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Stabile G, Verlato R, Arena G, Pieragnoli P, Tondo C, Molon G, Manfrin M, Perego GB, Rovaris G, Sciarra L, Mantica M, Sacchi R, Nicolis D, Iacopino S. Timing of cryoballoon pulmonary vein isolation to prevent atrial fibrillation recurrence. J Interv Card Electrophysiol 2024; 67:609-616. [PMID: 37697222 DOI: 10.1007/s10840-023-01636-3] [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: 06/02/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND The aims of this analysis were: to evaluate the impact of timing of ablation on the rate of atrial arrhythmias recurrence, verify if the timing of ablation impact differently in patients with paroxysmal and persistent AF. METHODS Three thousand two hundred and five patients (60.5 ± 10 years, female 28.4%%, 78.8%% paroxysmal AF) were included in the analysis. All patients underwent only cryoballoon (CB) pulmonary vein (PV) isolation during the index procedure. RESULTS The mean procedure time was 102.8 ± 50 min, with a mean fluoroscopy time of 26.3 ± 49 min. Acute PV isolation was achieved in 11760/11793 (99.7%) PVs. A total of 91 (2.8%) patients experienced a procedure-related complication. During the observation period 913/3205 (28.5%) patients had at least one atrial arrhythmias episode: 28% of patients with paroxysmal AF vs 33% of patients with persistent AF. In multivariate analysis, persistent AF together with time from symptomatic AF diagnosis to ablation, female sex, and ablation time showed to be significant predictors for AF recurrence. In particular, months from first symptomatic AF episode > 18 months was a significant predictor of AF recurrence (HR = 1.23, 95% CI = 1.03-1.46, p = 0.020). In patients with paroxysmal AF, the multivariate analysis confirmed that months from first symptomatic AF episode > 18 month was an independent predictor of AF recurrence together with age > 62 years and female sex. In patients with persistent AF, the time from persistent AF showed to be significant predictor for AF recurrence. CONCLUSIONS In this multicenter analysis, time from first symptomatic AF episode > 18 months was a significant predictor of AF recurrence after CB PV isolation.
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Affiliation(s)
- Giuseppe Stabile
- Mediterranea Cardiocentro, Naples, Italy.
- Anthea Hospital, Bari, Italy.
- Clinica Montevergine, Mercogliano, AV, Italy.
- Casa Di Cura San Michele, Maddaloni, CE, Italy.
| | - Roberto Verlato
- ULSS 6 Euganea, Ospedale Di Camposampiero, Cittadella, Italy
| | | | | | - Claudio Tondo
- Centro Cardiologico Monzino, IRCCS, Department of Electrophysiology & Cardiac Pacing, Department of Biomedical, Surgery and Dentist Sciences, University of Milan, Milan, Italy
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Molon G, Arena G, Tondo C, Ricciardi D, Rossi P, Pieragnoli P, Verlato R, Manfrin M, Girardengo G, Campisi G, Pecora D, Luzi M, Iacopino S. Patient report outcomes in cryoballoon ablation of atrial fibrillation during the COVID Era: Insights from the 1STOP project. J Interv Card Electrophysiol 2024; 67:61-69. [PMID: 37178189 PMCID: PMC10182349 DOI: 10.1007/s10840-023-01561-5] [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: 02/06/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Pulmonary vein isolation by cryoablation (PVI-C) is a standard therapy for the treatment of patients with symptomatic atrial fibrillation (AF). AF symptoms are highly subjective; however, they are important outcomes for the patient. The aim is to describe the use and impact of a web-based App to collect AF-related symptoms in a population of patients who underwent PVI-C in seven Italian centers. METHODS A patient App to collect AF-related symptoms and general health status was proposed to all patients who underwent an index PVI-C. Patients were divided into two groups according to the utilization of the App or the non-usage. RESULTS Out of 865 patients, 353 (41%) subjects composed the App group, and 512 (59%) composed the No-App group. Baseline characteristics were comparable between the two cohorts except for age, sex, type of AF, and body mass index. During a mean follow-up of 7.9±13.8 months, AF recurrence was found in 57/865 (7%) subjects with an annual rate of 7.36% (95% CI:5.67-9.55%) in the No-App versus 10.99% (95% CI:9.67-12.48%) in the App group, p=0.007. In total, 14,458 diaries were sent by the 353 subjects in the App group and 77.1% reported a good health status and no symptoms. In only 518 diaries (3.6%), the patients reported a bad health status, and bad health status was an independent parameter of AF recurrence during follow-up. CONCLUSIONS The use of a web App to record AF-related symptoms was feasible and effective. Additionally, a bad health status reporting in the App was associated with AF recurrence during follow-up.
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Affiliation(s)
- Giulio Molon
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy.
| | | | - Claudio Tondo
- Centro Cardiologico Monzino, IRCCS Department of Electrophysiology&Cardiac Pacing Department of Biomedical, Surgery and Dentist Sciences, University of Milan, Milan, Italy
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Genovesi S, Porcu L, Rebora P, Slaviero G, Casu G, Bertoli S, Airoldi F, Buskermolen M, Gallieni M, Pieruzzi F, Rovaris G, Montoli A, Piccaluga E, Molon G, Alberici F, Adamo M, Gaspardone A, D'Angelo G, Merella P, Vezzoli G, Trezzi B, Mazzone P. Long-term safety and efficacy of left atrial appendage occlusion in dialysis patients with atrial fibrillation: a multi-center, prospective, open label, observational study. Clin Kidney J 2023; 16:2683-2692. [PMID: 38046009 PMCID: PMC10689152 DOI: 10.1093/ckj/sfad221] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Indexed: 12/05/2023] Open
Abstract
Background The prevalence of atrial fibrillation (AF) in end stage kidney disease (ESKD) patients undergoing dialysis is high, however, the high risk of bleeding often hampers with a correct anticoagulation in ESKD patients with AF, despite high thromboembolic risk. Left atrial appendage (LAA) occlusion is a anticoagulation (OAT) for thromboembolism prevention in AF populations with high hemorrhagic risk. Methods and Results The purpose of the study was to evaluate the efficacy and safety of LAA occlusion in a cohort of dialysis patients undergoing the procedure (LAA occlusion cohort, n = 106), in comparison with two other ESKD cohorts, one taking warfarin (Warfarin cohort, n = 114) and the other without anticoagulation therapy (No-OAT cohort, n = 148). After a median follow-up of 4 years, a Cox regression model, adjusted for possible confounding factors, showed that the hazard ratios (HRs) of thromboembolic events in the LAA occlusion cohort were 0.19 (95%CI 0.04-0.96; p = 0.045) and 0.16 (95%CI 0.04-0.66; p = 0.011) as compared with Warfarin and No-OAT cohorts, respectively. The HR of bleeding in the LAA occlusion cohort was 0.37 (95%CI 0.16-0.83; p = 0.017) compared to Warfarin cohort, while there were no significant differences between the LAA occlusion and the No-OAT cohort (HR 0.51; 95%CI 0.23-1.12; p = 0.094). Adjusted Cox regression models showed lower mortality in patients undergoing LAA occlusion as compared with both the Warfarin cohort (HR 0.60; 95%CI 0.38-0.94; p = 0.027) and no-OAT cohort (HR 0.52; 95%CI 0.34-0.78; p = 0.002). Thromboembolic events in the LAA occlusion cohort were lower than expected according to the CHA2DS2VASc score (1.7 [95%CI 0.3-3.0] vs 6.7 events per 100 person/years, p < 0.001). Conclusion In ESKD patients with AF, LAA occlusion is safe and effective and is associated with reduced mortality compared with OAT or no therapy.
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Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Luca Porcu
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Paola Rebora
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Gavino Casu
- Cardiology Unit, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy
| | - Silvio Bertoli
- Dialysis and Nephrology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy
| | - Flavio Airoldi
- Electrophysiology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy
| | | | - Maurizio Gallieni
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milano, Italy
- Department of Biomedical and Clinical Sciences, University of Milano, Milano, Italy
| | - Federico Pieruzzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giovanni Rovaris
- Interventional Electrophysiology Unit, San Gerardo Hospital, Monza, Italy
| | | | | | - Giulio Molon
- Cardiology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Federico Alberici
- Nephrology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | | | | | - Pierluigi Merella
- Cardiology Unit, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy
| | | | - Barbara Trezzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Patrizio Mazzone
- Cardiology 3, “A. De Gasperis” Cardio Center, ASST GOM Niguarda Ca' Granda, Milan, Italy
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Marinelli A, Trachanas K, Corso M, Costa A, Bonapace S, Molon G. Epicardial adipose tissue, pulmonary veins anatomy, and the P-wave/PR interval ratio in young patients with atrial fibrillation. Heart Rhythm O2 2023; 4:692-699. [PMID: 38034892 PMCID: PMC10685158 DOI: 10.1016/j.hroo.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Background Atrial fibrillation (AF) is uncommon in the youngest population. Epicardial adipose tissue (EAT) volume has been proposed as an independent AF risk factor. Objective The aim of this retrospective study was to evaluate the impact of the EAT, the anatomy of the pulmonary veins (PVs), and electrocardiogram (ECG) features in these young patients with AF. Methods Sixty-two patients divided in 2 groups, one with history of paroxysmal AF treated with ablation and the other, a control group, all younger than 30 years of age, were included. Computed tomography scans were performed in both groups to estimate the PVs anatomy and EAT volume. Twelve-lead ECGs were performed in all patients. Patients underwent follow-up in our outpatient clinic (35.9 ± 18.3 months). Results In the AF group, the EAT volume around the left atrium was 22.25 ± 9.3 cm3 compared with 12.61 ± 3.37 cm3, showing a statistically significance difference (P = .003). Family history resulted to be another significant risk factor (P = .009). During follow-up, 67.7% of the patients treated were still free of events. The anatomy and morphology of the right-sided PVs seemed to play a more consistent role in the patients with AF recurrences (P = .04). The P/PR ratio, a new ECG index, seemed predict AF recurrences after ablation (P = .03). Conclusion The abundance of EAT seems related to the risk of developing AF in young patients. The recurrence of AF is about 33% and does not seem related to the EAT volume, but rather to the anatomy of the PVs. A higher P/PR ratio might suggest recurrences.
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Affiliation(s)
- Alessio Marinelli
- Cardiology Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Konstantinos Trachanas
- Cardiology Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Maurizio Corso
- Cardiology Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Alessandro Costa
- Cardiology Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Stefano Bonapace
- Cardiology Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Giulio Molon
- Cardiology Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
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Ziacchi M, Molon G, Giudici V, Botto GL, Viscusi M, Brasca F, Santoro A, Curcio A, Manzo M, Mauro E, Biffi M, Costa A, Dell’Aquila A, Casale MC, Boriani G. Integration of a Smartphone HF-Dedicated App in the Remote Monitoring of Heart Failure Patients with Cardiac Implantable Electronic Devices: Patient Access, Acceptance, and Adherence to Use. J Clin Med 2023; 12:5528. [PMID: 37685593 PMCID: PMC10488122 DOI: 10.3390/jcm12175528] [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: 07/17/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
(200 w) Introduction. Remote monitoring (RM) of cardiac implantable electronic device (CIED) diagnostics helps to identify patients potentially at risk of worsening heart failure (HF). Additionally, knowledge of patient HF-related symptoms is crucial for decision making. Patient smartphone applications may represent an ideal option to remotely collect this information. PURPOSE To assess real-world HF patient access, acceptance, and adherence to use of an HF-dedicated smartphone application (HF app). METHODS In this study, 10 Italian hospitals administered a survey on smartphone/app use to HF patients with CIED. The subgroup who accepted it downloaded the HF app. Mean 1-year adherence of the HF app use was evaluated. RESULTS A total of 495 patients (67 ± 13 years, 79% males, 26% NYHA III-IV) completed the survey, of which 84% had access to smartphones and 85% were willing to use the HF app. In total, 311/495 (63%) downloaded the HF app. Patients who downloaded the HF app were younger and had higher school qualification. Patients who were ≥60 years old had higher mean 1-year adherence (54.1%) than their younger counterparts (42.7%; p < 0.001). Hospitals with RM-dedicated staff had higher mean 1-year patient adherence (64.0% vs. 33.5%; p < 0.001). Adherence to HF app decreased from 63.3% (weeks_1-13) to 42.2% (weeks_40-52, p < 0.001). CONCLUSIONS High access and acceptance of smartphones/apps by HF patients with CIED allow HF app use for RM of patient signs/symptoms. Younger patients with higher school qualifications are more likely to accept HF app; however, older patients have higher long-term adherence.
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Affiliation(s)
- Matteo Ziacchi
- Istituto di Cardiologia, IRCCS Azienda Ospedaliero Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy;
| | - Giulio Molon
- IRCCS Sacro Cuore Don Calabria, 37024 Negrar, Italy; (G.M.); (A.C.)
| | - Vittorio Giudici
- Cardiologia Riabilitativa, ASST Bergamo EST, 24068 Seriate, Italy;
| | | | | | - Francesco Brasca
- Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, 20095 Milano, Italy;
| | | | | | - Michele Manzo
- AOU S. Giovanni di Dio e Ruggi d’ Aragona, 84131 Salerno, Italy;
| | - Erminio Mauro
- Policlinico di Modena, AOU Modena, 41125 Modena, Italy;
| | - Mauro Biffi
- Istituto di Cardiologia, IRCCS Azienda Ospedaliero Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy;
| | - Alessandro Costa
- IRCCS Sacro Cuore Don Calabria, 37024 Negrar, Italy; (G.M.); (A.C.)
| | - Andrea Dell’Aquila
- Elettrofisiologia e Aritmologia, ASST Bergamo EST, 24068 Seriate, Italy;
| | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy;
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Bonapace S, Lanzoni L, Rossi A, Cicciò C, Cicoira M, Dugo C, Maffeis C, Valbusa F, Canali G, Guerriero M, Molon G. Sensitivity and Specificity of Transthoracic Echocardiography in Diagnosing the Presence of the Anomalous Origin of Left Circumflex Coronary Artery From the Right Sinus of Valsalva in an Adult Population. J Am Heart Assoc 2023:e030173. [PMID: 37382112 PMCID: PMC10356079 DOI: 10.1161/jaha.123.030173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Affiliation(s)
- Stefano Bonapace
- Division of Cardiology Istituto di Ricovero e Cura a Carattere Scientifico Sacro Cuore-Don Calabria Negrar Italy
| | - Laura Lanzoni
- Division of Cardiology Istituto di Ricovero e Cura a Carattere Scientifico Sacro Cuore-Don Calabria Negrar Italy
| | - Andrea Rossi
- Division of Cardiology, Department of Medicine University of Verona Verona Italy
| | - Carmelo Cicciò
- Division of Radiology, Department of Imaging Istituto di Ricovero e Cura a Carattere Scientifico Sacro Cuore-Don Calabria Negrar Italy
| | | | - Clementina Dugo
- Division of Cardiology Istituto di Ricovero e Cura a Carattere Scientifico Sacro Cuore-Don Calabria Negrar Italy
| | - Caterina Maffeis
- Division of Cardiology, Department of Medicine University of Verona Verona Italy
| | - Filippo Valbusa
- Division of Internal Medicine Istituto di Ricovero e Cura a Carattere Scientifico Sacro Cuore-Don Calabria Negrar Italy
| | - Guido Canali
- Division of Cardiology Istituto di Ricovero e Cura a Carattere Scientifico Sacro Cuore-Don Calabria Negrar Italy
| | - Massimo Guerriero
- Clinical Research Unit Istituto di Ricovero e Cura a Carattere Scientifico Sacro Cuore-Don Calabria Negrar Italy
| | - Giulio Molon
- Division of Cardiology Istituto di Ricovero e Cura a Carattere Scientifico Sacro Cuore-Don Calabria Negrar Italy
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Regolisti G, Rebora P, Occhino G, Lieti G, Molon G, Maloberti A, Algeri M, Giannattasio C, Valsecchi MG, Genovesi S. Elevated Serum Urea-to-Creatinine Ratio and In-Hospital Death in Patients with Hyponatremia Hospitalized for COVID-19. Biomedicines 2023; 11:1555. [PMID: 37371650 DOI: 10.3390/biomedicines11061555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Hyponatremia is associated with adverse outcomes in hospitalized patients. An elevated value of the serum urea-to-creatinine ratio (UCR) has been proposed as a proxy of hypovolemia. The aim of this study was to investigate the relationship between the UCR and in-hospital death in patients hospitalized with COVID-19 and hyponatremia. We studied 258 patients admitted for COVID-19 between January 2020 and May 2021 with serum sodium at < 135 mmol/L. The primary end-point was all-cause mortality. A 5-unit increase in the serum UCR during hospital stays was associated with an 8% increase in the hazard of all-cause death (HR = 1.08, 95% CI: 1.03-1.14, p = 0.001) after adjusting for potential confounders. In patients with a UCR > 40 at baseline, a > 10 mmol/L increase in serum sodium values within the first week of hospitalization was associated with higher odds of in-hospital death (OR = 2.93, 95% CI: 1.03-8.36, p = 0.044) compared to patients who experienced a < 10 mmol/L change. This was not observed in patients with a UCR < 40. Hypovolemia developing during hospital stays in COVID-19 patients with hyponatremia detected at hospital admission bears an adverse prognostic impact. Moreover, in hypovolemic patients, a > 10 mmol/L increase in serum sodium within the first week of hospital stays may further worsen the in-hospital prognosis.
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Affiliation(s)
- Giuseppe Regolisti
- Clinica e Immunologia Medica, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Paola Rebora
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Giuseppe Occhino
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Giulia Lieti
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Giulio Molon
- Cardiology Department, Istituto Ricovero Cura Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy
| | - Alessandro Maloberti
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
- Cardiology 4, Cardio Center, ASST-GOM Niguarda, Niguarda Hospital, 20162 Milan, Italy
| | - Michela Algeri
- Cardiology 4, Cardio Center, ASST-GOM Niguarda, Niguarda Hospital, 20162 Milan, Italy
| | - Cristina Giannattasio
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
- Cardiology 4, Cardio Center, ASST-GOM Niguarda, Niguarda Hospital, 20162 Milan, Italy
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Simonetta Genovesi
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
- Istituto Auxologico Italiano, Istituto Ricovero Cura Carattere Scientifico (IRCCS), 20135 Milan, Italy
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Bonapace S, Marinelli A, Costa A, Trachanas K, Molon G. Atrial Fibrillation, Tricuspid Regurgitation, and Pacemaker: A Vicious Circle. J Am Coll Cardiol 2023; 81:e139. [PMID: 37076221 DOI: 10.1016/j.jacc.2022.12.032] [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] [Received: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 04/21/2023]
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Genovesi S, Regolisti G, Rebora P, Occhino G, Belli M, Molon G, Citerio G, Beltrame A, Maloberti A, Generali E, Giannattasio C, Epis OM, Rossetti C, Bellelli G, De Nalda AL, Capua I, Valsecchi MG. Negative prognostic impact of electrolyte disorders in patients hospitalized for Covid-19 in a large multicenter study. J Nephrol 2023; 36:621-626. [PMID: 36001295 PMCID: PMC9400003 DOI: 10.1007/s40620-022-01429-3] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/31/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The prognostic impact of electrolyte disorders in hospitalized COVID-19 patients is unclear. METHODS The study included all adult patients hospitalized for COVID-19 in four hospitals in Northern Italy between January 2020 and May 2021 with at least one serum potassium and sodium measurement performed within 3 days since admission. Primary outcome was in-hospital death; secondary outcome was Intensive Care Unit (ICU) admission. A cause-specific Cox proportional-hazards regression model was used for investigating the association between potassium and sodium (as either categorical or continuous variables) and mortality or admission to ICU. RESULTS Analyses included 3,418 adult hospitalized COVID-19 patients. At multivariable analysis, both hyperkalemia (Hazard Ratio, [HR] 1.833, 95% Confidence Interval [CI] 1.371-2.450) and sK above the median (K 5.1 vs 4.1 mmol/L: HR 1.523, 95% CI 1.295-1.798), and hypernatremia (HR 2.313, 95%CI 1.772-3.018) and sNa above the median (Na 149 vs 139 mmol/L: HR 1.442, 95% CI 1.234-1.686), were associated with in-hospital death, whereas hypokalemia and hyponatremia were not. Hyponatremia was associated with increased hazard of ICU admission (HR 1.884, 95%CI 1.389-2.556). CONCLUSIONS Electrolyte disorders detected at hospital admission may allow early identification of COVID-19 patients at increased risk of adverse outcomes.
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Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, Nephrology Clinic, Milano-Bicocca University, Milan, Italy.
- Istituto Auxologico Italiano, IRCCS, Milan, Italy.
| | - Giuseppe Regolisti
- Clinica e Immunologia Medica, Azienda Ospedaliero-Universitaria, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paola Rebora
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre, School of Medicine and Surgery Milano-Bicocca University, Milan, Italy
| | - Giuseppe Occhino
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre, School of Medicine and Surgery Milano-Bicocca University, Milan, Italy
| | - Michele Belli
- School of Medicine and Surgery, Nephrology Clinic, Milano-Bicocca University, Milan, Italy
| | - Giulio Molon
- Cardiology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Giuseppe Citerio
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- NeuroIntensive Care Unit, ASST-Monza, Monza, Italy
| | - Anna Beltrame
- Department of Infectious/Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Alessandro Maloberti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Cardiology 4, Cardio Center, ASST GOM Niguarda Hospital, Milan, Italy
| | - Elena Generali
- Department of Biomedical Sciences, Humanitas University, Emanuele, Italy
- Internal Medicine and Hepatology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Cristina Giannattasio
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Cardiology 4, Cardio Center, ASST GOM Niguarda Hospital, Milan, Italy
| | - Oscar Massimiliano Epis
- Division of Rheumatology, Multispecialist Medical Department, Niguarda Hospital, Milan, Italy
| | - Claudio Rossetti
- Department of Training and Research, Niguarda Hospital, Milan, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Acute Geriatric Unit, ASST San Gerardo Hospital, Monza, Italy
| | - Ana Lleo De Nalda
- Department of Biomedical Sciences, Humanitas University, Emanuele, Italy
- Internal Medicine and Hepatology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Ilaria Capua
- One Health Center of Excellence, University of Florida, Gainesville, FL, 32611, USA
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre, School of Medicine and Surgery Milano-Bicocca University, Milan, Italy
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10
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Grehn M, Mandija S, Miszczyk M, Krug D, Tomasik B, Stickney KE, Alcantara P, Alongi F, Anselmino M, Aranda RS, Balgobind BV, Boda-Heggemann J, Boldt LH, Bottoni N, Cvek J, Elicin O, De Ferrari GM, Hassink RJ, Hazelaar C, Hindricks G, Hurkmans C, Iotti C, Jadczyk T, Jiravsky O, Jumeau R, Buus Kristiansen S, Levis M, López MA, Martí-Almor J, Mehrhof F, Møller DS, Molon G, Ouss A, Peichl P, Plasek J, Postema PG, Quesada A, Reichlin T, Rordorf R, Rudic B, Saguner AM, Ter Bekke RMA, Torrecilla JL, Troost EGC, Vitolo V, Andratschke N, Zeppenfeld K, Blamek S, Fast M, de Panfilis L, Blanck O, Pruvot E, Verhoeff JJC. STereotactic Arrhythmia Radioablation (STAR): the Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary consortium (STOPSTORM.eu) and review of current patterns of STAR practice in Europe. Europace 2023; 25:1284-1295. [PMID: 36879464 PMCID: PMC10105846 DOI: 10.1093/europace/euac238] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/18/2022] [Indexed: 03/08/2023] Open
Abstract
The EU Horizon 2020 Framework-funded Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary (STOPSTORM) consortium has been established as a large research network for investigating STereotactic Arrhythmia Radioablation (STAR) for ventricular tachycardia (VT). The aim is to provide a pooled treatment database to evaluate patterns of practice and outcomes of STAR and finally to harmonize STAR within Europe. The consortium comprises 31 clinical and research institutions. The project is divided into nine work packages (WPs): (i) observational cohort; (ii) standardization and harmonization of target delineation; (iii) harmonized prospective cohort; (iv) quality assurance (QA); (v) analysis and evaluation; (vi, ix) ethics and regulations; and (vii, viii) project coordination and dissemination. To provide a review of current clinical STAR practice in Europe, a comprehensive questionnaire was performed at project start. The STOPSTORM Institutions' experience in VT catheter ablation (83% ≥ 20 ann.) and stereotactic body radiotherapy (59% > 200 ann.) was adequate, and 84 STAR treatments were performed until project launch, while 8/22 centres already recruited VT patients in national clinical trials. The majority currently base their target definition on mapping during VT (96%) and/or pace mapping (75%), reduced voltage areas (63%), or late ventricular potentials (75%) during sinus rhythm. The majority currently apply a single-fraction dose of 25 Gy while planning techniques and dose prescription methods vary greatly. The current clinical STAR practice in the STOPSTORM consortium highlights potential areas of optimization and harmonization for substrate mapping, target delineation, motion management, dosimetry, and QA, which will be addressed in the various WPs.
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Affiliation(s)
- Melanie Grehn
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel 24105, Germany
| | - Stefano Mandija
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Marcin Miszczyk
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Ul. Wybrzeze Armii Krajowej, Gliwice 44102, Poland
| | - David Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel 24105, Germany
| | - Bartłomiej Tomasik
- Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Ul. Wybrzeze Armii Krajowej, Gliwice 44102, Poland.,Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdansk, M. Sklodowskiel-Curie 3a, Gdansk 80210, Poland
| | - Kristine E Stickney
- Research Support Office, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Pino Alcantara
- Department of Radiation Oncology, Hospital Clínico San Carlos, Faculty of Medicine, University Complutense of Madrid, Profesor Martin Lagos, Madrid 28040, Spain
| | - Filippo Alongi
- Department of Advanced Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, University of Brescia, Via San Zeno in Monte 23, Verona 37129, Italy
| | - Matteo Anselmino
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Via Giuseppe Verdi 8, Torino 10124, Italy.,Department of Medical Sciences, University of Turin, Via Verdi 8, Torino 10124, Italy
| | - Ricardo Salgado Aranda
- Electrophysiology Unit, Department of Cardiology, Hospital Clínico San Carlos Madrid, Professor Martin Lagos, Madrid 28040, Spain
| | - Brian V Balgobind
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, Amsterdam 1105AZ, The Netherlands
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
| | - Leif-Hendrik Boldt
- Department of Rhythmology, Charité-University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Nicola Bottoni
- Cardiology Arrhythmology Center, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia 42100, Italy
| | - Jakub Cvek
- Department of Oncology, University Hospital and Faculty of Medicine, Listopadu 1790, Ostrava Poruba 70852, Czech Republic
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Via Giuseppe Verdi 8, Torino 10124, Italy
| | - Rutger J Hassink
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Colien Hazelaar
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht 6229 HX, The Netherlands
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Michelangelolaan 2, Eindhoven 5623 EJ, The Netherlands
| | - Cinzia Iotti
- Radiation Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia 42100, Italy
| | - Tomasz Jadczyk
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ul. Poniatowskiego 15, Katowice 40055, Poland.,Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Otakar Jiravsky
- Cardiocenter, Hospital Agel Trinec Podlesi and Masaryk University, Konska 453, Trinec 73961, Czech Republic
| | - Raphaël Jumeau
- Department of Radio-Oncology, Lausanne University Hospital, Rue du Bugnon 21, Lausanne 1011, Switzerland
| | - Steen Buus Kristiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark
| | - Mario Levis
- Department of Oncology, University of Torino, Via Giuseppe Verdi 8, Torino 10124, Italy
| | - Manuel Algara López
- Department of Radiation Oncology, Hospital del Mar, Universitat Pompeu Fabra, Institut Hospital del Mar d'Investigacions Mèdiques, Paseo Maritim 25-29, Barcelona 08003, Spain
| | - Julio Martí-Almor
- Department of Cardiology, Hospital del Mar, Universitat Pompeu Fabra, Institut Hospital del Mar d'Investigacions Mèdiques, Paseo Maritim 25-29, Barcelona 08003, Spain
| | - Felix Mehrhof
- Department for Radiation Oncology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Ditte Sloth Møller
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark
| | - Giulio Molon
- Department of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, Via San Zeno in Monte 23, Verona 37129, Italy
| | - Alexandre Ouss
- Department of Cardiology, Catharina Hospital, Michelangelolaan 2, Eindhoven 5623 EJ, The Netherlands
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Videnska 9, Prague 14000, Czech Republic
| | - Jiri Plasek
- Department of Cardiovascular Medicine, University Hospital Ostrava, Listopadu 1790. Ostrava Poruba 70852, Czech Republic
| | - Pieter G Postema
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, Amsterdam 1105AZ, The Netherlands
| | - Aurelio Quesada
- Arrhythmia Unit, Department of Cardiology, Consorcio Hospital General Universitario de Valencia, Av Tres Cruces 2, Valencia 46014, Spain
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland
| | - Roberto Rordorf
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Camillo Golgi Avenue 5, Pavia 27100, Italy
| | - Boris Rudic
- Department of Medicine I, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
| | - Ardan M Saguner
- Arrhythmia Unit, Department of Cardiology, University Hospital Zurich, Ramistrasse 71, Zurich 8006, Switzerland
| | - Rachel M A Ter Bekke
- Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, Maastricht 6229 HX, The Netherlands
| | - José López Torrecilla
- Department of Radiation Oncology, Hospital General Valencia, Av Tres Cruces 2, Valencia 46014, Spain
| | - Esther G C Troost
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, Dresden 01307, Germany.,OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus. Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse 74, Dresden 01307, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstr. 400, Dresden 01328, Germany
| | - Viviana Vitolo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Strada Campeggi 53, Pavia PV27100, Italy
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital of Zurich, Ramistrasse 71, Zurich 8006, Switzerland
| | - Katja Zeppenfeld
- Unit of Clinical Electrophysiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - Slawomir Blamek
- Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Ul. Wybrzeze Armii Krajowej, Gliwice 44102, Poland
| | - Martin Fast
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Ludovica de Panfilis
- Bioethics Unit, Azienda Unità Sanitaria Locale-IRCCS, Via Amendola 2, Reggio Emilia 42100, Italy
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel 24105, Germany
| | - Etienne Pruvot
- Heart and Vessel Department, Service of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 21, Lausanne 1011, Switzerland
| | - Joost J C Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
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11
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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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12
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Maloberti A, Giannattasio C, Rebora P, Occhino G, Ughi N, Rizzo J, Fabbri S, Leidi F, Cartella I, Rossetti C, Epis OM, Molon G, Bonfanti P, Valsecchi MG, Genovesi S. 85 ATRIAL FIBRILLATION INCIDENCE IN SARS-COV-2 INFECTED PATIENTS: PREDICTORS AND RELATIONSHIP WITH IN-HOSPITAL MORTALITY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Among the different CardioVascular (CV) manifestation of the COronaVIrus-related Disease (COVID) particular attention has been paid to arrhythmia and particularly to Atrial fibrillation (AF). The aim of our study was to assess the incidence of AF episodes in patients hospitalized for COVID and to evaluate its predictors and its relationship with in-hospital all-cause mortality.
Methods
We enrolled 3435 cases of SARS-CoV2 infection admitted in four hospitals in Northern Italy. We collected data on clinical history, vital signs, Intensive Care Unit (ICU) admission, laboratory tests and pharmacological treatment. AF incident and all-cause in-hospital mortality were considered as outcomes.
Results
145 (4.2%) patients develop AF during hospitalization, with a median time of 3 days (IQR: 0, 11.5) from admission. Incident AF patients were older and had lower eGFR, lower platelet and lymphocytes count and higher C-Reactive Protein (CRP), were admitted more frequently to ICU and more frequently died compared to subjects that didn't present AF. At the Cox regression model significant determinants of incident AF were older age (HR 1.070; 95% CI: 1.048, 1.092), history of AF (HR 2.800; 95% CI: 1.465, 5.351), ischemic heart disease (HR 0.324; 95% CI: 0.130, 0.811) and ICU admission (HR 8.030; 95% CI: 4.511, 14.292). Incident AF was a predictor of all-cause mortality (HR 1.679; 95% CI: 1.170, 2.410), together with age (HR 1.053; 95% CI: 1.042, 1.065), dementia (HR 1.553; 95% CI 1.151, 2.095), platelet count (HR 0.997; 95% CI: 0.996, 0.999) higher CRP (HR 1.004; 95% CI: 1.003, 1.005) and eGFR (HR: 0.991; 95% CI: 0.986, 0.996)
Conclusion
AF present as the main arrhythmia in COVID-19 patients and its development during the hospitalization strongly relates with in-hospital mortality.
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Affiliation(s)
| | | | | | | | | | | | - Saverio Fabbri
- Ospedale Metropolitano Niguarda
- Universita Di Milano Bicocca
| | - Filippo Leidi
- Ospedale Metropolitano Niguarda
- Universita Di Milano Bicocca
| | - Iside Cartella
- Ospedale Metropolitano Niguarda
- Universita Di Milano Bicocca
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13
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Bertaglia E, Iacopino S, Verlato R, Arena G, Pieragnoli P, Tondo C, Molon G, Manfrin M, Perego GB, Rovaris G, Rivezzi F, Mantica M, Startari U, Sciarra L. Safety and efficacy of cryoablation for atrial fibrillation in young patients: A multicenter experience in the 1STOP project. Clin Cardiol 2022; 46:142-150. [PMID: 36448243 PMCID: PMC9933101 DOI: 10.1002/clc.23951] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/11/2022] [Accepted: 10/30/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is an uncommon arrhythmia in young adults without structural heart disease, and cryoballoon pulmonary vein isolation (CB-PVI) is an important therapeutic strategy for rhythm control in patients with drug-refractory AF. The aim of this analysis was to evaluate efficacy and safety of CB-PVI in a large cohort of young patients in comparison with middle-aged adults in a real-world setting. METHODS From 2012 to 2020, a total of 3033 patients with AF underwent CB-PVI and were followed prospectively in the framework of the 1STOP Clinical Service project, involving 34 Italian centers. Out of 3033 total 1STOP project subjects, a subgroup of 1318 patients were defined which included a YOUNG group (age ≤ 45 years; n = 368) and a MIDDLE-AGED group (age 60-65 years; n = 950). RESULTS The acute success rate of PVI did not differ between the two cohorts (99.9 ± 1.3% vs. 99.8 ± 3.2%, p = 0.415). There was no difference in procedural characteristics, and periprocedural complication rates were similar among the two cohort (1.9% vs. 2.3%, p = 0.646). The 12-month freedom from AF recurrence was 88.9% (95% confidence interval [CI]: 84.7-92.0) in the YOUNG cohort and 85.6% (95% CI: 82.9-88.0) in the MIDDLE-AGED group. At 36-month follow-up, freedom from AF recurrence was 72.4% (65.5%-78.2%) and 71.8% (67.7%-75.6%), respectively with no significant difference among groups (p = 0.550). CONCLUSION CB-PVI had similar efficacy and safety in YOUNG and MIDDLE-AGED patients. Younger age did not affect acute procedural results, complication rate, or AF recurrence after a single procedure.
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Affiliation(s)
- Emanuele Bertaglia
- Department of Cardiac, Thoracic and Vascular Sciences and Public HealthUniversity of PaduaPaduaItaly
| | | | | | | | | | - Claudio Tondo
- Heart Rhythm Center, Department of Clinical Electrophysiology&Cardiac Pacing Monzino Cardiac Center, IRCCS Department of BiochemicalSurgical and Dentist Sciences University of MilanMilanItaly
| | | | | | | | | | - Francesco Rivezzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public HealthUniversity of PaduaPaduaItaly
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14
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Rordorf R, Iacopino S, Verlato R, Arena G, Tondo C, Molon G, Manfrin M, Rovaris G, Perego GB, Sciarra L, Mantica M, Sacchi R, Pieragnoli P. Role of CHA2DS2-VASc score in predicting atrial fibrillation recurrence in patients undergoing pulmonary vein isolation with cryoballoon ablation. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01430-7. [DOI: 10.1007/s10840-022-01430-7] [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] [Received: 08/26/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022]
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15
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Costa A, Marinelli A, Rauhe W, Martignani C, Ignatiuk B, Sabbatani P, Nangah R, Basso F, Molon G. Voltage mapping of Koch’s triangle in atrioventricular nodal reentrant tachycardia ablation. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01432-5. [DOI: 10.1007/s10840-022-01432-5] [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] [Received: 08/16/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022]
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16
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Maloberti A, Giannattasio C, Rebora P, Occhino G, Ughi N, Fabbri S, Cartella I, Algeri M, Scarpellini S, Rossetti C, Epis OM, Molon G, Bonfanti P, Valsecchi MG, Genovesi S. Atrial fibrillation incidence in SARS-CoV-2 infected patients: predictors and relationship with in-hospital mortality. Eur Heart J 2022. [PMCID: PMC9619513 DOI: 10.1093/eurheartj/ehac544.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Among the different CardioVascular (CV) manifestation of the COronaVIrus-related Disease (COVID) particular attention has been paid to arrhythmia and particularly to Atrial fibrillation (AF). The aim of our study was to assess the incidence of AF episodes in patients hospitalized for COVID and to evaluate its predictors and its relationship with in-hospital all-cause mortality. Methods We enrolled 3435 cases of SARS-CoV2 infection admitted in four hospitals in Northern Italy. We collected data on clinical history, vital signs, Intensive Care Unit (ICU) admission, laboratory tests and pharmacological treatment. AF incident and all-cause in-hospital mortality were considered as outcomes. Results 145 (4.2%) patients develop AF during hospitalization, with a median time of 3 days (IQR: 0, 11.5) from admission. Incident AF patients were older and had lower eGFR, lower platelet and lymphocytes count and higher C-Reactive Protein (CRP), were admitted more frequently to ICU and more frequently died compared to subjects that didn't present AF. At the Cox regression model significant determinants of incident AF were older age (HR 1.070; 95% CI: 1.048, 1.092), history of AF (HR 2.800; 95% CI: 1.465, 5.351), ischemic heart disease (HR 0.324; 95% CI: 0.130, 0.811) and ICU admission (HR 8.030; 95% CI: 4.511, 14.292). Incident AF was a predictor of all-cause mortality (HR 1.679; 95% CI: 1.170, 2.410), together with age (HR 1.053; 95% CI: 1.042, 1.065), dementia (HR 1.553; 95% CI 1.151, 2.095), platelet count (HR 0.997; 95% CI: 0.996, 0.999) higher CRP (HR 1.004; 95% CI: 1.003, 1.005) and eGFR (HR: 0.991; 95% CI: 0.986, 0.996) Conclusion AF present as the main arrhythmia in COVID-19 patients and its development during the hospitalization strongly relates with in-hospital mortality. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): ASST GOM Niguarda Ca' Granda, Milan, Italy
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Affiliation(s)
- A Maloberti
- Niguarda Ca' Granda Hospital, Cardiology 4 , Milan , Italy
| | - C Giannattasio
- Niguarda Ca' Granda Hospital, Cardiology 4 , Milan , Italy
| | - P Rebora
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine , monza , Italy
| | - G Occhino
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine , monza , Italy
| | - N Ughi
- ASST Great Metropolitan Niguarda, Rheumatology, Multispecialist Medical Department , Milan , Italy
| | - S Fabbri
- Niguarda Ca' Granda Hospital, Cardiology 4 , Milan , Italy
| | - I Cartella
- Niguarda Ca' Granda Hospital, Cardiology 4 , Milan , Italy
| | - M Algeri
- Niguarda Ca' Granda Hospital, Cardiology 4 , Milan , Italy
| | - S Scarpellini
- Niguarda Ca' Granda Hospital, Cardiology 4 , Milan , Italy
| | - C Rossetti
- ASST Great Metropolitan Niguarda, Nuclear Medicine , Milan , Italy
| | - O M Epis
- ASST Great Metropolitan Niguarda, Rheumatology, Multispecialist Medical Department , Milan , Italy
| | - G Molon
- ASST Great Metropolitan Niguarda, Nuclear Medicine , Milan , Italy
| | - P Bonfanti
- Niguarda Ca' Granda Hospital, Cardiology 4 , Milan , Italy
| | - M G Valsecchi
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine , monza , Italy
| | - S Genovesi
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine , monza , Italy
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17
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Zuin M, Mugnai G, Zamboni A, Zakja E, Valle R, Turiano G, Themistoclakis S, Scarpa D, Saccà S, Roncon L, Rizzetto F, Purita P, Polo A, Pantano I, Mugnolo A, Molon G, Meneghin S, Mancuso D, Lia M, Grassi G, Cutolo A, Chirillo F, Bozzini P, Bonapace S, Anselmi M, Rigatelli G, Bilato C. Decline of Admission for Acute Coronary Syndromes and Acute Cardiovascular Conditions during COVID-19 Pandemic in Veneto Region. Viruses 2022; 14:v14091925. [PMID: 36146731 DOI: 10.3390/v1409192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/22/2022] [Accepted: 08/27/2022] [Indexed: 05/27/2023] Open
Abstract
Background: The present study aimed to examine longitudinal trends in hospitalizations for acute coronary syndrome (ACS) before and during the COVID-19 pandemic, by reviewing the data from 13 hospitals of the Veneto Region, in the north-east of Italy. Methods: We performed a multicenter, retrospective analysis including all the consecutive patients presenting with ACS and other acute cardiovascular (CV) conditions (defined as heart failure, arrhythmias, cardiac arrest and venous thromboembolism) hospitalized in 13 different hospitals of the Veneto Region covering a population of 2,554,818 inhabitants, during the first (between 15 March 2020 and 30 April 2020) and second (between 15 November 2020 and 30 December 2020) COVID-19 pandemic waves (the 2020 cohort). Data were compared with those obtained at the same time-windows of years 2018 and 2019 (the historical cohorts). Results: Compared to the historical cohorts, a significant decrease in the number of ACS cases was observed in 2020 (−27.3%, p = 0.01 and −32%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). The proportion of patients hospitalized for acute CV conditions decreased during the first and second wave COVID-19 pandemic when compared to the historical cohorts (−36.5%, p < 0.001 and −40.6%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). Pearson’s correlation evidenced a significant inverse relationship between the number of COVID-19 cases and both ACS hospital admissions (r = −0.881, p = 0.005) and hospitalizations for acute CV conditions (r = −0.738, p = 0.01), respectively. Conclusions: The decrease in hospitalizations for ACS and other acute CV conditions will strongly affect future patients’ management since undiagnosed nonfatal CV events represent a source of increased (and unknown) CV morbidity and mortality.
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Affiliation(s)
- Marco Zuin
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
| | - Giacomo Mugnai
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
| | - Alberto Zamboni
- Division of Cardiology, Legnago General Hospital, 37045 Legnago, Verona, Italy
| | - Edlira Zakja
- Division of Cardiology, San Donà General Hospital, 30027 San Donà di Piave, Venezia, Italy
| | - Roberto Valle
- Division of Cardiology, Chioggia General Hospital, 30015 Chioggia, Venezia, Italy
| | - Giovanni Turiano
- Division of Cardiology, San Donà General Hospital, 30027 San Donà di Piave, Venezia, Italy
| | | | - Daniele Scarpa
- Division of Cardiology, Santi Giovanni & Paolo Hospital, 30122 Venezia, Venezia, Italy
| | - Salvatore Saccà
- Division of Cardiology, Mirano General Hospital, 30035 Mirano, Venezia, Italy
| | - Loris Roncon
- Department of Cardiology, Rovigo General Hospital, 45100 Rovigo, Rovigo, Italy
| | - Francesca Rizzetto
- Division of Cardiology, Verona University Hospital, 37100 Verona, Verona, Italy
| | - Paola Purita
- Division of Cardiology, Mirano General Hospital, 30035 Mirano, Venezia, Italy
| | - Angela Polo
- Division of Cardiology, San Bassiano Hospital, 36061 Bassano, Vicenza, Italy
| | - Ivan Pantano
- Division of Cardiology, Chioggia General Hospital, 30015 Chioggia, Venezia, Italy
| | - Antonio Mugnolo
- Division of Cardiology, Legnago General Hospital, 37045 Legnago, Verona, Italy
| | - Giulio Molon
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Verona, Italy
| | - Samuele Meneghin
- Division of Cardiology, Padua University Hospital, 35128 Padova, Padova, Italy
| | - Daniela Mancuso
- Division of Cardiology, Padua University Hospital, 35128 Padova, Padova, Italy
| | - Micaela Lia
- Division of Cardiology, Verona University Hospital, 37100 Verona, Verona, Italy
| | - Giuseppe Grassi
- Division of Cardiology, Santi Giovanni & Paolo Hospital, 30122 Venezia, Venezia, Italy
| | - Ada Cutolo
- Division of Cardiology, All'Angelo Hospital, 30174 Mestre, Venezia, Italy
| | - Fabio Chirillo
- Division of Cardiology, San Bassiano Hospital, 36061 Bassano, Vicenza, Italy
| | - Paolo Bozzini
- Division of Cardiology, Fracastoro Hospital, 37020 San Bonifacio, Verona, Italy
| | - Stefano Bonapace
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Verona, Italy
| | - Maurizio Anselmi
- Division of Cardiology, Fracastoro Hospital, 37020 San Bonifacio, Verona, Italy
| | - Gianluca Rigatelli
- Division of Cardiology, Madre Teresa Hospital, 35043 Padova, Schiavonia, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
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18
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Zuin M, Mugnai G, Zamboni A, Zakja E, Valle R, Turiano G, Themistoclakis S, Scarpa D, Saccà S, Roncon L, Rizzetto F, Purita P, Polo A, Pantano I, Mugnolo A, Molon G, Meneghin S, Mancuso D, Lia M, Grassi G, Cutolo A, Chirillo F, Bozzini P, Bonapace S, Anselmi M, Rigatelli G, Bilato C. Decline of Admission for Acute Coronary Syndromes and Acute Cardiovascular Conditions during COVID-19 Pandemic in Veneto Region. Viruses 2022; 14:v14091925. [PMID: 36146731 PMCID: PMC9502380 DOI: 10.3390/v14091925] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/22/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The present study aimed to examine longitudinal trends in hospitalizations for acute coronary syndrome (ACS) before and during the COVID-19 pandemic, by reviewing the data from 13 hospitals of the Veneto Region, in the north-east of Italy. Methods: We performed a multicenter, retrospective analysis including all the consecutive patients presenting with ACS and other acute cardiovascular (CV) conditions (defined as heart failure, arrhythmias, cardiac arrest and venous thromboembolism) hospitalized in 13 different hospitals of the Veneto Region covering a population of 2,554,818 inhabitants, during the first (between 15 March 2020 and 30 April 2020) and second (between 15 November 2020 and 30 December 2020) COVID-19 pandemic waves (the 2020 cohort). Data were compared with those obtained at the same time-windows of years 2018 and 2019 (the historical cohorts). Results: Compared to the historical cohorts, a significant decrease in the number of ACS cases was observed in 2020 (−27.3%, p = 0.01 and −32%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). The proportion of patients hospitalized for acute CV conditions decreased during the first and second wave COVID-19 pandemic when compared to the historical cohorts (−36.5%, p < 0.001 and −40.6%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). Pearson’s correlation evidenced a significant inverse relationship between the number of COVID-19 cases and both ACS hospital admissions (r = −0.881, p = 0.005) and hospitalizations for acute CV conditions (r = −0.738, p = 0.01), respectively. Conclusions: The decrease in hospitalizations for ACS and other acute CV conditions will strongly affect future patients’ management since undiagnosed nonfatal CV events represent a source of increased (and unknown) CV morbidity and mortality.
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Affiliation(s)
- Marco Zuin
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
- Correspondence: (M.Z.); (C.B.); Tel.: +39-0444-479106 (C.B.); Fax: +39-0444-931163 (C.B.)
| | - Giacomo Mugnai
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
| | - Alberto Zamboni
- Division of Cardiology, Legnago General Hospital, 37045 Legnago, Verona, Italy
| | - Edlira Zakja
- Division of Cardiology, San Donà General Hospital, 30027 San Donà di Piave, Venezia, Italy
| | - Roberto Valle
- Division of Cardiology, Chioggia General Hospital, 30015 Chioggia, Venezia, Italy
| | - Giovanni Turiano
- Division of Cardiology, San Donà General Hospital, 30027 San Donà di Piave, Venezia, Italy
| | | | - Daniele Scarpa
- Division of Cardiology, Santi Giovanni & Paolo Hospital, 30122 Venezia, Venezia, Italy
| | - Salvatore Saccà
- Division of Cardiology, Mirano General Hospital, 30035 Mirano, Venezia, Italy
| | - Loris Roncon
- Department of Cardiology, Rovigo General Hospital, 45100 Rovigo, Rovigo, Italy
| | - Francesca Rizzetto
- Division of Cardiology, Verona University Hospital, 37100 Verona, Verona, Italy
| | - Paola Purita
- Division of Cardiology, Mirano General Hospital, 30035 Mirano, Venezia, Italy
| | - Angela Polo
- Division of Cardiology, San Bassiano Hospital, 36061 Bassano, Vicenza, Italy
| | - Ivan Pantano
- Division of Cardiology, Chioggia General Hospital, 30015 Chioggia, Venezia, Italy
| | - Antonio Mugnolo
- Division of Cardiology, Legnago General Hospital, 37045 Legnago, Verona, Italy
| | - Giulio Molon
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Verona, Italy
| | - Samuele Meneghin
- Division of Cardiology, Padua University Hospital, 35128 Padova, Padova, Italy
| | - Daniela Mancuso
- Division of Cardiology, Padua University Hospital, 35128 Padova, Padova, Italy
| | - Micaela Lia
- Division of Cardiology, Verona University Hospital, 37100 Verona, Verona, Italy
| | - Giuseppe Grassi
- Division of Cardiology, Santi Giovanni & Paolo Hospital, 30122 Venezia, Venezia, Italy
| | - Ada Cutolo
- Division of Cardiology, All’Angelo Hospital, 30174 Mestre, Venezia, Italy
| | - Fabio Chirillo
- Division of Cardiology, San Bassiano Hospital, 36061 Bassano, Vicenza, Italy
| | - Paolo Bozzini
- Division of Cardiology, Fracastoro Hospital, 37020 San Bonifacio, Verona, Italy
| | - Stefano Bonapace
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Verona, Italy
| | - Maurizio Anselmi
- Division of Cardiology, Fracastoro Hospital, 37020 San Bonifacio, Verona, Italy
| | - Gianluca Rigatelli
- Division of Cardiology, Madre Teresa Hospital, 35043 Padova, Schiavonia, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
- Correspondence: (M.Z.); (C.B.); Tel.: +39-0444-479106 (C.B.); Fax: +39-0444-931163 (C.B.)
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19
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Maloberti A, Giannattasio C, Rebora P, Occhino G, Ughi N, Rizzo J, Fabbri S, Leidi F, Cartella I, Algeri M, Scarpellini S, Rossetti C, Epis O, Molon G, Bonfanti P, Valsecchi M, Genovesi S. Atrial fibrillation incidence in SARS-CoV-2 infected patients: Predictors and relationship with in-hospital mortality. Atherosclerosis 2022. [PMCID: PMC9425751 DOI: 10.1016/j.atherosclerosis.2022.06.769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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20
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Maloberti A, Giannattasio C, Rebora P, Occhino G, Ughi N, Rizzo J, Fabbri S, Leidi F, Cartella I, Algeri M, Scarpellini S, Rossetti C, Epis O, Molon G, Bonfanti P, Valsecchi MG, Genovesi S. ATRIAL FIBRILLATION INCIDENCE IN SARS-COV-2 INFECTED PATIENTS: PREDICTORS AND RELATIONSHIP WITH IN-HOSPITAL MORTALITY. J Hypertens 2022. [DOI: 10.1097/01.hjh.0000835888.39220.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Marinelli A, Giaj Levra N, Trachanas K, Costa A, Sicignano G, Cuccia F, Corso M, Alongi F, Molon G. Stereotactic ablative body radiotherapy of ventricular tachycardia. Single italian centre experience. Europace 2022. [DOI: 10.1093/europace/euac053.362] [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
Ventricular tachycardia (VT) is a life-threatening condition. Usual management of VT is based on anti-arrhythmic drugs or catheter ablation. In this scenario, stereotactic body radiation therapy (SBRT) is arising as an attractive non-invasive alternative for the treatment of VT in some patients (pts).
Purpose
The aim of this study was to assess safety, feasibility and outcomes of SBRT in fragile pts admitted in our centre for VT storms.
Methods
Pts with implantable cardioverter-defibrillator (ICD), presenting with VT storms and not responsive to drugs or suitable for catheter ablation were enrolled for SBRT. All pts underwent a computed tomography (CT) and an 18F-fluorodeoxyglucose positron emission (FDG PET)-CT scan in order to detect a possible area of scar responsible of the VT. All pts had also an electrophysiological study and ventricular programmed stimulation inducing clinical VT while wearing a multi-electrodes ECG vest. Merging the CT scan imagines and the VT 3D reconstruction, we identified the possible circuit of the VT and its exit sites. Treatment planning was performed for a total dose of 21-25 Gy delivered in a single session. For the first year, follow-up (FU) were scheduled every 3 months since the SBRT treatment. Toxicity was prospectively assessed.
Results
From January 2020 to March 2021, we treated 6 (5 males) pts. Mean age was 78±4. NYHA class was II for 3 pts, 2 were class III and only one pts was class IV. Four pts had an ischaemic heart disease background, two had dilated cardiomyopathy (DCM). Mean ejection fraction (EF) was 31±6%. The mean FU was 17 months, with the longest of 23 months. Of these 6 pts, only one died because of end stage heart failure, no VT/VF were recorded on his ICD. This was the pts with DCM and class NYHA IV at the time of procedure. Of the 5 pts remaining, 2/5 reported new therapies delivered by their ICDs. One pts had a single ICD shock during acute urine tract infection and sepsis at one month since SBRT. ICD interrogation documented inappropriate shock on fast conducted atrial fibrillation. No VTs have been recorded after 7 months. The other pts was admitted after 5 months since SBRT. The ICD showed appropriate therapies on VTs. This pts had the biggest scar volume compared to the others (anterior wall of the left ventricle with aneurysmatic apex). On the other 3 pts, no VTs were recorded by ICDs. Of these 3 pts, interestingly, 2 had class NYHA III and the mean EF 28.6±3%. The overall outcome with no appropriate ICD shocks due to VTs is above 70%. No radiotherapy toxicity was documented.
Conclusion
To the best of our knowledge this is one of the biggest groups of pts treated with this technology and the longest FU so far, of a single centre in Italy. SBRT seems to be a safe and feasible approach to treat fragile pts with VTs when not suitable for standard catheter ablation or responsive to medications. It also shows a good outcome even in pts with more advanced heart failure.
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Affiliation(s)
- A Marinelli
- IRCCS Sacro Cuore - Don Calabria, Negrar, Italy
| | | | - K Trachanas
- IRCCS Sacro Cuore - Don Calabria, Negrar, Italy
| | - A Costa
- IRCCS Sacro Cuore - Don Calabria, Negrar, Italy
| | - G Sicignano
- IRCCS Sacro Cuore - Don Calabria, Negrar, Italy
| | - F Cuccia
- IRCCS Sacro Cuore - Don Calabria, Negrar, Italy
| | - M Corso
- IRCCS Sacro Cuore - Don Calabria, Negrar, Italy
| | - F Alongi
- IRCCS Sacro Cuore - Don Calabria, Negrar, Italy
| | - G Molon
- IRCCS Sacro Cuore - Don Calabria, Negrar, Italy
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22
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Molon G, Costa A, Bonapace S, Marinelli A, Alongi F, Giaj Levra N, Sicignano G, Cuccia F. C2 STEREOTACTIC ABLATIVE RADIOTHERAPY (STAR) IN PATIENTS WITH ICD AND ARRHYTHMIC STORMS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
The current therapy of recurrent ventricular tachycardia (VT) and arrhythmic storms is the radiofrequency catheter ablation (RFCA). The first experiences of stereotaxic radioablation of arrhythmia (STAR) as an alternative in patients (pts) with defibrillator (ICD) and Arrhythmic Storms are emerging. However, a standardized method for STAR is not yet available and many issues are still under discussion. We present the preliminary results of STAR in the pts of our Center.
Material and method
Pts with ICDs and Arrhythmic Storms, excluded from RFCA, were referred to STAR. Diagnostics performed were Electrophysiological study (EPS) using 3D electroanatomical mapping (3DEAM) using CardioInsightTM vest (Medtronic, Minneapolis, MN), cardio–CT scan and 18F–fluorine–2–deoxy–D–glucose positron emission tomography (18FDG – PET scan) in order to identify the target area of the ventricle. In all pts a sustained monomorphic VT was induced during EPS, and 3DEAM was used to identify the exit point of the VT (Fig. 1). In all cases, a 3 mm thick 4D CT scan was used (Fig. 2) with the aid of an abdominal thermoplastic mask. Each patient was treated with a TrueBeam Linac (Varian Medical Systems, Palo Alto, CA). The prescription of the dose from 21 to 25 Gy in a single delivery. Ethics committee approval was obtained prior to each treatment.
Results
From January 2020 to March 2021, 6 patients (5 M, 1 F), mean age 78 years (58–80) were treated with STAR. The median delivered dose was 25 Gy (range 21–25 Gy). In follow–up (FU) one patient died from end–stage heart failure after 30 days. At a median FU of 13 months, STAR treatment efficacy was observed in 3/5 patients, in whom no defibrillator activation was recorded. 2/5 patients had recurrence of TV, 2 and 6 months after STAR. No severe acute toxicity was recorded after radiotherapy.
Conclusions
Arrhythmic stereotaxic radioablation appears to be a safe and effective therapy in PTS with ICDs and arrhythmic storms. Completely non–invasive diagnostics and therapy make it very interesting and ambitious. Additional data is needed to improve the definition of the target zone and to standardize it in patients not eligible for RFCA.
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Affiliation(s)
- G Molon
- IRCCS SACRO CUORE DON CALABRIA, NEGRAR; UNIVERSITY OF BRESCIA, BRESCIA
| | - A Costa
- IRCCS SACRO CUORE DON CALABRIA, NEGRAR; UNIVERSITY OF BRESCIA, BRESCIA
| | - S Bonapace
- IRCCS SACRO CUORE DON CALABRIA, NEGRAR; UNIVERSITY OF BRESCIA, BRESCIA
| | - A Marinelli
- IRCCS SACRO CUORE DON CALABRIA, NEGRAR; UNIVERSITY OF BRESCIA, BRESCIA
| | - F Alongi
- IRCCS SACRO CUORE DON CALABRIA, NEGRAR; UNIVERSITY OF BRESCIA, BRESCIA
| | - N Giaj Levra
- IRCCS SACRO CUORE DON CALABRIA, NEGRAR; UNIVERSITY OF BRESCIA, BRESCIA
| | - G Sicignano
- IRCCS SACRO CUORE DON CALABRIA, NEGRAR; UNIVERSITY OF BRESCIA, BRESCIA
| | - F Cuccia
- IRCCS SACRO CUORE DON CALABRIA, NEGRAR; UNIVERSITY OF BRESCIA, BRESCIA
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23
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Maloberti A, Giannattasio C, Rebora P, Occhino G, Ughi N, Rizzo J, Fabbri S, Leidi F, Cartella I, Algeri M, Scarpellini S, Rossetti C, Epis O, Molon G, Bonfanti P, Valsecchi M, Genovesi S. P16 ATRIAL FIBRILLATION INCIDENCE IN SARS–COV–2 INFECTED PATIENTS: PREDICTORS AND RELATIONSHIP WITH IN–HOSPITAL MORTALITY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Among the different CardioVascular (CV) manifestation of the COronaVIrus–related Disease (COVID) particular attention has been paid to arrhythmia and particularly to Atrial fibrillation (AF). The aim of our study was to assess the incidence of AF episodes in patients hospitalized for COVID and to evaluate its predictors and its relationship with in–hospital all–cause mortality.
Methods
We enrolled 3435 cases of SARS–CoV2 infection admitted in four hospitals in Northern Italy. We collected data on clinical history, vital signs, Intensive Care Unit (ICU) admission, laboratory tests and pharmacological treatment. AF incident and all–cause in–hospital mortality were considered as outcomes.
Results
145 (4.2%) patients develop AF during hospitalization, with a median time of 3 days (IQR: 0, 11.5) from admission. Incident AF patients were older and had lower eGFR, lower platelet and lymphocytes count and higher C–Reactive Protein (CRP), were admitted more frequently to ICU and more frequently died compared to subjects that didn’t present AF. At the Cox regression model significant determinants of incident AF were older age (HR 1.070; 95% CI: 1.048, 1.092), history of AF (HR 2.800; 95% CI: 1.465, 5.351), ischemic heart disease (HR 0.324; 95% CI: 0.130, 0.811) and ICU admission (HR 8.030; 95% CI: 4.511, 14.292). Incident AF was a predictor of all–cause mortality (HR 1.679; 95% CI: 1.170, 2.410), together with age (HR 1.053; 95% CI: 1.042, 1.065), dementia (HR 1.553; 95% CI 1.151, 2.095), platelet count (HR 0.997; 95% CI: 0.996, 0.999) higher CRP (HR 1.004; 95% CI: 1.003, 1.005) and eGFR (HR: 0.991; 95% CI: 0.986, 0.996)
Conclusion
AF present as the main arrhythmia in COVID–19 patients and its development during the hospitalization strongly relates with in–hospital mortality.
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Affiliation(s)
- A Maloberti
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - C Giannattasio
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - P Rebora
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - G Occhino
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - N Ughi
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - J Rizzo
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - S Fabbri
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - F Leidi
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - I Cartella
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - M Algeri
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - S Scarpellini
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - C Rossetti
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - O Epis
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - G Molon
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - P Bonfanti
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - M Valsecchi
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - S Genovesi
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
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Lavalle C, Coscia V, Ammendola E, Busacca G, Adduci C, de Ruvo E, PANCHETTI L, VIANI STEFANO, Ammirati G, Sanna G, Molon G, Quartieri F, Di Rosa R, Valsecchi S, Bianchi V. PO-631-05 A MOBILE APP FOR IMPROVING THE COMPLIANCE TO REMOTE MONITORING OF PATIENTS WITH CARDIAC IMPLANTABLE DEVICES: A MULTICENTER EVALUATION IN CLINICAL PRACTICE. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.905] [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: 11/25/2022]
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Molon G, Giaj-Levra N, Costa A, Bonapace S, Cuccia F, Marinelli A, Trachanas K, Sicignano G, Alongi F. Stereotactic ablative radiotherapy in patients with refractory ventricular tachyarrhythmia. Eur Heart J Suppl 2022; 24:C248-C253. [PMID: 35602256 PMCID: PMC9117912 DOI: 10.1093/eurheartj/suac016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Stereotactic ablative body radiotherapy (SABR) is an innovative therapeutic approach in patients (pts) with a diagnosis of refractory ventricular tachyarrhythmia (VT) after the use of drugs, radiofrequency catheter ablation, and/or defibrillator (ICD) implant. The current efficacy data of SABR are limited and several prospective clinical studies are ongoing to support the use of ablative radiation dose to control VT. The aim of the current prospective pilot study is to report the efficacy and tolerability of SABR in ICD implanted pts with refractory VT in our centre. Non-invasive electroanatomical mapping (EAM), cardiac computed tomography (CT), and 18F-fluorodeoxyglucose positron emission (FDG-PET)-CT scan were used and combined with a radiation CT scan. A dose prescription of 25 Gy in a single dose was delivered by volumetric modulated arc therapy (VMAT) Linac-based. The primary endpoint was efficacy, defined as a reduction in ICD shocks after SABR treatment, while the secondary endpoint was safety. Six consecutive pts (five males and one female) implanted with an ICD and with three or more VT were enrolled. One pts died after 1 month, due to end-stage heart failure. Two pts experienced ICD shocks in VT 2 and 5 months after treatment. Three pts experienced no more ICD shocks on VT after therapy. Our data suggest the efficacy and safety of SABR treatment in pts with VT. Larger dataset of pts and longer follow-up are otherwise required to validate the impact of SABR as a standardized treatment in these pts.
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Affiliation(s)
- Giulio Molon
- Cardiology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Niccolò Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Alessandro Costa
- Cardiology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Stefano Bonapace
- Cardiology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Francesco Cuccia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Alessio Marinelli
- Cardiology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | | | - Gianluisa Sicignano
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
- University of Brescia, Brescia, Italy
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26
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Nicosia L, Giaj-Levra N, Sicignano G, Cuccia F, Figlia V, Mazzola R, Ricchetti F, Rigo M, Vitale C, Attinà G, De Simone A, Gurrera D, Ruggeri R, Molon G, Alongi F. PO-1452 Stereotactic ablative radiotherapy in patients with refractory ventricular tachyarrhythmia. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03416-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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27
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Boriani G, Iacopino S, Arena G, Pieragnoli P, Verlato R, Manfrin M, Molon G, Rovaris G, Curnis A, Perego GB, Dello Russo A, Landolina M, Vitolo M, Tondo C. Chronic Kidney Disease with Mild and Mild to Moderate Reduction in Renal Function and Long-Term Recurrences of Atrial Fibrillation after Pulmonary Vein Cryoballoon Ablation. J Cardiovasc Dev Dis 2022; 9:jcdd9050126. [PMID: 35621837 PMCID: PMC9147782 DOI: 10.3390/jcdd9050126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/01/2022] [Accepted: 04/14/2022] [Indexed: 02/01/2023] Open
Abstract
The aim of this research was to evaluate if patients with chronic kidney disease (CKD) and mild or mild to moderate depression of renal function have an increased risk of atrial fibrillation (AF) recurrences after cryoballoon (CB) ablation. We performed a retrospective analysis of AF patients undergoing pulmonary vein isolation (PVI) by CB. The cohort was divided according to the KDIGO CKD-EPI classification into a (1) normal, (2) mildly decreased, or (3) mild to moderate reduction in estimated glomerular filtration rate (eGFR). Freedom from AF recurrences was the primary endpoint. A total of 1971 patients were included (60 ± 10 years, 29.0% females, 73.6% paroxysmal AF) in the study. Acute success and complication rates were 99.2% and 3.7%, respectively, with no significant differences among the three groups. After a follow-up of 24 months, AF recurrences were higher in the mildly and mild to moderate CKD groups compared to the normal kidney function group (23.4% vs. 28.3% vs. 33.5%, p < 0.05). Mild to moderate CKD was an independent predictor of AF recurrences after the blanking period (hazard ratio:1.38, 95% CI 1.02−1.86, p = 0.037). In conclusion, a multicenter analysis of AF patients treated with cryoablation revealed mild to moderate reductions in renal functions were associated with a higher risk of AF recurrences. Conversely, the procedural success and complication rates were similar in patients with normal, mildly reduced, or mild to moderate reduction in eGFR.
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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, 41121 Modena, Italy;
- Correspondence:
| | - Saverio Iacopino
- Electrophysiology Unit, Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy;
| | | | | | - Roberto Verlato
- ULSS 6 Euganea, Ospedale di Camposampiero-Cittadella, 35013 Cittadella, Italy;
| | | | - Giulio Molon
- IRCCS Sacro Cuore don Calabria, 37024 Negrar, Italy;
| | | | | | | | | | | | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41121 Modena, Italy;
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Heart Rhythm Center, Monzino Cardiac Center IRCCS, 20122 Milan, Italy;
- Department of Biochemical, Surgical and Dentist Sciences, University of Milan, 20122 Milan, Italy
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Manfrin M, Verlato R, Arena G, Pieragnoli P, Molon G, Tondo C, Perego GB, Rovaris G, Sciarra L, Mantica M, Sacchi R, Ricciardi D, Marini M, Iacopino S. Second versus fourth generation of cryoballoon catheters: the 1STOP real-world multicenter experience. Pacing Clin Electrophysiol 2022; 45:968-974. [PMID: 35417055 DOI: 10.1111/pace.14494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/25/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION It has been observed that the fourth-generation cryoballoon (CB4) ablation catheter increased the rate of acute real-time recordings of pulmonary vein isolation (PVI) during the ablation for the treatment of atrial fibrillation (AF). The aim of this analysis was to compare the long-term outcome results between patients treated with the CB4 and second-generation cryoballoon (CB2). METHODS In total, 492 patients suffering from AF, underwent PVI ablation with either the CB2 or CB4 catheter within this examination of the 1STOP real-world Italian project and were included in the analysis. Specifically, 246 consecutive patients treated by CB4 were compared to 246 propensity-matched control patients who underwent PVI using CB2. RESULTS When comparing the patient cohorts treated with CB2 versus CB4, acute success rate (99.6±4.7% vs. 99.7±3.6%, P = 0.949) and peri-procedural complications (3.7% vs.1.2%, P = 0.080) were similar in both groups, respectively. However, procedure time (100 vs.75 min, P<0.001) and fluoroscopy duration (21 vs.17 min, P<0.001) were all significantly lower in the CB4 treated patient cohort. At the 12-month follow-up, the freedom from AF recurrence after a 90-day blanking period was significant higher in the CB4 as compared with the CB2 group (93.3% vs.81.3%, P<0.001). CONCLUSIONS In summary, usage of the CB4 ablation catheter increased the rate of acute PVI recording capability and resulted in a higher rate of long-term PVI success, as demonstrated by the reduced rate of AF recurrence in comparison to the CB2 cohort at the 12-month follow-up period. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Roberto Verlato
- ULSS 6 Euganea, Ospedale di Cittadella-Camposampiero, Padova, Italy
| | | | | | | | - Claudio Tondo
- Heart Rhythm Center, Department of Clinical Electrophysiology&Cardiac Pacing Monzino Cardiac Center, IRCCS Dept. of Biochemical, Surgical and Dentist Sciences University of Milan, Milan, Italy
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Lanzoni L, Bonapace S, Dugo C, Chiampan A, Anselmi A, Ghiselli L, Molon G. Cardiac masses and contrast echocardiography. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.296] [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: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
echocardiography may be the first imaging modality detecting a cardiac mass. Although echocardiography cannot give the histopathology, certain imaging features and adjunctive tools such as contrast echocardiography may aid in the differential diagnosis. Methods: we describe five cardiac masses in which echo-contrast helped to assess the presence or not of vascularization. Panel A shows a left atrial mass attached to the fossa ovalis with a large stalk prolapsing to the mitral inflow. Contrast echocardiography showed late but homogeneous opacification of the mass. Gross pathology confirmed an atrial mixoma. Panel B shows two masses in a patient with non-small cell lung cancer one embedded in the inferior left ventricular wall and the other floating in the left atrium. Administration of echo-contrast showed late and inhomogeneous enhancement of the myocardial mass and absent opacification of the atrial mass suggesting a metastatic infiltration of the myocardium together with an avascular neoplastic thrombus in the left atrium. Panel C shows a multi-lobulated and mobile mass in the right atrium straddling the tricuspid valve. Contrast echocardiography highlighted an inhomogeneous diffusion of the contrast within the mass with a rapid opacification only of its atrial portion. Gross pathology confirmed a recurrent thymoma. Panel D shows an intraventricular mass arising from the interventricular septum with multiple hypoechoic areas in a patient with metastatic carcinoid. Contrast administration showed a very late and mild degree of inhomogeneous enhancement. Conclusion: the echo-contrast allows a good differentiation between vascularized and non-vascularized cardiac masses, providing an important indication to differentiate thrombus from tumor. In those hypervascularized masses the homogeneous or inhomogeneous distribution of the contrast could be an interesting clue that orientates between primary or secondary cardiac tumors. Abstract Figure.
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Affiliation(s)
- L Lanzoni
- IRCCS Sacro Cuore - Don Calabria, Negrar, Italy
| | - S Bonapace
- IRCCS Sacro Cuore - Don Calabria, Negrar, Italy
| | - C Dugo
- IRCCS Sacro Cuore - Don Calabria, Negrar, Italy
| | - A Chiampan
- IRCCS Sacro Cuore - Don Calabria, Negrar, Italy
| | - A Anselmi
- IRCCS Sacro Cuore - Don Calabria, Negrar, Italy
| | - L Ghiselli
- IRCCS Sacro Cuore - Don Calabria, Negrar, Italy
| | - G Molon
- IRCCS Sacro Cuore - Don Calabria, Negrar, Italy
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Mantovani A, Bonapace S, Dugo C, Beatrice G, Petracca G, Cappelli D, Csermely A, Molon G, Targher G. Association between higher serum uric acid levels and plasma N-terminal pro-B-type natriuretic peptide concentrations in patients with coronary artery disease and without overt heart failure. Int J Cardiol 2022; 353:127-130. [DOI: 10.1016/j.ijcard.2022.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
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Diemberger I, Vicentini A, Cattafi G, Ziacchi M, Iacopino S, Morani G, Pisanò E, Molon G, Giovannini T, Russo AD, Boriani G, Bertaglia E, Biffi M, Bongiorni MG, Rordorf R, Zucchelli G. The Impact of COVID-19 Pandemic and Lockdown Restrictions on Cardiac Implantable Device Recipients with Remote Monitoring. J Clin Med 2021; 10:jcm10235626. [PMID: 34884329 PMCID: PMC8658316 DOI: 10.3390/jcm10235626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/20/2021] [Revised: 11/13/2021] [Accepted: 11/18/2021] [Indexed: 12/22/2022] Open
Abstract
From 2020, many countries have adopted several restrictions to limit the COVID-19 pandemic. The forced containment impacted on healthcare organizations and the everyday life of patients with heart disease. We prospectively analyzed data recorded from implantable defibrillators and/or cardiac resynchronization devices of Italian patients during the lockdown (LDP), post-lockdown period (PLDP) and a control period (CP) of the previous year. We analyzed device data of the period 9 March 2019–31 May 2020 of remotely monitored patients from 34 Italian centers. Patients were also categorized according to areas with high/low infection prevalence. Among 696 patients, we observed a significant drop in median activity in LDP as compared to CP that significantly increased in the PLDP, but well below CP (all p < 0.0001). The median day heart rate and heart rate variability showed a similar trend. This behavior was associated during LDP with a significant increase in the burden of atrial arrhythmias (p = 0.0150 versus CP) and of ventricular arrhythmias [6.6 vs. 1.5 per 100 patient-weeks in CP; p = 0.0026]; the latter decreased in PLDP [0.3 per 100 patient-weeks; p = 0.0035 vs. LDP]. No modifications were recorded in thoracic fluid levels. The high/low prevalence of COVID-19 infection had no significant impact. We found an increase in the arrhythmic burden in LDP coupled with a decrease in physical activity and heart rate variability, without significant modifications of transthoracic impedance, independent from COVID-19 infection prevalence. These findings suggest a negative impact of the COVID-19 pandemic, probably related to lockdown restrictions.
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Affiliation(s)
- Igor Diemberger
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy
- UOC di Cardiologia, IRCCS Policlinico S.Orsola-Malpighi, 40138 Bologna, Italy; (M.Z.); (M.B.)
- Correspondence: ; Tel.: +39-051-214-9034
| | - Alessandro Vicentini
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (A.V.); (R.R.)
| | - Giuseppe Cattafi
- Cardiologia 3, Dipartimento Cardiotoracovascolare, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy;
| | - Matteo Ziacchi
- UOC di Cardiologia, IRCCS Policlinico S.Orsola-Malpighi, 40138 Bologna, Italy; (M.Z.); (M.B.)
| | | | - Giovanni Morani
- UOC di Cardiologia, Azienda Ospedaliero Universitaria Integrata di Verona, 37126 Verona, Italy;
| | - Ennio Pisanò
- UOC di Cardiologia, Ospedale Vito Fazzi Lecce, 73100 Lecce, Italy;
| | - Giulio Molon
- UOC di Cardiologia, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy;
| | | | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti”, 60126 Ancona, Italy;
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy;
| | - Emanuele Bertaglia
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, Azienda Ospedaliera Universitaria di Padova, 35128 Padova, Italy;
| | - Mauro Biffi
- UOC di Cardiologia, IRCCS Policlinico S.Orsola-Malpighi, 40138 Bologna, Italy; (M.Z.); (M.B.)
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, Cardio Thoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (M.G.B.); (G.Z.)
| | - Roberto Rordorf
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (A.V.); (R.R.)
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardio Thoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (M.G.B.); (G.Z.)
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Tarakji KG, Zaidi AM, Zweibel SL, Varma N, Sears SF, Allred J, Roberts PR, Shaik NA, Silverstein JR, Maher A, Mittal S, Patwala A, Schoenhard J, Emert M, Molon G, Augello G, Patel N, Seide H, Porfilio A, Maus B, Di Jorio SL, Holloman K, Natera AC, Turakhia MP. Performance of first pacemaker to use smart device app for remote monitoring. Heart Rhythm O2 2021; 2:463-471. [PMID: 34667961 PMCID: PMC8505204 DOI: 10.1016/j.hroo.2021.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Indexed: 11/17/2022] Open
Abstract
Background High adherence to remote monitoring (RM) in pacemaker (PM) patients improves outcomes; however, adherence remains suboptimal. Bluetooth low-energy (BLE) technology in newer-generation PMs enables communication directly with patient-owned smart devices using an app without a bedside console. Objective To evaluate the success rate of scheduled RM transmissions using the app compared to other RM methods. Methods The BlueSync Field Evaluation was a prospective, international cohort evaluation, measuring the success rate of scheduled RM transmissions using a BLE PM or cardiac resynchronization therapy PM coupled with the MyCareLink Heart app. App transmission success was compared to 3 historical “control” groups from the Medtronic de-identified CareLink database: (1) PM patients with manual communication using a wand with a bedside console (PM manual transmission), (2) PM patients with wireless automatic communication with the bedside console (PM wireless); (3) defibrillator patients with similar automatic communication (defibrillator wireless). Results Among 245 patients enrolled (age 64.8±15.6 years, 58.4% men), 953 transmissions were scheduled through 12 months, of which 902 (94.6%) were successfully completed. In comparison, transmission success rates were 56.3% for PM manual transmission patients, 77.0% for PM wireless patients, and 87.1% for defibrillator wireless patients. Transmission success with the app was superior across matched cohorts based on age, sex, and device type (single vs dual vs triple chamber). Conclusion The success rate of scheduled RM transmissions was higher among patients using the smart device app compared to patients using traditional RM using bedside consoles. This novel technology may improve patient engagement and adherence to RM.
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Affiliation(s)
- Khaldoun G Tarakji
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Amir M Zaidi
- Central Manchester University Hospitals, NHS Foundation Trust, Manchester, United Kingdom
| | - Steven L Zweibel
- Hartford Healthcare and Vascular Institute, Hartford, Connecticut
| | - Niraj Varma
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Paul R Roberts
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | | | - Abdul Maher
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, United Kingdom
| | | | - Ashish Patwala
- Royal Stoke University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | | | - Martin Emert
- University of Kansas Medical Center, Kansas City, Kansas
| | - Giulio Molon
- Ospedale Sacro Cuore don Calabria, Negrar, Italy
| | | | | | | | | | - Baerbel Maus
- Bakken Research Center, Medtronic plc, Maastricht, The Netherlands
| | | | | | | | - Mintu P Turakhia
- Center for Digital Health, Stanford University, Stanford, California.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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Bonapace S, Molon G, Marinelli A, Lanzoni L, Targher G. Prognostic Role of Pericardial Fat on the Incidence of Heart Failure. J Am Coll Cardiol 2021; 78:e111. [PMID: 34620416 DOI: 10.1016/j.jacc.2021.06.053] [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] [Received: 06/21/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
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Ungar A, Pescini F, Rafanelli M, De Angelis MV, Faustino M, Tomaselli C, Petrone A, Forleo G, Morani G, Forlivesi S, Molon G, Adami A, Maines M, Stegagno C, Poggesi A, Pantoni L. Detection of subclinical atrial fibrillation after cryptogenic stroke using implantable cardiac monitors. Eur J Intern Med 2021; 92:86-93. [PMID: 34247889 DOI: 10.1016/j.ejim.2021.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Implantable cardiac monitor (ICM) revealed subclinical atrial fibrillation (SCAF) in up to 30% of cryptogenic stroke (CS) patients in randomized trials. However, real world data are limited. OBJECTIVES We investigated SCAF occurrence, treatments, clinical outcomes and predictors of SCAF in a multicenter real-world population subjected to ICM after CS. METHODS From September 2016 to November 2019, 20 Italian centers collected data of consecutive patients receiving ICM after CS and followed with remote and outpatient follow-up according to clinical practice. All device-detected AF events were confirmed by the cardiologist to diagnose SCAF. RESULTS ICM was implanted in 334 CS patients (mean age±SD 67.4±11.5 years, 129 (38.6%) females, 242 (76.1%) with CHA2DS2-VASC score≥4). During a follow-up of 23.6 (IQR 14.6-31.5) months, SCAF was diagnosed in 92 (27.5%) patients. First episode was asymptomatic in 81 (88.1%). SCAF daily burden ≥5 minutes was 22.0%, 24.1% and 31.5% at 6, 12, and 24 months after ICM implantation. Median time to first day with AF was 60 (IQR 18-140) days. Female gender, age>69 years, PR interval>160 ms and cortical-subcortical infarct type at enrolment were independently associated with an increased risk of SCAF. CONCLUSIONS In a real-world population, ICM detected SCAF in more than a quarter of CS patients. This experience confirms the relevance of implanting CS patients, for maximizing the possibilities to detect AF, following failure of Holter monitoring, according to guidelines. However, there is need to demonstrate that shift to oral anticoagulation following SCAF detection is associated with reduced risk of recurrent stroke.
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Affiliation(s)
- Andrea Ungar
- Division of Geriatric and Intensive Care Medicine, Syncope Unit, University of Florence, Firenze, Italy.
| | - Francesca Pescini
- Stroke Unit Emergency Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Martina Rafanelli
- Division of Geriatric and Intensive Care Medicine, Syncope Unit, University of Florence, Firenze, Italy
| | | | | | | | | | | | - Giovanni Morani
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Stefano Forlivesi
- Neurology and Stroke Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giulio Molon
- Cardiology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Alessandro Adami
- Stroke Center, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | | | - Chiara Stegagno
- Neurology Department, S. Maria del Carmine Hospital, Rovereto, Italy
| | - Anna Poggesi
- Stroke Unit Emergency Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy; IRCCS Fondazione Don Carlo Gnocchi, Firenze, Italy; NEUROFARBA Department, University of Florence, Firenze, Italy
| | - Leonardo Pantoni
- "Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milano, Italy.
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Lanzoni L, Bonapace S, Molon G, Basso C, De Gaspari M. An intracardiac mass arising from the coronary sinus. Eur Heart J Cardiovasc Imaging 2021; 22:e163. [PMID: 34322705 DOI: 10.1093/ehjci/jeab146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Laura Lanzoni
- Cardiology Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Stefano Bonapace
- Cardiology Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Giulio Molon
- Cardiology Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health-Azienda Ospedaliera, University of Padua Medical School, Padua, Italy
| | - Monica De Gaspari
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health-Azienda Ospedaliera, University of Padua Medical School, Padua, Italy
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Inno A, Chiampan A, Lanzoni L, Verzè M, Molon G, Gori S. Immune Checkpoint Inhibitors and Atherosclerotic Vascular Events in Cancer Patients. Front Cardiovasc Med 2021; 8:652186. [PMID: 34124192 PMCID: PMC8193098 DOI: 10.3389/fcvm.2021.652186] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 01/11/2021] [Accepted: 04/27/2021] [Indexed: 12/26/2022] Open
Abstract
In clinical trials and meta-analysis, atherosclerotic vascular events (AVEs) during treatment with immune-checkpoint inhibitors (ICIs) have been reported with low incidence. However, preclinical data suggest that these drugs can promote atherosclerosis inflammation and progression of atherosclerosis plaques, and there is now growing and convincing evidence from retrospective studies that ICIs increase the risk of atherosclerotic vascular events including arterial thrombosis, myocardial infarction and ischemic stroke. Prospective studies are needed to increase knowledge on long-term effect of ICIs or their combinations with other cardio-toxic drugs, but in the meantime a careful assessment and optimization of cardiovascular risk factors among patients treated with ICIs is advisable.
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Affiliation(s)
- Alessandro Inno
- Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | - Andrea Chiampan
- Cardiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | - Laura Lanzoni
- Cardiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | - Matteo Verzè
- Medical Direction, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | - Giulio Molon
- Cardiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | - Stefania Gori
- Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Sacro Cuore Don Calabria, Verona, Italy
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Marinelli A, Costa A, Dugo C, Cecchetto A, Lanzoni L, Molon G. A unique case of left ventricle apical hypoplasia presenting with a type 1 Brugada ECG pattern and NEXN mutation. Are they related? HeartRhythm Case Rep 2021; 7:273-277. [PMID: 34026514 PMCID: PMC8134760 DOI: 10.1016/j.hrcr.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alessio Marinelli
- IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Alessandro Costa
- IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Clementina Dugo
- IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | | | - Laura Lanzoni
- IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Giulio Molon
- IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
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Costa A, Rauhe W, Martignani C, Igniatiuk B, Sabbatani P, Nangah R, Marinelli A, Molon G. Voltage bridge mapping in atrioventricular nodal reentry tachycardia ablation in adult population: results from a multicenter registry. Europace 2021. [DOI: 10.1093/europace/euab116.065] [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
The presence of Low Voltage Bridge (LVB) in Atrioventricular Nodal Reentry Tachycardia (AVNRT) ablation has been described in children populations. Slow pathway ablations visualizing and targeting the LVB has been described to be safe and effective. However, the incidence of LVB in AVNRT ablation has not been widely explored in adult population.
Purpose
We aim to investigate the presence of LVB in adult patients (pts) undergoing AVNRT ablation, and the relationship between the LVB and the successful ablation site. We have also investigated the correlations between the Koch’s triangle (KT) anatomy and biophysical pts data.
Methods
The observational registry prospectively collected data of 165 pts. undergoing AVNRT ablation guided by 3D electroanatomical mapping system (EnSite - Abott, St Paul, MN) in 6 EP centers. Gender: 90F – 75M (55% - 45%) - Age: 57 ± 17 ys (min 15 – max 87) - Weight: 73 ± 15 kgs (min 42 - max 150) Prior of ablation a voltage map of KT was created using diagnostic and ablation catheters.
We define as Type I LVB a clear, long area of low voltage within the KT between the CS ostium and the AV node with the base on the edge of the tricuspid annulus and Type II LVB a narrow low voltage channel between normal-voltage regions with the base on the edge of the tricuspid annulus.
The relationship between LVB and successful site was evaluated at the end of the procedure. KT anatomical data were correlated to gender, age and weight.
Results
The LVB was identified in 134 pts (81%) with a prevalence of type I (91 - 68%) over type II (33 - 25%). In 10 pts (7%) the LVB did not match type I nor type II. When an LVB was identified, the correspondence between the LVB and the successful ablation site was verified in 117 pts (87%). In addition, a shorter RF time was applied when an LVB was found (396s vs 298s; p = 0.03). Strong correlations between KT anatomy and biophysical pts data were not identified. The distance between His electrograms and the successful ablation site weakly correlated (ρ = -0.24, p < 0.01) with pts age suggesting a shortening in the distance with age progression.
Conclusion
The visualization of the Low Voltage Bridge may be a helpful tool to guide AVNRT ablation in a large cohort of pts; furthermore it is associated with reduced RF applications time. The KT characteristics are difficult to be predicted a priori according to patient gender, age or weight.
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Affiliation(s)
- A Costa
- IRCCS Sacro Cuore - Don Calabria, Negrar, Italy
| | - W Rauhe
- San Maurizio Regional Hospital of Bolzano, Bolzano, Italy
| | - C Martignani
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - B Igniatiuk
- Ospedali Riuniti Padova Sud, Monselice, Italy
| | | | - R Nangah
- AULSS4 Veneto Orientale, San Dona di Piave, Italy
| | - A Marinelli
- IRCCS Sacro Cuore - Don Calabria, Negrar, Italy
| | - G Molon
- IRCCS Sacro Cuore - Don Calabria, Negrar, Italy
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Moltrasio M, Iacopino S, Arena G, Pieragnoli P, Molon G, Manfrin M, Verlato R, Ottaviano L, Rovaris G, Catanzariti D, Cipolletta L, Nicolis D, Cattafi G, Tondo C. First-line therapy: insights from a real-world analysis of cryoablation in patients with atrial fibrillation. J Cardiovasc Med (Hagerstown) 2021; 22:618-623. [PMID: 34009837 DOI: 10.2459/jcm.0000000000001176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Pulmonary vein isolation (PVI) using cryoballoon ablation (CBA) is mainly reserved for patients with drug-refractory or drug-intolerant symptomatic atrial fibrillation. We evaluated a large cohort of patients treated in a real-world setting and examined the safety and efficacy profile of CBA when applied as a first-line treatment for atrial fibrillation. METHODS In total, 249 patients (23% women; 56 ± 13 years; mean left atrial diameter 41 ± 7 mm; 73.5% paroxysmal atrial fibrillation; and 26.5% persistent atrial fibrillation) underwent an index PVI by CBA. Data were collected prospectively in the framework of the 1STOP ClinicalService project, involving 26 Italian cardiology centers. RESULTS Median procedure and fluoroscopy times were 90.0 and 21.0 min, respectively. Acute procedural success was 99.8%. Acute/periprocedural complications were observed in seven patients (2.8%), including: four transient diaphragmatic paralyses, one pericardial effusion (not requiring any intervention), one transient ischemic attack, and one minor vascular complication. The Kaplan--Meier freedom from atrial fibrillation recurrence was 86.3% at 12 months and 76% at 24 months. Seventeen patients (6.8%) had a repeat catheter ablation procedure during the follow-up period. At last follow-up, 10% of patients were on an anticoagulation therapy, whereas 6.8% were on an antiarrhythmic drug. CONCLUSION In our multicenter real-world experience, PVI by CBA in a first-line atrial fibrillation patient population was well tolerated, effective, and promising. CBA with a PVI strategy can be used to treat patients with paroxysmal and persistent atrial fibrillation with good acute procedural success, short procedure times, and acceptable safety. CLINICAL TRIAL REGISTRATION clinicaltrials.gov (NCT01007474).
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Affiliation(s)
| | | | | | | | - Giulio Molon
- IRCCS Sacro Cuore Don Calabria Don Calabria, Negrar
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Deledda G, Riccardi N, Gori S, Poli S, Giansante M, Geccherle E, Mazzi C, Silva R, Desantis N, Giovannetti AM, Solari A, Confalonieri P, Grazzi L, Sarcletti E, Biffa G, Biagio AD, Sestito C, Keim R, Gangi Hermis AMRD, Mazzoldi M, Failo A, Scaglione A, Faldetta N, Dorangricchia P, Moschetto M, Soto Parra HJ, Faietti J, Profio AD, Rusconi S, Giacomelli A, Marchioretto F, Alongi F, Marchetta A, Molon G, Bisoffi Z, Angheben A. The Impact of the SARS-CoV-2 Outbreak on the Psychological Flexibility and Behaviour of Cancelling Medical Appointments of Italian Patients with Pre-Existing Medical Condition: The "ImpACT-COVID-19 for Patients" Multi-Centre Observational Study. Int J Environ Res Public Health 2021; 18:E340. [PMID: 33466374 PMCID: PMC7794735 DOI: 10.3390/ijerph18010340] [Citation(s) in RCA: 9] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/24/2020] [Accepted: 12/29/2020] [Indexed: 12/13/2022]
Abstract
Psychological distress imposed by the SARS-CoV-2 outbreak particularly affects patients with pre-existing medical conditions, and the progression of their diseases. Patients who fail to keep scheduled medical appointments experience a negative impact on care. The aim of this study is to investigate the psychosocial factors contributing to the cancellation of medical appointments during the pandemic by patients with pre-existing health conditions. Data were collected in eleven Italian hospitals during the last week of lockdown, and one month later. In order to assess the emotional impact of the SARS-CoV-2 outbreak and the subject's degree of psychological flexibility, we developed an ad hoc questionnaire (ImpACT), referring to the Acceptance and Commitment Therapy (ACT) model. The Impact of Event Scale-Revised (IES-R), the Depression, Anxiety and Stress Scale (DASS) and the Cognitive Fusion Questionnaire (CFQ) were also used. Pervasive dysfunctional use of experiential avoidance behaviours (used with the function to avoid thought, emotions, sensations), feelings of loneliness and high post-traumatic stress scores were found to correlate with the fear of COVID-19, increasing the likelihood of cancelling medical appointments. Responding promptly to the information and psychological needs of patients who cancel medical appointments can have positive effects in terms of psychological and physical health.
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Affiliation(s)
- Giuseppe Deledda
- Clinical Psychology Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (S.P.); (M.G.); (E.G.)
| | - Niccolò Riccardi
- Department of Infectious—Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (N.R.); (Z.B.); (A.A.)
| | - Stefania Gori
- Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy;
| | - Sara Poli
- Clinical Psychology Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (S.P.); (M.G.); (E.G.)
| | - Matteo Giansante
- Clinical Psychology Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (S.P.); (M.G.); (E.G.)
| | - Eleonora Geccherle
- Clinical Psychology Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (S.P.); (M.G.); (E.G.)
| | - Cristina Mazzi
- Clinical Research Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (C.M.); (R.S.); (N.D.)
| | - Ronaldo Silva
- Clinical Research Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (C.M.); (R.S.); (N.D.)
| | - Nicoletta Desantis
- Clinical Research Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (C.M.); (R.S.); (N.D.)
| | - Ambra Mara Giovannetti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20145 Milan, Italy; (A.M.G.); (A.S.)
- Multiple Sclerosis Centre, Neuroimmunology Unit, Clinical Neurology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20145 Milan, Italy;
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, 4072 QLD, Australia
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20145 Milan, Italy; (A.M.G.); (A.S.)
| | - Paolo Confalonieri
- Multiple Sclerosis Centre, Neuroimmunology Unit, Clinical Neurology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20145 Milan, Italy;
| | - Licia Grazzi
- Headache Center, Neurology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20145 Milan, Italy;
| | - Elena Sarcletti
- Clinical Psychology and Psychotherapy Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (E.S.); (G.B.)
| | - Gabriella Biffa
- Clinical Psychology and Psychotherapy Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (E.S.); (G.B.)
| | - Antonio Di Biagio
- Infectious Diseases Clinic, Policlinico San Martino Hospital-IRCCS, 16132 Genoa, Italy;
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, 16132 Genoa, Italy
| | - Carlo Sestito
- Service of Psycho Oncology, San Giovanni di Dio Hospital, Azienda Sanitaria Provinciale di Crotone, 88900 Crotone, Italy;
| | - Roland Keim
- General Hospital Bressanone, Azienda Sanitaria dell’Alto Adige, Bressanone, 39042 Bolzano, Italy; (R.K.); (A.M.R.D.G.H.)
| | - Alida M. R. Di Gangi Hermis
- General Hospital Bressanone, Azienda Sanitaria dell’Alto Adige, Bressanone, 39042 Bolzano, Italy; (R.K.); (A.M.R.D.G.H.)
| | - Mariantonietta Mazzoldi
- General Hospital Bolzano Azienda Sanitaria dell’Alto Adige, 39100 Bolzano, Italy; (M.M.); (A.F.)
| | - Alessandro Failo
- General Hospital Bolzano Azienda Sanitaria dell’Alto Adige, 39100 Bolzano, Italy; (M.M.); (A.F.)
| | - Anna Scaglione
- CFU-Italia ODV (Fybromyalgia Association), Castenaso, 40085 Bologna, Italy;
| | - Naida Faldetta
- Department of Oncoplastic Surgery of Breast Unit. V. Cervello Hospital, 90100 Palermo, Italy; (N.F.); (P.D.)
| | - Patrizia Dorangricchia
- Department of Oncoplastic Surgery of Breast Unit. V. Cervello Hospital, 90100 Palermo, Italy; (N.F.); (P.D.)
| | - Maria Moschetto
- Oncology Unit, Azienda Ospedaliero Universitaria (A.O.U.) Policlinico Vittorio Emanuele, 95123 Catania, Italy; (M.M.); (H.J.S.P.)
| | - Hector Josè Soto Parra
- Oncology Unit, Azienda Ospedaliero Universitaria (A.O.U.) Policlinico Vittorio Emanuele, 95123 Catania, Italy; (M.M.); (H.J.S.P.)
| | - Jennifer Faietti
- Cardiac Surgery Unit, Salus Hospital GVM Care & Research, 42123 Regio Emilia, Italy;
| | - Anna Di Profio
- Clinical Oncology Unit, S.S. Annunziata Hospital, 66100 Chieti, Italy;
| | - Stefano Rusconi
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences (DIBIC) Luigi Sacco, University of Milan, 20157 Milan, Italy; (S.R.); (A.G.)
| | - Andrea Giacomelli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences (DIBIC) Luigi Sacco, University of Milan, 20157 Milan, Italy; (S.R.); (A.G.)
| | - Fabio Marchioretto
- Neurological Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy;
| | - Filippo Alongi
- Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy;
- University of Brescia, 25121 Brescia, Italy
| | - Antonio Marchetta
- Rheumatology Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy;
| | - Giulio Molon
- Cardiology Deparment, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy;
| | - Zeno Bisoffi
- Department of Infectious—Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (N.R.); (Z.B.); (A.A.)
| | - Andrea Angheben
- Department of Infectious—Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (N.R.); (Z.B.); (A.A.)
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Malaspina D, Brasca F, Iacopino S, Arena G, Molon G, Pieragnoli P, Tondo C, Manfrin M, Rovaris G, Verlato R, Dello Russo A, Startari U, Sgarito G, Perego GB. Cryoablation for pulmonary veins isolation in obese patients with atrial fibrillation compared to nonobese patients. Pacing Clin Electrophysiol 2020; 44:306-317. [PMID: 33372267 DOI: 10.1111/pace.14149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/09/2020] [Accepted: 12/06/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pulmonary veins isolation (PVI) by cryoballoon (CB) ablation is marginally represented in clinical studies in obese patients. The aim of this analysis was to evaluate the safety and efficacy of CB-PVI in a large cohort of overweight and obese patients from the 1STOP project. METHODS From 2012 to 2018, 2048 patients with atrial fibrillation (AF) (70% male, 59 ± 11 years; 75% paroxysmal AF) underwent index CB-PVI. The patient data were separated into three cohorts for statistical evaluation, including: normal weight (body mass index [BMI] < 25 kg/m2 ), overweight (BMI = 25-30 kg/m2 ), and obese patients (BMI > 30 kg/m2 ). RESULTS Out of 2048 patients, 693 (34%) patients had a BMI < 25 and were deemed as normal. There were 944 (46%) patients categorized as overweight (BMI = 25-30) and 411 (20%) as obese (BMI > 30). Overweight or obese patients were more often in persistent AF, had more frequently hypertension and diabetes, had higher CHA2 DS2 -VASc score, and had a number of failed antiarrhythmic drug (AAD). Periprocedural complication rates were similar among the three cohorts. The 12-month freedom from AF recurrence was 76.4% in the normal BMI group as compared to 79.2% in the overweight and 73.5% in the obese group (p = .35). However, 48% of overweight patients were on AAD treatment during the follow-up. By multivariate analysis, BMI was not a predictor for AF recurrence following the index CB-PVI. CONCLUSION CB-PVI in obese patients is a safe procedure. Increased BMI (either moderate or severe) does not seem to be associated with a worse outcome or to a different rate of AAD discontinuation at 12 months.
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Affiliation(s)
- Daniele Malaspina
- Department of Cardiology, ASST Santi Paolo e Carlo, Presidio Ospedaliero San Carlo Borromeo, Milano, Italy
| | - Francesco Brasca
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico, Milano, Italy
| | - Saverio Iacopino
- Arrhythmology Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giuseppe Arena
- Ospedale delle Apuane, Cardiology Department, Massa, Italy
| | - Giulio Molon
- Department of Cardiology, IRCCS Sacro Cuore don Calabria, Negrar, Italy
| | | | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS. Milan
| | | | | | - Roberto Verlato
- AULSS 6 Euganea, Ospedale di Cittadella-Camposampiero, Padova, Italy
| | - Antonio Dello Russo
- Biomedical Science and Public Health Department, Cardiology and Arrhythmology Clinic, Polytechnic University, Ancona, Italy
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42
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Stabile G, Iacopino S, Verlato R, Arena G, Pieragnoli P, Molon G, Manfrin M, Rovaris G, Curnis A, Bertaglia E, Mantica M, Sciarra L, Landolina M, Tondo C. Predictive role of early recurrence of atrial fibrillation after cryoballoon ablation. Europace 2020; 22:1798-1804. [DOI: 10.1093/europace/euaa239] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Abstract
Aims
The aims of this study were to determine the rate and the predictors of early recurrences of atrial fibrillation (ERAF) after cryoballoon (CB) ablation and to evaluate whether ERAF correlate with the long-term outcome.
Methods and results
Three thousand, six hundred, and eighty-one consecutive patients (59.9 ± 10.5 years, female 26.5%, and 74.3% paroxysmal AF) were included in the analysis. Atrial fibrillation recurrence, lasting at least 30 s, was collected during and after the 3-month blanking period. Three-hundred and sixteen patients (8.6%) (Group A) had ERAF during the blanking period, and 3365 patients (Group B) had no ERAF. Persistent AF and number of tested anti-arrhythmic drugs ≥2 resulted as significant predictors of ERAF. After a mean follow-up of 16.8 ± 16.4 months, 923/3681 (25%) patients had at least one AF recurrence. The observed freedom from AF recurrence, at 24-month follow-up from procedure, was 25.7% and 64.8% in Groups A and B, respectively (P < 0.001). ERAF, persistent AF, and number of tested anti-arrhythmic drugs ≥2 resulted as significant predictors of AF. In a propensity score matching, the logistic model showed that ERAF 1 month after ablation are the best predictor of long-term AF recurrence (P = 0.042).
Conclusion
In patients undergoing CB ablation for AF, ERAF are rare and are a strong predictor of AF recurrence in the follow-up, above all when occur >30 days after the ablation.
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Affiliation(s)
- Giuseppe Stabile
- Clinica Montevergine, Mercogliano, Avellino, Italy
- Clinica San Michele, via Montella 16, 81024 Maddaloni, Caserta, Italy
- Anthea Hospital, Bari, Italy
| | - Saverio Iacopino
- Maria Cecilia Hospital, GVM Care&Research, Cotignola, Ravenna, Italy
| | - Roberto Verlato
- AULSS 6 Euganea, Ospedale di Cittadella-Camposampiero, Padova, Italy
| | | | | | - Giulio Molon
- IRCCS Sacro Cuore Don Calabria Don Calabria, Negrar, Italy
| | | | | | | | | | | | | | | | - Claudio Tondo
- Heart Rhythm Centre, Centro Cardiologico Monzino IRCCS Milan, Italy
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43
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Boehmer JP, Molon G, Wen G, Thakur P, Gardner RS. Comparison of Nt-proBNP Concentrations When in or out of Heartlogic Alerts. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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44
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Genovesi S, Porcu L, Slaviero G, Casu G, Bertoli S, Sagone A, Buskermolen M, Pieruzzi F, Rovaris G, Montoli A, Oreglia J, Piccaluga E, Molon G, Gaggiotti M, Ettori F, Gaspardone A, Palumbo R, Viazzi F, Breschi M, Gallieni M, Contaldo G, D'Angelo G, Merella P, Galli F, Rebora P, Valsecchi M, Mazzone P. Correction to: Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis. J Nephrol 2020; 34:75-76. [PMID: 32661734 PMCID: PMC7881957 DOI: 10.1007/s40620-020-00800-6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The original article can be found online.
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Affiliation(s)
- Simonetta Genovesi
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy. .,Nephrology Unit, San Gerardo Hospital, Monza, Italy.
| | - Luca Porcu
- Laboratory of Methodology for Clinical Research, Oncology Department, Istituto di Ricerche Farmacologiche IRCCS Mario Negri, Milan, Italy
| | | | - Gavino Casu
- San Francesco Hospital, Nuoro. ATS Sardegna Nuoro, Nuoro, Italy
| | - Silvio Bertoli
- Dialysis and Nephrology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy
| | - Antonio Sagone
- Electrophysiology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy
| | | | - Federico Pieruzzi
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy.,Nephrology Unit, San Gerardo Hospital, Monza, Italy
| | - Giovanni Rovaris
- Interventional Electrophysiology Unit, San Gerardo Hospital, Monza, Italy
| | | | - Jacopo Oreglia
- Interventional Cardiology Unit, Niguarda Hospital, Milan, Italy
| | | | - Giulio Molon
- Cardiology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Mario Gaggiotti
- Nephrology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - Federica Ettori
- Cardiology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | | | | | | | - Marco Breschi
- Cardiology Unit, USL Toscana Sud-Est, Grosseto, Italy
| | - Maurizio Gallieni
- Department of Nephrology and Dialysis, Luigi Sacco Hospital, Milan, Italy
| | - Gina Contaldo
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | | | | | - Fabio Galli
- Laboratory of Methodology for Clinical Research, Oncology Department, Istituto di Ricerche Farmacologiche IRCCS Mario Negri, Milan, Italy
| | - Paola Rebora
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Mariagrazia Valsecchi
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
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45
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Genovesi S, Porcu L, Slaviero G, Casu G, Bertoli S, Sagone A, Buskermolen M, Pieruzzi F, Rovaris G, Montoli A, Oreglia J, Piccaluga E, Molon G, Gaggiotti M, Ettori F, Gaspardone A, Palumbo R, Viazzi F, Breschi M, Gallieni M, Contaldo G, D'Angelo G, Merella P, Galli F, Rebora P, Valsecchi M, Mazzone P. Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis. J Nephrol 2020; 34:63-73. [PMID: 32535831 PMCID: PMC7881969 DOI: 10.1007/s40620-020-00774-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/06/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND In patients with end stage renal disease and atrial fibrillation (AF), undergoing chronic dialysis, direct oral agents are contraindicated and warfarin does not fully prevent embolic events while increasing the bleeding risk. The high hemorrhagic risk represents the main problem in this population. Aim of the study was to estimate the safety and efficacy for thromboembolic prevention of left atrial appendage (LAA) occlusion in a cohort of dialysis patients with AF and high hemorrhagic risk. METHODS Ninety-two dialysis patients with AF who underwent LAA occlusion were recruited. For comparative purposes, two cohorts of dialysis patients with AF, one taking warfarin (oral anticoagulant therapy, OAT cohort, n = 114) and the other not taking any OAT (no-therapy cohort, n = 148) were included in the study. Primary endpoints were (1) incidence of peri-procedural complications, (2) incidence of 2-year thromboembolic and hemorrhagic events, (3) mortality at 2 years. In order to evaluate the effect of the LAA occlusion on the endpoints with respect to the OAT and No-therapy cohorts, a multivariable Cox regression model was applied adjusted for possible confounding factors. RESULTS The device was successfully implanted in 100% of cases. Two major peri-procedural complications were reported. No thromboembolic events occurred at 2-year follow-up. The adjusted multivariable Cox regression model showed no difference in bleeding risk in the OAT compared to the LAA occlusion cohort in the first 3 months of follow-up [HR 1.65 (95% CI 0.43-6.33)], when most of patients were taking two antiplatelet drugs. In the following 21 months the bleeding incidence became higher in OAT patients [HR 6.48 (95% CI 1.32-31.72)]. Overall mortality was greater in both the OAT [HR 2.76 (95% CI 1.31-5.86)] and No-Therapy [HR 3.09 (95% CI 1.59-5.98)] cohorts compared to LAA occlusion patients. CONCLUSIONS The study could open the way to a non-pharmacological option for thromboembolic protection in dialysis patients with AF and high bleeding risk.
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Affiliation(s)
- Simonetta Genovesi
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy. .,Nephrology Unit, San Gerardo Hospital, Monza, Italy.
| | - Luca Porcu
- Laboratory of Methodology for Clinical Research, Oncology Department, Istituto di Ricerche Farmacologiche IRCCS Mario Negri, Milan, Italy
| | | | - Gavino Casu
- San Francesco Hospital, Nuoro. ATS Sardegna Nuoro, Nuoro, Italy
| | - Silvio Bertoli
- Dialysis and Nephrology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy
| | - Antonio Sagone
- Electrophysiology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy
| | | | - Federico Pieruzzi
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy.,Nephrology Unit, San Gerardo Hospital, Monza, Italy
| | - Giovanni Rovaris
- Interventional Electrophysiology Unit, San Gerardo Hospital, Monza, Italy
| | | | - Jacopo Oreglia
- Interventional Cardiology Unit, Niguarda Hospital, Milan, Italy
| | | | - Giulio Molon
- Cardiology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Mario Gaggiotti
- Nephrology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - Federica Ettori
- Cardiology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | | | | | | | - Marco Breschi
- Cardiology Unit, USL Toscana Sud-Est, Grosseto, Italy
| | - Maurizio Gallieni
- Department of Nephrology and Dialysis, Luigi Sacco Hospital, Milan, Italy
| | - Gina Contaldo
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | | | | | - Fabio Galli
- Laboratory of Methodology for Clinical Research, Oncology Department, Istituto di Ricerche Farmacologiche IRCCS Mario Negri, Milan, Italy
| | - Paola Rebora
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Mariagrazia Valsecchi
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
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46
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Verlato R, Pieragnoli P, Iacopino S, Rauhe W, Molon G, Stabile G, Rebellato L, Allocca G, Arena G, Rovaris G, Sacchi R, Catanzariti D, Pepi P, Tondo C. Cryoballoon or radiofrequency ablation? Alternating technique for repeat procedures in patients with atrial fibrillation. Pacing Clin Electrophysiol 2020; 43:687-697. [PMID: 32510595 DOI: 10.1111/pace.13975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/21/2020] [Accepted: 05/31/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Which technique is better for repeat ablation in patients with atrial fibrillation (AF) remains unclear. The aim of the study was to compare long-term efficacy of repeat ablation using the alternative technique for the first redo ablation procedure: (a) cryoballoon (CB) re-ablation after a failed index pulmonary vein isolation (PVI) with radiofrequency (RF) ablation, RF-then-CB group or (b) RF repeat ablation following a failed CB ablation, CB-then-RF group. METHODS Within the 1STOP Italian Project, consecutive patients undergoing repeat ablation with a different technique from the index procedure were included. RESULTS We studied 474 patients, 349 in RF-then-CB and 125 in CB-then-RF group. Less women (21% vs 30%; P = .041), more persistent AF (33% vs 22%; P = .015), longer duration of AF (60 vs 31 months; P < .001), and more hypertension (50% vs 36%; P = .007) were observed in the RF-then-CB cohort as compared with the CB-then-RF group. The number of reconnected PVs was 3.7 ± 0.7 and 1.4 + 1.3 in RF-then-CB and CB-then-RF group, respectively (P < .001). During the follow-up, significantly less AF recurrence occurred in the CB-then-RF group (22% vs 8%, HR = 0.46; 95% CI: 0.24-0.92; P = .025). Cohort designation was the only independent predictor of AF recurrence. CONCLUSION Alternation of energy source for repeat ablation was safe and effective, regardless the energy used first. However, patients initially treated with CB PVI undergoing repeat ablation with RF current had less AF recurrence at long-term follow-up as compared with those originally treated by RF ablation receiving a CB repeat ablation.
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Affiliation(s)
- Roberto Verlato
- AULSS 6 Euganea, Ospedale di Cittadella-Camposampiero, Padova, Italy
| | | | | | | | | | - Giuseppe Stabile
- Casa di Cura Montevergine, Mercogliano, Italy.,Clinica San Michele, Maddaloni, Italy
| | - Luca Rebellato
- Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Giuseppe Allocca
- Santa Maria dei Battuti, Presidio Ospedaliero, Conegliano, Italy
| | | | | | | | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS Milan, Milan, Italy
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47
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Tomasi C, Severi S, Zanon F, Molon G, Corzani A, Rossillo A, Biffi M, Marcantoni L, Costa A, Dal Monte A, Santarelli G, Lanzoni L, Corsi C. P544Evaluation of three-dimensional trajectory of pacing cathode pole in coronary sinus to predict long-term response to cardiac resynchronization therapy. Europace 2020. [DOI: 10.1093/europace/euaa162.298] [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
Background
An automated method for 3D reconstruction of coronary sinus (CS) lead’s pacing cathode trajectory (3DTJ) was proposed to acutely predict long term left ventricular (LV) mechanic response to cardiac resynchronization therapy (CRT). Preliminary data showed that 3DTJ at biventricular pacing (BIV) start changed in CRT responders (R) to be, becoming less eccentric and more multi-directional, as described by the ratio between its two major axes (S1/S2).
Purpose
The TRAJECTORIES study (Trajectory Changes Of Coronary Sinus Lead Tip And Cardiac Resynchronization Therapy Outcome, NCT02340546) is an observational study by seven Italian centers about the prediction of CRT-induced LV reverse remodeling by means of the acute 3DTJ changes at CRT implant.
Methods
In CRT implants with standard indications, stable CHF and regular ventricular rhythm, a fluoroscopic sequence in two standard X-rays views of a few seconds was acquired immediately before (T-1) and after the start of BIV (T0). 3DTJ of CS lead cathode pole throughout the cardiac cycle at T-1 and T0 were reconstructed and analyzed. Changes of the ratio between its two major axes (S1/S2) between T-1 and T0 (ΔS1/S2), were compared with the volumetric response at six-month f.u: the percent negative variation of S1/S2 (ΔS1/S2 < 0), marking a more multi-directional shape of 3DTJ, was assumed to predict the response to CRT. Volumetric response was adjudicated by a core-lab using a cut-off reduction ≥ 15% in echocardiographic LV end-systolic volume at f.u..
Results
Out of 119 patients enrolled in 42 months, 74 pts ended f.u. (55 m; age 69 ± 10) and 30 dropped–out. Patients baseline features were: ischemic heart disease (IHD) 34 /74 pts; sinus rhythm 64/74 pts; upgrade from PM/ICD 13/74 pts; QRS morphology with LBBB 57/74, intraventricular aspecific delay 6 and RV pace 11 pts; LV ejection fraction (EF) 30 ± 9%; QRS duration 162 ± 25 ms. At f.u., volumetric R were 45/74 (60%). Concordance between ΔS1/S2 (as either ΔS1/S2 < 0 or ΔS1/S2 > 0) and volumetric response was 77% overall (57/74), 82% in R (37/45), 69% in non-R (20/29). Non-concordant patients were mostly non-R: 52% vs 35% of non-R in concordant group, but no other differences were found. The proposed 3DTJ metric showed sensitivity = 72%, specificity =80%; positive predictive value = 69%, negative predictive value = 82%.
Conclusions
Metrics of 3DTJ can be useful to acutely predict CS pacing site-specific response to CRT in long-term, above all in R. 3DTJ assessment might highlight aspects of CRT effects on LV mechanics.
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Affiliation(s)
- C Tomasi
- Santa Maria delle Croci Hospital, Department of Cardiovascular, Ravenna, Italy
| | - S Severi
- University of Bologna, Department DEIS, Cesena, Italy
| | - F Zanon
- General Hospital of Rovigo, Rovigo, Italy
| | - G Molon
- IRCCS Sacro Cuore Don Calabria Hospital, Cardiology, Negrar (VR), Italy
| | - A Corzani
- Bufalini Hospital, Cardiology, Cesena (FC), Italy
| | | | - M Biffi
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Cardiology , Bologna, Italy
| | | | - A Costa
- IRCCS Sacro Cuore Don Calabria Hospital, Cardiology, Negrar (VR), Italy
| | - A Dal Monte
- Santa Maria delle Croci Hospital, Department of Cardiovascular, Ravenna, Italy
| | - G Santarelli
- University of Bologna, Department DEIS, Cesena, Italy
| | - L Lanzoni
- IRCCS Sacro Cuore Don Calabria Hospital, Cardiology, Negrar (VR), Italy
| | - C Corsi
- University of Bologna, Department DEIS, Cesena, Italy
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Pecora D, Tavoletta V, Dello Russo A, De Ruvo E, Ammirati F, La Greca C, Favale S, Petracci B, Molon G, Montella GM, Santini L, Nozza C, Valsecchi S, Calo L. 48Remote monitoring of Heart Failure patients with a Multisensor ICD Algorithm: value of an alert-based follow-up strategy. Europace 2020. [DOI: 10.1093/europace/euaa162.194] [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
Background
The HeartLogic algorithm measures and combines multiple parameters, i.e. heart sounds, intrathoracic impedance, respiration pattern, night heart rate, and patient activity, in a single index. The associated alert has proved to be a sensitive and timely predictor of impending heart failure (HF) decompensation, and the HeartLogic alert condition was shown to identify patients during periods of significantly increased risk of HF events.
Purpose
To report the results of a multicenter experience of remote HF management with HeartLogic algorithm and appraise the value of an alert-based follow-up strategy.
Methods
The HeartLogic feature was activated in 104 patients (76 male, 71 ± 10 years, left ventricular ejection fraction 29 ± 7%). All patients were followed according to a standardized protocol that included remote data reviews and patient phone contacts every month and at the time of HeartLogic alerts. In-office visits were performed every 6 months or when deemed necessary.
Results
During a median follow-up of 13[11-18] months, centers performed remote follow-up at the time of 1284 scheduled monthly transmissions (10.5 per pt-year) and 100 HeartLogic alerts (0.82 alerts/pt-year). The mean delay from alert to the next monthly remote data review was 14 ± 8 days. Overall, the patient time in the alert state (i.e. HeartLogic index above the threshold) was 14% of the total observation period. HF events requiring active clinical actions were detected at the time of 11 (0.9%) monthly remote data reviews and at 43 (43%, p < 0.001) HeartLogic alerts. Moderate to severe symptoms of HF were reported during 2% of remote visits when the patient was out of HeartLogic alert condition and during 15% of remote visits performed in alert condition (p < 0.001). Out of 100 alerts, 17 required an in-office visit and 5 a hospitalization to manage the clinical condition. Overall, 282 scheduled and 56 unscheduled in-office visits were performed during follow-up. Any HF sign (i.e. S3 gallop, rales, jugular venous distension, edema) was detected during 18% of in-office visits when the patient was out of HeartLogic alert condition and during 34% of visits performed in alert condition (p = 0.002).
Conclusions
HeartLogic alerts are frequently associated with relevant actionable HF events. Events are detected earlier and the volume of alert-driven remote follow-ups is limited when compared with a monthly remote follow-up scheme. The probability of detecting common signs and symptoms of HF at regular remote or in-office assessment is extremely low when the patient is out of HeartLogic alert state. These results support the adoption of an alert-based follow-up strategy.
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Affiliation(s)
- D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - V Tavoletta
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - A Dello Russo
- Marche Polytechnic University of Ancona, Ancona, Italy
| | - E De Ruvo
- Polyclinic Casilino of Rome, Rome, Italy
| | | | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - S Favale
- Polyclinic Hospital of Bari, Bari, Italy
| | - B Petracci
- Policlinic Foundation San Matteo IRCCS, Pavia, Italy
| | - G Molon
- Sacred Heart Hospital of Negrar, Negrar, Italy
| | | | | | - C Nozza
- Boston Scientific, Milan, Italy
| | | | - L Calo
- Polyclinic Casilino of Rome, Rome, Italy
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Santini L, D'Onofrio A, Dello Russo A, Calò L, Pecora D, Favale S, Petracci B, Molon G, Bianchi V, De Ruvo E, Ammirati F, La Greca C, Campari M, Valsecchi S, Capucci A. Prospective evaluation of the multisensor HeartLogic algorithm for heart failure monitoring. Clin Cardiol 2020; 43:691-697. [PMID: 32304098 PMCID: PMC7368302 DOI: 10.1002/clc.23366] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/15/2022] Open
Abstract
Background The HeartLogic algorithm measures data from multiple implantable cardioverter‐defibrillator‐based sensors and combines them into a single index. The associated alert has proved to be a sensitive and timely predictor of impending heart failure (HF) decompensation. Hypothesis We describe a multicenter experience of remote HF management by means of HeartLogic and appraise the value of an alert‐based follow‐up strategy. Methods The alert was activated in 104 patients. All patients were followed up according to a standardized protocol that included remote data reviews and patient phone contacts every month and at the time of alerts. In‐office examinations were performed every 6 months or when deemed necessary. Results During a median follow‐up of 13 (10–16) months, the overall number of HF hospitalizations was 16 (rate 0.15 hospitalizations/patient‐year) and 100 alerts were reported in 53 patients. Sixty alerts were judged clinically meaningful, and were associated with multiple HF‐related conditions. In 48 of the 60 alerts, the clinician was not previously aware of the condition. Of these 48 alerts, 43 triggered clinical actions. The rate of alerts judged nonclinically meaningful was 0.37/patient‐year, and the rate of hospitalizations not associated with an alert was 0.05/patient‐year. Centers performed remote follow‐up assessments of 1113 scheduled monthly transmissions (10.3/patient‐year) and 100 alerts (0.93/patient‐year). Monthly remote data review allowed to detect 11 (1%) HF events requiring clinical actions (vs 43% actionable alerts, P < .001). Conclusions HeartLogic allowed relevant HF‐related clinical conditions to be identified remotely and enabled effective clinical actions to be taken; the rates of unexplained alerts and undetected HF events were low. An alert‐based management strategy seemed more efficient than a scheduled monthly remote follow‐up scheme.
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Affiliation(s)
- Luca Santini
- Cardiology Division, "Giovan Battista Grassi" Hospital, Rome, Italy
| | - Antonio D'Onofrio
- "Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie", Monaldi Hospital, Naples, Italy
| | | | - Leonardo Calò
- Cardiology Division, Policlinico Casilino, Rome, Italy
| | - Domenico Pecora
- Cardiology Division, Fondazione Poliambulanza, Brescia, Italy
| | | | - Barbara Petracci
- Cardiology Division, Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy
| | - Giulio Molon
- Cardiology Division, Sacro Cuore-Don Calabria Hospital, Verona, Italy
| | - Valter Bianchi
- "Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie", Monaldi Hospital, Naples, Italy
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Mantovani A, Lunardi G, Bonapace S, Dugo C, Altomari A, Molon G, Conti A, Bovo C, Laaksonen R, Byrne CD, Bonnet F, Targher G. Association between increased plasma ceramides and chronic kidney disease in patients with and without ischemic heart disease. Diabetes Metab 2020; 47:101152. [PMID: 32283179 DOI: 10.1016/j.diabet.2020.03.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/21/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
AIM Plasma levels of certain ceramides are increased in patients with ischemic heart disease (IHD). Many risk factors for IHD are also risk factors for chronic kidney disease (CKD), but it is currently uncertain whether plasma ceramide levels are increased in patients with CKD. METHODS We measured six previously identified high-risk plasma ceramide concentrations [Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/20:0), Cer(d18:1/22:0), Cer(d18:1/24:0) and Cer(d18:1/24:1)] in 415 middle-aged individuals who attended our clinical Cardiology and Diabetes services over a period of 9 months. RESULTS A total of 97 patients had CKD (defined as e-GFRCKD-EPI<60ml/min/1.73m2 and/or urinary albumin-to-creatinine ratio≥30mg/g), 117 had established IHD and 242 had type 2 diabetes. Patients with CKD had significantly (P=0.005 or less) higher levels of plasma Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/20:0), Cer(d18:1/22:0), Cer(d18:1/24:0), and Cer(d18:1/24:1) compared to those without CKD. The presence of CKD remained significantly associated with higher levels of plasma ceramides (standardized beta coefficients ranging from 0.124 to 0.227, P<0.001) even after adjustment for body mass index, smoking, hypertension, diabetes, prior IHD, plasma LDL-cholesterol, hs-C-reactive protein levels and use of any lipid-lowering medications. Notably, more advanced stages of CKD and abnormal albuminuria were both associated (independently of each other) with increased levels of plasma ceramides. These results were consistent in all subgroups considered, including patients with and without established IHD or those with and without diabetes. CONCLUSION Increased levels of plasma ceramides are associated with CKD independently of pre-existing IHD, diabetes and other established cardiovascular risk factors.
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Affiliation(s)
- A Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale Stefani, 1, 37126 Verona, Italy
| | - G Lunardi
- Medical Analysis Laboratory, "IRCCS Sacro Cuore - Don Calabria" Hospital, Negrar, VR, Italy
| | - S Bonapace
- Division of Cardiology, "IRCCS Sacro Cuore - Don Calabria" Hospital, Negrar, VR, Italy
| | - C Dugo
- Division of Cardiology, "IRCCS Sacro Cuore - Don Calabria" Hospital, Negrar, VR, Italy
| | - A Altomari
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale Stefani, 1, 37126 Verona, Italy
| | - G Molon
- Division of Cardiology, "IRCCS Sacro Cuore - Don Calabria" Hospital, Negrar, VR, Italy
| | - A Conti
- Medical Analysis Laboratory, "IRCCS Sacro Cuore - Don Calabria" Hospital, Negrar, VR, Italy
| | - C Bovo
- Medical Direction, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - R Laaksonen
- Zora Biosciences Oy, Espoo, Finland; Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere University Hospital, Tampere, Finland
| | - C D Byrne
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, Southampton General Hospital, Southampton, UK; Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK
| | - F Bonnet
- University Hospital of Rennes, University of Rennes 1, CHU, Rennes, France
| | - G Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale Stefani, 1, 37126 Verona, Italy.
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