale "Ferrari", Castrovillari, CS, Italy
| | - Antonio Bisignani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - Gennaro Sosto
- Direzione Generale ASL Napoli 3 - Coordinatore Area Innovazione e Tecnologie Sanitarie di Federsanità, Italy
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38
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De Bonis S, Salerno N, Bisignani A, Capristo A, Sosto G, Verta A, Borselli R, Capristo C, Bisignani G. COVID-19 and STEMI: The role of telecardiology in the management of STEMI diagnosis during COVID 19 pandemic. Int J Cardiol Heart Vasc 2021; 32:100720. [PMID: 33501370 PMCID: PMC7817440 DOI: 10.1016/j.ijcha.2021.100720] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/04/2021] [Accepted: 01/13/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Telecardiology has the advantage of reducing patient's access time to the hemodynamics units. Data from literature show a reduction in ST-elevation myocardial infarction (STEMI) during COVID-19 pandemic. However, there is a low number of studies on the impact of telecardiology during the pandemic. METHODS Our telecardiology system is composed of a Hub-and-Spoke network of hospitals and ambulances that ensures a rapid exchange of information allowing STEMI patients to be treated in the shortest time possible. We compared data from electrocardiograms (ECGs) transmissions and STEMI diagnosis collected between February and April 2020 with the data from the same period of 2019. RESULTS Despite a significant reduction of ECGs transmissions from the telecardiology network was observed, the number of diagnosed STEMI during 2020 was stable and did not show any significant difference compared to 2019. The total number of STEMI diagnosis in the months under examination during 2019 were 47 out of 7463 ECGs (0.63%), while in 2020 were 48 out of 5797 ECGs (0.83%). CONCLUSIONS The efficiency of our telecardiology system along with the low spread of the infection in our region contributed to maintaining the number of STEMI diagnosis and patient's care in line with the past even during the pandemic.
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Affiliation(s)
- Silvana De Bonis
- Department of Cardiology, Ospedale “Ferrari”, Castrovillari, CS, Italy
| | - Nadia Salerno
- Department of Cardiology, Ospedale “Ferrari”, Castrovillari, CS, Italy
| | - Antonio Bisignani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - Gennaro Sosto
- Direzione Generale ASL Napoli 3 – Coordinatore Area Innovazione e Tecnologie Sanitarie di Federsanità, Italy
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39
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Ricciardi D, Ziacchi M, Gasperetti A, Schiavone M, Picarelli F, Diemberger I, Bontempi L, Di Belardino N, Bisignani G, De Bonis S, Mitacchione G, Calabrese V, Lavalle C, Piro A, Pignalberi C, Santini L, Grigioni F, Tondo C, Biffi M, Forleo GB. Clinical impact of defibrillation testing in a real‐world S‐ICD population: Data from the ELISIR registry. J Cardiovasc Electrophysiol 2020; 32:468-476. [DOI: 10.1111/jce.14833] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/29/2020] [Accepted: 11/19/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Danilo Ricciardi
- Department of Cardiology Policlinico Universitario Campus Bio‐Medico Roma Italy
| | - Matteo Ziacchi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine‐DIMES University of Bologna Bologna Italy
| | | | | | - Francesco Picarelli
- Department of Cardiology Policlinico Universitario Campus Bio‐Medico Roma Italy
- Department of Cardiology Ospedali Riuniti Anzio‐Nettuno Anzio Italy
| | - Igor Diemberger
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine‐DIMES University of Bologna Bologna Italy
| | - Luca Bontempi
- Department of Cardiology Spedali Civili Brescia Brescia Italy
| | | | - Giovanni Bisignani
- Department of Cardiology Ospedale “Ferrari”, Castrovillari Cosenza Italy
| | - Silvia De Bonis
- Department of Cardiology Ospedale “Ferrari”, Castrovillari Cosenza Italy
| | | | - Vito Calabrese
- Department of Cardiology Policlinico Universitario Campus Bio‐Medico Roma Italy
| | - Carlo Lavalle
- Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences Policlinico Umberto I Sapienza University of Rome Rome Italy
| | - Agostino Piro
- Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences Policlinico Umberto I Sapienza University of Rome Rome Italy
| | | | - Luca Santini
- Division of Cardiology Ospedale G.B. Grassi Ostia Italy
| | - Francesco Grigioni
- Department of Cardiology Policlinico Universitario Campus Bio‐Medico Roma Italy
| | - Claudio Tondo
- Heart Rhythm Center Centro Cardiologico Monzino, IRCCS Milan Italy
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
| | - Mauro Biffi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine‐DIMES University of Bologna Bologna Italy
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40
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Boriani G, Palmisano P, Guerra F, Bertini M, Zanotto G, Lavalle C, Notarstefano P, Accogli M, Bisignani G, Forleo GB, Landolina M, D'Onofrio A, Ricci R, De Ponti R. Impact of COVID-19 pandemic on the clinical activities related to arrhythmias and electrophysiology in Italy: results of a survey promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing). Intern Emerg Med 2020; 15:1445-1456. [PMID: 32889687 PMCID: PMC7474489 DOI: 10.1007/s11739-020-02487-w] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022]
Abstract
COVID-19 outbreak had a major impact on the organization of care in Italy, and a survey to evaluate provision of for arrhythmia during COVID-19 outbreak (March-April 2020) was launched. A total of 104 physicians from 84 Italian arrhythmia centres took part in the survey. The vast majority of participating centres (95.2%) reported a significant reduction in the number of elective pacemaker implantations during the outbreak period compared to the corresponding two months of year 2019 (50.0% of centres reported a reduction of > 50%). Similarly, 92.9% of participating centres reported a significant reduction in the number of implantable cardioverter-defibrillator (ICD) implantations for primary prevention, and 72.6% a significant reduction of ICD implantations for secondary prevention (> 50% in 65.5 and 44.0% of the centres, respectively). The majority of participating centres (77.4%) reported a significant reduction in the number of elective ablations (> 50% in 65.5% of the centres). Also the interventional procedures performed in an emergency setting, as well as acute management of atrial fibrillation had a marked reduction, thus leading to the conclusion that the impact of COVID-19 was disrupting the entire organization of health care, with a massive impact on the activities and procedures related to arrhythmia management in Italy.
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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
| | - Matteo Bertini
- Cardiology Unit, Azienda Ospedaliero-Universitaria Di Ferrara "Arcispedale S. Anna", Cona, Ferrara, Italy
| | - Gabriele Zanotto
- Department of Cardiology, Mater Salutis Hospital, Legnago, Verona, Italy
| | - Carlo Lavalle
- Department of Cardiology, Policlinico Universitario Umberto I, Roma, Italy
| | | | | | - Giovanni Bisignani
- Cardiology Division, Castrovillari Hospital, ASP Cosenza, Castrovillari, Italy
| | | | | | - Antonio D'Onofrio
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, Naples, Italy
| | | | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale Di Circolo-University of Insubria, Varese, Italy
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Palmisano P, Guerra F, Bisignani G, Forleo GB, Landolina M, Soldati E, Stabile G, Zanotto G, Berisso MZ, De Ponti R, Boriani G, Ricci RP. [Position paper of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) on driving by patients with cardiac implantable electronic devices]. G Ital Cardiol (Rome) 2020; 21:819-825. [PMID: 32968320 DOI: 10.1714/3431.34209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In patients with cardiac implantable electronic devices (CIEDs) (implantable cardioverter-defibrillators [ICDs] and pacemakers [PMs]), the potential risk of suddenly being unable to drive, and hence of causing road accidents, is higher than in the general population. In ICD patients, this risk stems from the possibility that an arrhythmic event leading to loss of consciousness may occur while driving. In PM patients, it may be the result of a device malfunction in a PM-dependent patient. To determine a CIED patient's ability to drive, two variables must be taken into account: (i) the risk of events, which depends on the type of underlying heart disease (ICD patients have a higher risk than PM patients); (ii) the time spent driving and the type of vehicle driven (professional drivers are at higher risk than private drivers). This position paper reports the recommendations of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) regarding driving by patients with CIEDs, on the basis of the available literature and the European reference recommendations.
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Affiliation(s)
| | - Federico Guerra
- Università Politenica delle Marche, Ospedali Riuniti, Ancona
| | | | | | | | | | - Giuseppe Stabile
- Clinica Montevergine, Mercogliano (AV), Clinica San Michele, Maddaloni (CE)
| | | | | | | | - Giuseppe Boriani
- Università di Modena e Reggio Emilia, Policlinico di Modena, Modena
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Ziacchi M, Bisignani G, Palmisano P, Scalone A, Martignani C, Mocavero PE, Caravati F, Della Cioppa N, Mazzuero A, Pecora D, Vicentini A, Landolina ME, Lovecchio M, Valsecchi S, Droghetti A. P524Serratus anterior plane block in subcutaneous implantable cardioverter defibrillator implantation: a case-control analysis. Europace 2020. [DOI: 10.1093/europace/euaa162.142] [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
No Funding
OnBehalf
RHYTHM DETECT study group
Background
A two-incision technique, in association with inter-muscular positioning of the subcutaneous defibrillator (S-ICD), is now the most frequently adopted implantation approach in Europe. Ultrasound-guided serratus anterior plane block (SAPB) has been proposed in order to provide anesthesia/analgesia during S-ICD implantation.
Objective
We performed a case-control analysis in which a standardized SAPB approach was compared with the typical local anesthesia and sedation approach.
Methods
91 consecutive patients underwent implantation of an S-ICD with the SAPB approach for anesthesia/analgesia at 10 centers. The control group consisted of 55 consecutive patients who underwent S-ICD implantation with standard local approach.
Results
The mean procedure duration was 59 ± 15min in the SAPB group and 76 ± 23min in the control group (p < 0.001). No operative complications were reported in either group. During the procedure, 79 (87%) patients in the SAPB group and 25 (46%) patients in the control group (p < 0.001) remained awake. Lower values of pain intensity at the device pocket (p = 0.005) and the lateral tunneling site (p = 0.046) were reported in the SAPB group. The difference in static (p = 0.002) and dynamic (p = 0.007) pain intensity between the groups persisted at 1 hour, while no differences were observed 6 hours after the end of the procedure.
Conclusions
SAPB is feasible and effective in providing anesthesia/analgesia during S-ICD implantation. The procedures were successfully accomplished and no complications occurred in either group. However, SAPB was associated with lower pain levels, enabling the need for sedation to be reduced and more patients to remain awake. Moreover, it resulted in shorter procedure durations.
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Affiliation(s)
- M Ziacchi
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - G Bisignani
- Hospital Ferrari, Cardiology, Castrovillari, Italy
| | - P Palmisano
- Cardinale G. Panico Hospital, Tricase, Italy
| | | | - C Martignani
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - P E Mocavero
- Parthenope University of Naples, Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Napoli, Italy
| | - F Caravati
- Circolo e Fondazione Macchi Hospital , Varese, Italy
| | - N Della Cioppa
- Second University of Naples, Monaldi Hospital, NAPOLI, Italy
| | | | - D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - A Vicentini
- Policlinic Foundation San Matteo IRCCS, Cardiology, Pavia, Italy
| | | | | | | | - A Droghetti
- ASST Mantova-Cremona, Thoracic Surgery , MANTOVA, Italy
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Ricciardi D, Picarelli F, Forleo GB, Di Belardino N, Bisignani A, Bisignani G, Santini L, Lavalle C, Pignalberi C, Picarelli S, Aurino L, Creta A, Calabrese V, Gioia FA, Grigioni F. P529Efficacy and safety of S-ICD implantation without use of defibrillation threshold testing: a retrospective multicentric observational study. Europace 2020. [DOI: 10.1093/europace/euaa162.206] [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
Introduction
The subcutaneous ICD (S-ICD) is a valid alternative to transvenous systems (TV-ICD) for the treatment of life-threatening arrhythmias, and the extravascular position of the lead allows a significant reduction of the risk of infection. Current guidelines recommend defibrillation threshold testing (DFT) at the time of S-ICD implantation (class I). Although randomised trials have proven the safety of TV-ICD implantation with no DFT, it is unclear whether such an approach could be adopted for S-ICD as well. The PRAETORIAN score, based on post-implantation chest X-ray, can accurately predict a high defibrillation threshold after S-ICD implantation. The aim of this retrospective multicentre study was to evaluate the efficacy and safety of S-ICD implantation with no DFT.
Methods
We enrolled 203 consecutive patients undergoing S-ICD implantation in six different centres between October 2012 and January 2019. It was left at discretion of the operator whether performing or not DFT at the time of the procedure. Baseline device settings were collected, and the PRAETORIAN score was retrospectively calculated whenever chest X-ray was available. Both remote or in-clinic device interrogation reports were systemically analysed, and all the shocks and arrhythmia episodes identified. All the patients provided consent form and ethical approval was obtained.
Results
The population (mean age 57.6 ± 14.2) was divided in two groups, based on whether DFT was performed at the time of the S-ICD implantation: 72 patients (35.4%) underwent DFT (DFT+ group), while 131 patients (64.5%) did not (DFT- group). In the DFT- group, mean LVEF was lower (32 ± 8% vs 42 ± 17%, p < 0.0001) and prevalence of diabetes mellitus and atrial fibrillation higher compared to the DFT+ group (27.5% vs 13.9%, p = 0.04 and 38.9% vs 19.44%, p = 0.007; respectively). In addition, the indication for S-ICD was more frequently primary prevention in the DFT- vs DFT+ group (70.8% vs 90.8%, p = 0.0004; respectively). No differences in terms of device programming were identified between the two cohorts. The PRAETORIAN score was significantly higher in the DFT- vs DFT+ patients (50 ± 26 vs 36 ± 18, p = 0.032; respectively). After a median follow-up of … months, we observed 5 appropriate shocks in 3 patients from the DFT+ group vs. 15 shocks in 8 patients from the DFT- group (p = 0.81). All the life-threatening arrhythmias were successfully recognised and treated by the device. DFT was complicated by pulseless electrical activity in one patient. One patient in the DFT- group suffered from an episode of ventricular tachycardia requiring a total of 4 shocks for being terminated. Six patients in the DFT- group died for non-arrhythmic causes. On the Kaplan-Meier analysis, cumulative survival was comparable between the two groups (log rank p value = 0.13).
Conclusions
This study suggests that implantation of S-ICD with no DFT might be reasonable. These results should be confirmed in prospective randomised trials.
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Affiliation(s)
- D Ricciardi
- University Campus Bio-Medico of Rome, Rome, Italy
| | - F Picarelli
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
| | - G B Forleo
- Luigi Sacco Hospital, Cardiology, Milan, Italy
| | - N Di Belardino
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
| | - A Bisignani
- Polyclinic Agostino Gemelli, Cardiology, Rome, Italy
| | | | | | - C Lavalle
- Umberto I Polyclinic of Rome, Cardiology, Rome, Italy
| | | | | | - L Aurino
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
| | - A Creta
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
| | - V Calabrese
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
| | - F A Gioia
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
| | - F Grigioni
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
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Russo V, Viani S, Migliore F, Tola G, Bisignani G, Biffi M, Dello Russo A, Sartori P, Rordorf R, Ottaviano L, Perego GB, Papa A, Segreti L, Lovecchio M, Bongiorni MG. 852Lead abandonment and subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation in a cohort of patients with ICD lead malfunction. Europace 2020. [DOI: 10.1093/europace/euaa162.211] [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
NO FUNDING
OnBehalf
Rhythm Detect Registry
Background
Currently, when an implantable-cardioverter defibrillator (ICD) lead becomes nonfunctional, a class IIa recommendation exists for either lead abandonment or for removal. The benefits of removal include creation of an access for insertion of a new lead. However, the subcutaneous ICD (S-ICD) does not require the insertion of any leads into the cardiovascular system, and may represent an additional option for patients not requiring pacing.
Purpose
To report outcomes associated with a strategy of lead abandonment and S-ICD implantation in the setting of lead malfunction.
Methods
We analyzed all consecutive patients who underwent S-ICD implantation after abandonment of malfunctioning leads and we compared outcomes with those of patients who underwent transvenous extraction and subsequent reimplantation of a single-chamber transvenous ICD (T- ICD).
Results
43 patients were implanted with an S-ICD after abandonment of malfunctioning leads, while in 62 patients extraction and subsequent reimplantation of a T-ICD. The two groups were comparable (Age 55 ± 16 vs. 54 ± 33years, BMI 26 ± 3 vs. 24 ± 4kg/m2, LVEF 43 ± 15 vs. 48 ± 8%). S-ICD defibrillation test success rate at implantation was 96% at 65J. In the extraction group, no major complications were reported during extraction, while the procedure failed and an S-ICD was implanted in 4 patients. During a median follow-up of 21 months, the rate of major complications was not higher in the S-ICD group than in the T-ICD group (HR 1.07; 95%CI 0.29–3.94; P = 0 .912; Figure), as well as the rate of minor complications (HR 2.13; 95%CI 0.49–9.24; P = 0 .238).
Conclusions
In case of ICD lead malfunction, extraction prevents potential long-term risks of abandoned leads, e.g. increased complications for a possible future mandatory extraction indication such as infection, and allows magnetic resonance imaging. Nonetheless in this series, the strategy of lead abandonment and S-ICD implantation appeared to be feasible and safe with no significant increase in adverse outcomes for patients not requiring pacing and may represent an option in selected clinical settings (very high risk or failed extractions, older patients, etc.). Longer follow-up studies are needed to fully understand the potential risks of lead abandonment.
Abstract Figure
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Affiliation(s)
- V Russo
- Second University of Naples, Naples, Italy
| | - S Viani
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - F Migliore
- University Hospital of Padova, Padua, Italy
| | - G Tola
- AO Brotzu Hospital, Cagliari, Italy
| | | | - M Biffi
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - A Dello Russo
- Marche Polytechnic University of Ancona, Ancona, Italy
| | - P Sartori
- Policlinc San Martino Hospital, Genoa, Italy
| | - R Rordorf
- Policlinic Foundation San Matteo IRCCS, Pavia, Italy
| | - L Ottaviano
- Sant"Ambrogio Clinical Institute, Milan, Italy
| | - G B Perego
- Istituto Auxologico Italiano, Milan, Italy
| | - A Papa
- Second University of Naples, Naples, Italy
| | - L Segreti
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - M G Bongiorni
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Occhetta E, Rillo M, Berisso MZ, Bisignani G, Forleo GB, Guerra F, Landolina M, Palmisano P, Soldati E, Stabile G, Zanotto G, De Ponti R, Ricci RP. [Quality and performance in cardiac pacing and electrophysiology. An update to the 2010 Italian Association of Arrhythmology and Cardiac Pacing (AIAC) - Italian Federation of Cardiology (IFC) Document 'Structure and functional organization of Arrhythmology']. G Ital Cardiol (Rome) 2020; 21:385-393. [PMID: 32310930 DOI: 10.1714/3343.33141] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In the last decade the field of cardiac pacing and electrophysiology underwent major advancements thanks to both new ways of arrhythmia management and technological innovations. At the same time, the clinical competence and the procedural qualitative level of Cardiac Rhythm Centers have increased significantly. In 2010 an ad hoc Committee of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) and the Italian Federation of Cardiology (FIC) published a consensus document on the organization of Cardiac Rhythm Centers and on the standards of professional practice in pacing and electrophysiology in Italy. In particular, this document focused on the minimal requirements of a Center to be qualified as suitable to perform first, second and third-level cardiac pacing and electrophysiology activities. However, most of these indicators have been overcome over time. Thus, an update of the previously published organizational model appeared necessary. In this document several new requirements and indicators about the organization and performance of both operators and Cardiac Arrhythmia Centers have been introduced. These include: (i) "structural and procedural requirements" (types of diagnostic and therapeutic procedures performed, logistic structures, healthcare staff and technologies), (ii) "activity indicators" (number of procedures performed); (iii) "appropriateness indicators" (adherence to guideline recommendations); (iv) "outcome indicators" (procedural success and complications); and (v) "quality of care indicators" (management and continuity of care levels). By applying these requirements and indicators, each center can optimize its procedures, increasing its performance and effectiveness. Finally, a new model for the organization of the Italian network of Cardiac Arrhythmia Centers is also suggested.
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Affiliation(s)
| | | | | | | | | | - Federico Guerra
- Università Politecnica delle Marche, Ospedali Riuniti, Ancona
| | | | | | | | - Giuseppe Stabile
- Clinica Montevergine, Mercogliano (AV), Clinica San Michele, Maddaloni (CE)
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Bisignani A, De Bonis S, Mancuso L, Ceravolo G, Giacopelli D, Pelargonio G, Lanza GA, Crea F, Bisignani G. Are implantable cardiac monitors reliable tools for cardiac arrhythmias detection? An intra-patient comparison with permanent pacemakers. J Electrocardiol 2020; 59:147-150. [PMID: 32120081 DOI: 10.1016/j.jelectrocard.2020.02.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Received: 08/29/2019] [Revised: 01/21/2020] [Accepted: 02/20/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Implantable cardiac monitor (ICM) is an established tool for the management of unexplained syncope and atrial fibrillation (AF) even if its accuracy of arrhythmia detection may be suboptimal. The aim of this study was to perform an intra-patient comparison of the diagnostic capability of ICM with a dual-chamber PM as a gold standard. METHODS We included 19 patients with a previously implanted ICM (BioMonitor 2 Biotronik, Berlin, Germany), who received a dual-chamber PM for standard indications. ICM-detected arrhythmic events in a 6-month follow-up were compared with those detected by the PM and classified by visual inspection of intracardiac electrograms. RESULTS During follow up, ICMs generated 15 false asystole and 39 false bradycardia detections in 5 patients (26.3%) due to recurrent premature ventricular contractions. A total of 34 true high ventricular rate (HVR) episodes were detected by the PM. Of them, 30 (88%) events were also recorded by the ICM, which further detected 14 false HVR snapshots, leading to a sensitivity and positive predictive value of 88% and 68%, respectively. In addition, PM identified 234 true AF episodes. Of them, 225 (96%) events were also detected by the ICM, while 8 (42%) ICMs stored 50 AF episodes classified as false positives. The ICM sensitivity for AF was 96% with a positive predictive value of 82%. CONCLUSION Our intra-patient comparison with permanent PM confirmed that ICM is an effective tool for cardiac arrhythmias detection. ICM algorithms for AF and HVR detection were highly sensitive with an acceptable rate of false positive episodes.
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Affiliation(s)
- Antonio Bisignani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Silvana De Bonis
- Department of Cardiology, Ospedale "Ferrari", Castrovillari, CS, Italy
| | | | | | | | - Gemma Pelargonio
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Gaetano Antonio Lanza
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
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Ziacchi M, Bisignani G, Palmisano P, Scalone A, Martignani C, Elvira Mocavero P, Caravati F, Della Cioppa N, Mazzuero A, Pecora D, Vicentini A, Landolina ME, Debonis S, Scimia P, Lovecchio M, Valsecchi S, Diemberger I, Droghetti A. Serratus anterior plane block in subcutaneous implantable cardioverter defibrillator implantation: A case‐control analysis. J Cardiovasc Electrophysiol 2019; 31:144-149. [DOI: 10.1111/jce.14293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/15/2019] [Accepted: 11/25/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Matteo Ziacchi
- Institute of CardiologyUniversity of Bologna, Policlinico S.Orsola‐MalpighiBologna Italy
| | | | | | | | - Cristian Martignani
- Institute of CardiologyUniversity of Bologna, Policlinico S.Orsola‐MalpighiBologna Italy
| | - Paola Elvira Mocavero
- “Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie”, Monaldi HospitalNaples Italy
| | - Fabrizio Caravati
- Division of Cardiology“Circolo e Fondazione Macchi” HospitalVarese Italy
| | - Nadia Della Cioppa
- Division of CardiologySecond University of Naples, Monaldi HospitalNaples Italy
| | | | | | | | | | | | - Paolo Scimia
- Department of Anesthesia and Intensive Care UnitASST CremonaCremona Italy
| | | | | | - Igor Diemberger
- Institute of CardiologyUniversity of Bologna, Policlinico S.Orsola‐MalpighiBologna Italy
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Stabile G, Bertaglia E, Guerra F, Palmisano P, Berisso MZ, Soldati E, Bisignani G, Forleo GB, Zanotto G, Landolina M, De Ponti R, Boriani G, Ricci RP. [2017 Catheter Ablation Registry of the Italian Association of Arrhythmology and Cardiac Pacing]. G Ital Cardiol (Rome) 2019; 20:590-592. [PMID: 31593164 DOI: 10.1714/3228.32059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND This report describes the findings of the 2017 Catheter Ablation Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC). METHODS Data collection was retrospective. A standardized questionnaire was completed by each of the participating centers. RESULTS A total of 15 601 ablation procedures were performed by 91 institutions, with a mean of 184 ± 213 procedures per center. The most frequently treated arrhythmia was atrial fibrillation (34%), followed by atrioventricular nodal reentrant tachycardia (25%) and common atrial flutter (14%). About 10% of overall ablation procedures were performed in patients with ventricular arrhythmias. On-site cardiothoracic surgery was available in 42% of the centers performing ablation and in 49% of the centers performing atrial fibrillation ablation. In most patients, the ablation procedure was guided by a three-dimensional mapping system, and in 15% of patients a near-zero X-ray strategy was used. CONCLUSIONS The Italian Catheter Ablation Registry systematically collected 1-year data on ablation procedures performed in Italy, revealing that atrial fibrillation is the most commonly treated arrhythmia in the ablation centers with an increasing number of patients treated for ventricular tachycardia.
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Affiliation(s)
- Giuseppe Stabile
- Clinica Montevergine, Mercogliano (AV) - Clinica San Michele, Maddaloni (CE)
| | | | - Federico Guerra
- Università Politenica delle Marche, Ospedali Riuniti, Ancona
| | | | | | | | | | | | | | | | - Roberto De Ponti
- Dipartimento Cardiocerebrovascolare, Ospedale di Circolo e Fondazione Macchi, Università dell'Insubria, Varese
| | - Giuseppe Boriani
- Università di Modena e Reggio Emilia, Policlinico di Modena, Modena
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49
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Bisignani A, De Bonis S, Mancuso L, Ceravolo G, Bisignani G. Pacemaker pocket infection: Innovative conservative treatment in elderly patients with no signs of systemic infection. Pacing Clin Electrophysiol 2019; 42:1340-1346. [PMID: 31429949 DOI: 10.1111/pace.13787] [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: 02/27/2019] [Revised: 07/02/2019] [Accepted: 08/18/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The gold standard to treat cardiovascular implantable electronic devices (CIEDs) infections is the complete system removal. The aim of this retrospective analysis is to assess the feasibility and safety of an alternative conservative surgical system revision approach, to be applied in elderly patients who refused the extraction procedure, in case of no signs of systemic infection. METHODS Between May 2009 and January 2019, we performed system revision of 25 patients (15 men and 10 women, median age 81 [IQ: 75-85] years) with negative blood culture, no signs of vegetation, who experienced CIED infections. RESULTS In all patients the following surgical procedure was applied: the pocket was opened, the wound's necrotic tissue was dissected en bloc; fibrotic tissue was excised. The pocket was washed with hydrogen peroxide and saline solution. The pocket was then closed without implanting the device and left with a continuous infusion of antibiotics and normal saline for 4 days. Subsequently the new generator was implanted, possibly in a different pocket than the previous one. All patients underwent a median follow up of 24 [IQ: 14-34] months. In 24 patients out of the 25 observed the procedure was safe and effective, except for one patient who needed the extraction. CONCLUSIONS The two-stage surgical revision technique is feasible and safe. It may be considered for elderly patients who refused extraction and presented no signs of systemic infection or in some categories of patients. In case of failure of the procedure, subsequent treatment with complete extraction of the system would not be precluded.
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Affiliation(s)
- Antonio Bisignani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Silvana De Bonis
- Department of Cardiology, Ospedale "Ferrari", Castrovillari, Cosenza, Italy
| | | | | | - Giovanni Bisignani
- Department of Cardiology, Ospedale "Ferrari", Castrovillari, Cosenza, Italy
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Bisignani A, De Bonis S, Mancuso L, Ceravolo G, Bisignani G. Implantable loop recorder in clinical practice. J Arrhythm 2019; 35:25-32. [PMID: 30805041 PMCID: PMC6373656 DOI: 10.1002/joa3.12142] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [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: 09/11/2018] [Revised: 10/01/2018] [Accepted: 10/24/2018] [Indexed: 12/13/2022] Open
Abstract
The implantable loop recorder (ILR), also known as insertable cardiac monitor (ICM) is a subcutaneous device used for diagnosing heart rhythm disorders. These devices have been strongly improved and miniaturized during the last years showing several reliable features along with the availability of remote monitoring which improves the diagnostic timing and the follow-up strategy with a potential reduction of costs for health care. The recent advent of injectable ILRs makes the procedure even easier and more tolerated by patients. ILR allows the investigation of unexplained recurrent syncope with uncertain diagnosis, revealing a possible relationship with cardiac arrhythmias. In addition, it has recently been equipped with sophisticated algorithms able to detect atrial fibrillation episodes. This new opportunity may provide to the physicians systematic heart rhythm screening with possible effects on patient antiarrhythmic and anticoagulant therapy management. The use of such devices will surely increase, since they may be helpful to diagnose a wide range of disorders and pathologies. Indeed, further studies should be performed in order to identify all the potentialities of these tools.
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Affiliation(s)
- Antonio Bisignani
- Institute of CardiologyCatholic University of the Sacred HeartRomeItaly
| | - Silvana De Bonis
- Department of CardiologyOspedale “Ferrari”Castrovillari (CS)Italy
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