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Pandozi C, Botto GL, Loricchio ML, D'Ammando M, Lavalle C, Del Giorno G, Matteucci A, Mariani MV, Nicolis D, Segreti L, Papa AA, Casale MC, Galeazzi M, Russo M, Di Belardino N, Pelargonio G, Centurion Aznaran C, Malacrida M, Maddaluno F, Treglia S, Piccolo F, Colivicchi F. High-density mapping of Koch's triangle during sinus rhythm and typical atrioventricular nodal re-entrant tachycardia, integrated with direct recording of atrio-ventricular node structure potential. J Cardiovasc Electrophysiol 2024; 35:379-388. [PMID: 38185855 DOI: 10.1111/jce.16168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND The mechanism of typical slow-fast atrioventricular nodal re-entrant tachycardia (AVNRT) and its anatomical and electrophysiological circuit inside the right atrium (RA) and Koch's Triangle (KT) are not well known. OBJECTIVE To identify the potentials of the compact AV node and inferior extensions and to perform accurate mapping of the RA and KT in sinus rhythm (SR) and during AVNRT, to define the tachycardia circuit. METHODS Consecutive patients with typical AVNRT were enrolled in 12 Italian centers and underwent mapping and ablation by means of a basket catheter with small electrode spacing for ultrahigh-density mapping and a modified signal-filtering toolset to record the potentials of the AV nodal structures. RESULTS Forty-five consecutive cases of successful ablation of typical slow-fast AVNRT were included. The mean SR cycle length (CL) was 784.1 ± 6 ms and the mean tachycardia CL was 361.2 ± 54 ms. The AV node potential had a significantly shorter duration and higher amplitude in sinus rhythm than during tachycardia (60 ± 40 ms vs. 160 ± 40 ms, p < .001 and 0.3 ± 0.2 mV vs. 0.09 ± 0.12 mV, p < .001, respectively). The nodal potential duration extension was 169.4 ± 31 ms, resulting in a time-window coverage of 47.6 ± 9%. The recording of AV nodal structure potentials enabled us to obtain 100% coverage of the tachycardia CL during slow-fast AVNRT. CONCLUSION Detailed recording of the potentials of nodal structures is possible by means of multipolar catheters for ultrahigh-density mapping, allowing 100% of the AVNRT CL to be covered. These results also have clinical implications for the ablation of right-septal and para-septal arrhythmias.
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Affiliation(s)
- Claudio Pandozi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | | | | | | | - Carlo Lavalle
- Azienda ospedaliero-universitaria Policlinico Umberto I, Rome, Italy
| | | | - Andrea Matteucci
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
- Department of System and Experimental Medicine, University of Rome 'Tor Vergata, Rome, Italy
| | | | | | | | - Andrea Antonio Papa
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli"-Monaldi Hospital, Naples, Italy
| | | | - Marco Galeazzi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Maurizio Russo
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | | | - Gemma Pelargonio
- Istituto di Cardiologia Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Arrhythmology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
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Palmisano P, Ziacchi M, Dell'Era G, Donateo P, Ammendola E, Aspromonte V, Pellegrino PL, Del Giorno G, Coluccia G, Bartoli L, Patti G, Senes J, Parlavecchio A, Di Fraia F, Brunetti ND, Carbone A, Nigro G, Biffi M, Accogli M. Ablate and pace: Comparison of outcomes between conduction system pacing and biventricular pacing. Pacing Clin Electrophysiol 2023; 46:1258-1268. [PMID: 37665040 DOI: 10.1111/pace.14813] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/20/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Conduction system pacing (CSP), including His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP), have been proposed as alternatives to biventricular pacing (BVP) in patients scheduled for ablate and pace (A&P) strategy. The aim of this study was to compare the clinical outcomes, including the rate and nature of device-related complications, between BVP and CSP in a cohort of patients undergoing A&P. METHODS Prospective, multicenter, observational study, enrolling consecutive patients undergoing A&P. The risk of device-related complications and of heart failure (HF) hospitalization was prospectively assessed. RESULTS A total of 373 patients (75.3 ± 8.7 years, 53.9% male, 68.9% with NYHA class ≥III) were enrolled: 263 with BVP, 68 with HBP, and 42 with LBBAP. Baseline characteristics of the three groups were similar. Compared to BVP and HBP, LBBAP was associated with the shortest mean procedural and fluoroscopy times and with the lowest acute capture thresholds (all p < .05). At 12-month follow-up LBBAP maintained the lowest capture thresholds and showed the longest estimated residual battery longevity (all p < .05). At 12-months follow-up the three study groups showed a similar risk of device-related complications (5.7%, 4.4%, and 2.4% for BVP, HBP, and LBBAP, respectively; p = .650), and of HF hospitalization (2.7%, 1.5%, and 2.4% for BVP, HBP, and LBBAP, respectively; p = .850). CONCLUSIONS In the setting of A&P, CSP is a feasible pacing modality, with a midterm safety profile comparable to BVP. LBBAP offers the advantage of reducing procedural times and obtaining lower and stable capture thresholds, with a positive impact on the device longevity.
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Affiliation(s)
| | - Matteo Ziacchi
- Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Gabriele Dell'Era
- Division of Cardiology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Paolo Donateo
- Department of Cardiology, Arrhythmology Center, Lavagna, Italy
| | - Ernesto Ammendola
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | | | - Pier Lugi Pellegrino
- Department of Cardiology, Policlinico Riuniti, University Hospital, Foggia, Italy
| | | | | | - Lorenzo Bartoli
- Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giuseppe Patti
- Division of Cardiology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Jacopo Senes
- Department of Cardiology, Arrhythmology Center, Lavagna, Italy
| | - Antonio Parlavecchio
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Di Fraia
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Natale Daniele Brunetti
- Department of Cardiology, Policlinico Riuniti, University Hospital, Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Angelo Carbone
- Cardiology Unit, "Maria Ss Addolorata" Hospital, Eboli, Italy
| | - Gerardo Nigro
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Mauro Biffi
- Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
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Palmisano P, Ziacchi M, Ammendola E, Dell'Era G, Guerra F, Donateo P, Del Giorno G, Laffi M, Coluccia G, Bartoli L, Gaggioli G, Carbone A, Senes J, Russo AD, Patti G, Nigro G, Biffi M, Accogli M. Impact of atrioventricular junction ablation and CRT-D on long-term mortality in patients with left ventricular dysfunction, permanent, refractory atrial fibrillation and narrow QRS: results of a propensity matched analysis. J Cardiovasc Electrophysiol 2022; 33:2288-2296. [PMID: 35930617 DOI: 10.1111/jce.15645] [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: 05/15/2022] [Revised: 07/13/2022] [Accepted: 07/27/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In patients with symptomatic permanent atrial fibrillation (PEAF) and narrow QRS, atrio-ventricular junction ablation (AVJA) plus cardiac resynchronization therapy (CRT) is superior to medical therapy in reducing heart failure (HF) hospitalization and all-cause mortality. To compare the mortality of a population of patients with HF, reduced EF (rEF) and PEAF treated with AVJA plus CRT with that of a contemporary cohort of patients in sinus rhythm (SR) with similar baseline characteristics. METHODS AND RESULTS In this prospective, multicentre, observational study, all-cause mortality in a group of consecutive patients undergoing AVJA and implantable cardioverter-defibrillator (ICD) combined with CRT implantation for HFrEF, narrow QRS, and PEAF with uncontrolled ventricular rate was compared with that of a contemporary cohort of patients in SR undergoing ICD implantation (not combined with CRT) for HFrEF and narrow QRS. Individual 1:1 propensity matching of baseline characteristics was performed. A total of 824 patients were enrolled. Propensity matching yielded 107 matched pairs. After a median follow-up of 52 months, all-cause mortality was similar in patients treated with AVJA plus CRT and in the control group (p=0.434). In AVJA plus CRT patients, mortality was significantly lower than in control group patients with a history of paroxysmal/persistent AF (n=45, p=0.020), and similar to that of patients without a history of AF (n=62, p=0.459). CONCLUSIONS After adjustment for patient characteristics, the long-term prognosis of patients with HFrEF, narrow QRS and PEAF who underwent AVJA plus CRT was similar to that of a population of patients in SR with similar characteristics. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Matteo Ziacchi
- Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Ernesto Ammendola
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Gabriele Dell'Era
- Division of Cardiology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Umberto I - Lancisi - Salesi", Ancona, Italy
| | - Paolo Donateo
- Department of Cardiology, Arrhythmology Center, ASL 4 Chiavarese, Lavagna-Genova, Italy
| | | | - Mattia Laffi
- Divisione Cardiologia, Ospedale Villa Scassi, Genova ASL 3, Genova, Italy
| | | | - Lorenzo Bartoli
- Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Germano Gaggioli
- Divisione Cardiologia, Ospedale Villa Scassi, Genova ASL 3, Genova, Italy
| | - Angelo Carbone
- Cardiology Unit, "Maria Ss Addolorata" Hospital, Eboli, Italy
| | - Jacopo Senes
- Department of Cardiology, Arrhythmology Center, ASL 4 Chiavarese, Lavagna-Genova, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Umberto I - Lancisi - Salesi", Ancona, Italy
| | - Giuseppe Patti
- Division of Cardiology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Gerardo Nigro
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Mauro Biffi
- Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
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Russo V, Pafundi PC, Rapacciuolo A, de Divitiis M, Volpicelli M, Ruocco A, Rago A, Uran C, Nappi F, Attena E, Chianese R, Esposito F, Del Giorno G, D'Andrea A, Ducceschi V, Russo G, Ammendola E, Carbone A, Covino G, Manzo G, Montella GM, Nigro G, D'Onofrio A. Cardiac pacing procedures during coronavirus disease 2019 lockdown in Southern Italy: insights from Campania Region. J Cardiovasc Med (Hagerstown) 2021; 22:857-859. [PMID: 33399343 DOI: 10.2459/jcm.0000000000001156] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Vincenzo Russo
- Chair of Cardiology, Department of Medical Translational Sciences, University of Campania 'Luigi Vanvitelli' - Monaldi Hospital, Naples
| | - Pia Clara Pafundi
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli'
| | - Antonio Rapacciuolo
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II
| | | | - Mario Volpicelli
- Division of Cardiology, San Giovanni Bosco Hospital, Health Authority Naples
| | - Antonio Ruocco
- Interventional Cardiology and Cardiological Care Unit, Cardarelli Hospital
| | - Anna Rago
- Cardiology Unit, AORN dei Colli, Naples
| | - Carlo Uran
- Cardiology Unit, San Giuseppe and Melorio Hospital, Santa Maria Capua Vetere, Caserta
| | - Felice Nappi
- Division of Cardiology, Moscati Hospital, Avellino
| | - Emilio Attena
- Division of Cardiology, San Giuliano Hospital, Giugliano in Campania, Health Authority Naples 2 North
| | - Raffaele Chianese
- Division of Cardiology, San Leonardo Hospital, Castellammare di Stabia, Health Authority Naples 3 South, Naples
| | - Francesca Esposito
- Division of Cardiology, San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | | | | | | | - Giovanni Russo
- Division of Cardiology, San Leonardo Hospital, Castellammare di Stabia, Health Authority Naples 3 South, Naples
| | | | | | - Gregorio Covino
- Division of Cardiology, San Giovanni Bosco Hospital, Health Authority Naples
| | | | | | - Gerardo Nigro
- Chair of Cardiology, Department of Medical Translational Sciences, University of Campania 'Luigi Vanvitelli' - Monaldi Hospital, Naples
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Russo V, Rapacciuolo A, Pafundi PC, de Divitiis M, Volpicelli M, Ruocco A, Rago A, Uran C, Nappi F, Attena E, Chianese R, Esposito F, Del Giorno G, D’Andrea A, Ducceschi V, Russo G, Ammendola E, Carbone A, Covino G, Manzo G, Montella GM, D’Onofrio A, Nigro G. Cardiac implantable electronic devices replacements in patients followed by remote monitoring during COVID-19 lockdown. European Heart Journal - Digital Health 2021; 2:171-174. [PMID: 37155653 PMCID: PMC7928967 DOI: 10.1093/ehjdh/ztaa018] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/02/2020] [Accepted: 12/30/2020] [Indexed: 01/25/2023]
Abstract
Aims Following coronavirus disease (COVID-19) outbreak, the Italian government adopted strict rules of lockdown and social distancing. The aim of our study was to assess the admission rate for cardiac implantable electronic devices (CIEDs) replacement procedures in Campania, the 3rd-most-populous region of Italy, during COVID-19 lockdown. Methods and results Data were sourced from 16 referral hospitals in Campania from 10 March to 4 May 2020 (lockdown period) and during the same period in 2019. We retrospectively evaluated consecutive patients hospitalized for CIEDs replacement procedures during the two observational periods. The number and type of CIEDs replacement procedures among patients followed by remote monitoring (RM), the admission rate, and the type of hospital admission between the two observational periods were compared. In total, 270 consecutive patients were hospitalized for CIEDs replacement procedures over the two observation periods. Overall CIEDs replacement procedures showed a reduction rate of 41.2% during COVID-19 lockdown. Patients were equally distributed for sex (P = 0.581), and both age [median 76 years (IQR: 68–83) vs. 79 years (IQR: 68–83); P = 0.497]. Cardiac implantable electronic devices replacement procedures in patients followed by RM significantly increased (IR: +211%; P < 0.001), mainly driven by the remarkable increase rate trend of both PM (IR: +475%; P < 0.001) and implantable cardiac defibrillator replacement procedures (IR: +67%, P = 0.01), during COVID-19 lockdown compared with 2019 timeframe. Conclusions We showed a significant increase trend rate of replacement procedures among CIEDs patients followed by RM, suggesting the hypothesis of its increased use to closely monitoring and to optimize the hospital admission time during COVID-19 lockdown.
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Affiliation(s)
- Vincenzo Russo
- Division of Cardiology, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Via L. Bianchi, 80131, Naples, Italy
| | - Antonio Rapacciuolo
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S. Pansini, 80131, Naples, Italy
| | - Pia Clara Pafundi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia, 80138, Naples, Italy
| | - Marcello de Divitiis
- Division of Cardiology, Pellegrini Hospital, Health Authority Naples 1, Via Portamedina, 80134, Naples, Italy
| | - Mario Volpicelli
- Division of Cardiology, San Giovanni Bosco Hospital, Health Authority Naples 1, Via F.M. Briganti, 80144, Naples, Italy
| | - Antonio Ruocco
- Interventional Cardiology and Cardiological Care Unit, Cardarelli Hospital, Via A. Cardarelli, 80131, Naples, Italy
| | - Anna Rago
- Cardiology Unit, AORN dei Colli, Via L. Bianchi, 80131, Naples, Italy
| | - Carlo Uran
- Cardiology Unit, San Giuseppe and Melorio Hospital, Santa Maria Capua Vetere, Via Melorio, 81055, Caserta, Italy
| | - Felice Nappi
- Division of Cardiology, Moscati Hospital, Contrada Amoretta, 83100, Avellino, Italy
| | - Emilio Attena
- Division of Cardiology, San Giuliano Hospital, Giugliano in Campania, Health Authority Naples 2 North, Via. G. Basile, 80014, Naples, Italy
| | - Raffaele Chianese
- Division of Cardiolgy, San Leonardo Hospital, Castellammare di Stabia, Health Authority Naples 3 South, Viale Europa, 80053, Naples, Italy
| | - Francesca Esposito
- Division of Cardiology, San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo, 84131 13, Salerno, Italy
| | | | - Antonello D’Andrea
- Cardiology Unit, Umberto I Hospital, Via A. de Nicola, 84014, Nocera Inferiore, Italy
| | - Valentino Ducceschi
- Division of Cardiology, Pellegrini Hospital, Health Authority Naples 1, Via Portamedina, 80134, Naples, Italy
| | - Giovanni Russo
- Division of Cardiolgy, San Leonardo Hospital, Castellammare di Stabia, Health Authority Naples 3 South, Viale Europa, 80053, Naples, Italy
| | - Ernesto Ammendola
- Cardiology Unit, AORN dei Colli, Via L. Bianchi, 80131, Naples, Italy
| | - Angelo Carbone
- Cardiology Unit, Maria SS Addolorata, Via M. Pagano, 84025, Eboli, Italy
| | - Gregorio Covino
- Division of Cardiology, San Giovanni Bosco Hospital, Health Authority Naples 1, Via F.M. Briganti, 80144, Naples, Italy
| | - Gianluca Manzo
- Cardiology Unit, Umberto I Hospital, Via A. de Nicola, 84014, Nocera Inferiore, Italy
| | | | - Antonio D’Onofrio
- Division of Cardiology, Monaldi Hospital, Via L. Bianchi, 80131, Naples, Italy
| | - Gerardo Nigro
- Division of Cardiology, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Via L. Bianchi, 80131, Naples, Italy
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Ducceschi V, Maddaluno F, Del Giorno G, Catalano A, Carbone A. Is signal resolution of linear cryocatheters appropriate to map superoparaseptal accessory pathways? A comparison with Orion high‐resolution mapping. J Arrhythm 2020; 36:942-944. [PMID: 33024475 PMCID: PMC7532270 DOI: 10.1002/joa3.12413] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 11/10/2022] Open
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Bossone E, Del Giorno G, LaBounty TM. Aging and functional decline: The prevention’s clock is ticking. Eur J Prev Cardiol 2018; 25:802-803. [DOI: 10.1177/2047487318762857] [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: 11/15/2022]
Affiliation(s)
- Eduardo Bossone
- Division of Cardiology “Cava de’ Tirreni and Amalfi Coast”, Cardiothoracic and Vascular Department, University Hospital, Salerno, Italy
| | - Giuseppe Del Giorno
- Division of Cardiology “Cava de’ Tirreni and Amalfi Coast”, Cardiothoracic and Vascular Department, University Hospital, Salerno, Italy
| | - Troy M LaBounty
- Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
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Ziacchi M, Palmisano P, Ammendola E, Dell'era G, Guerra F, Aquilani S, Aspromonte V, Boriani G, Accogli M, Del Giorno G, Occhetta E, Capucci A, Ricci RP, Maglia G, Biffi M. Clinically guided pacemaker choice and setting: pacemaker expert programming study. Europace 2017; 19:1500-1507. [PMID: 27738057 DOI: 10.1093/europace/euw256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/18/2016] [Indexed: 11/14/2022] Open
Abstract
Aim The aim of this multicentre, observational, transversal study was to evaluate pacemaker (PM) choice and setting in a large number of patients, in order to understand their relationship with the patients' clinical characteristics. Methods and results The study enrolled a total of 1858 patients (71 ± 14 years, 54% male), consecutively evaluated during scheduled PM follow-up visits in 7 Italian cardiac arrhythmia centres. To evaluate the appropriateness of PM choice in relation to the patients' clinical characteristics, we analysed their rhythm disorders at the time of device implantation and the characteristics of the devices implanted. To evaluate the appropriateness of device setting, current rhythm disorders and device setting at the time of enrolment were analysed. In the overall study population, 64.3% of the patients received a PM with all of the features required for their rhythm disorder [80.8% in persistent atrioventricular (AV) block, 76.5% in atrial fibrillation needing pacing, 71.0% in sinus node disease, 58.7% in non-persistent atrioventricular block (AVB), 52.7% in neuro-mediated syncope]. The most frequent cause of inappropriate PM choice was the lack of an algorithm to promote intrinsic AV conduction in non-persistent AVB patients (38.1%). In 76.2% of the patients with an appropriate PM (n = 1301), the PM was optimally set for their rhythm disorder. Conclusions In the present 'real-world' registry, a large number of patients (35.7%) did not receive an optimal PM for their rhythm disorders. Moreover, one-fourth of appropriate PMs were not programmed according to the patients' clinical characteristics.
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Affiliation(s)
- Matteo Ziacchi
- Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Ernesto Ammendola
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Gabriele Dell'era
- Division of Cardiology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Umberto I-Lancisi-Salesi", Ancona, Italy
| | - Stefano Aquilani
- Department of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | | | - Giuseppe Boriani
- Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.,Department of Cardiology, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | | | - Giuseppe Del Giorno
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Eraldo Occhetta
- Division of Cardiology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Alessandro Capucci
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Umberto I-Lancisi-Salesi", Ancona, Italy
| | | | - Giampiero Maglia
- Cardiology-Coronary Care Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Mauro Biffi
- Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
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D'Onofrio A, Palmisano P, Rapacciuolo A, Ammendola E, Calò L, Ruocco A, Bianchi V, Maresca F, Del Giorno G, Martino A, Mauro C, Campari M, Valsecchi S, Accogli M. Effectiveness of a management program for outpatient clinic or remote titration of beta-blockers in CRT patients: The RESTORE study. Int J Cardiol 2017; 236:290-295. [DOI: 10.1016/j.ijcard.2017.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
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Palmisano P, Aspromonte V, Ammendola E, Dell'era G, Ziacchi M, Guerra F, Aquilani S, Maglia G, Del Giorno G, Giubertoni A, Boriani G, Capucci A, Pietro Ricci R, Accogli M. Effect of fixed-rate vs. rate-RESPONSIve pacing on exercise capacity in patients with permanent, refractory atrial fibrillation and left ventricular dysfunction treated with atrioventricular junction aBLation and bivEntricular pacing (RESPONSIBLE): a prospective, multicentre, randomized, single-blind study. Europace 2017; 19:414-420. [PMID: 26941340 DOI: 10.1093/europace/euw035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 10/15/2015] [Accepted: 02/02/2016] [Indexed: 11/13/2022] Open
Abstract
Aims Atrioventricular junction (AVJ) ablation followed by biventricular pacing is an established strategy for improving symptoms and morbidity in patients with permanent atrial fibrillation (AF), reduced left ventricular ejection fraction (LVEF), and uncontrolled ventricular rate. There is no clear evidence that such patients benefit from rate-responsive (RR) pacing. Methods and results This prospective, randomized, single-blind, multicentre study was designed as an intra-patient comparison and enrolled 60 patients (age 69.5 ± 11.8 years, males 63.3%, NYHA 3.0 ± 0.6) with refractory AF and reduced LVEF (mean 32.4 ± 8.3%) treated with AVJ ablation and biventricular pacing. Two 6-minute walking tests (6MWT) were performed 1 week apart: one during VVI 70/min biventricular pacing and the other during VVIR 70-130/min biventricular pacing; patients were randomly and blindly assigned to Group A (n = 29, first 6MWT in VVIR mode) or B (n = 31, first 6MWT in VVI mode). Rate-responsive activation determined an increase of 18.8 ± 24.4 m in the distance walked during the 6MWT (P < 0.001). The increase was similar in both groups (P = 0.571). A >5% increase in the distance walked was observed in 76.7% of patients. The increase in the distance walked was linearly correlated with the increase in heart rate recorded during the 6MWT in the VVIR mode (r = 0.54; P < 0.001). Conclusion In permanent AF patients with uncontrolled rate and reduced LVEF who had undergone AVJ ablation and biventricular pacing, RR pacing yields a significant gain in exercise capacity, which seems to be related to the RR-induced frequency during effort.
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Affiliation(s)
- Pietro Palmisano
- Cardiology Unit, 'Card. G. Panico' Hospital, Via S. Pio X, 4, 73039 Tricase, Italy
| | - Vittorio Aspromonte
- Cardiology - Coronary Care Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Ernesto Ammendola
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Gabriele Dell'era
- Division of Cardiology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Matteo Ziacchi
- Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital 'Umberto I - Lancisi - Salesi', Ancona, Italy
| | - Stefano Aquilani
- Department of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Giampiero Maglia
- Cardiology - Coronary Care Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Giuseppe Del Giorno
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Ailia Giubertoni
- Division of Cardiology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Giuseppe Boriani
- Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.,Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Alessandro Capucci
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital 'Umberto I - Lancisi - Salesi', Ancona, Italy
| | | | - Michele Accogli
- Cardiology Unit, 'Card. G. Panico' Hospital, Via S. Pio X, 4, 73039 Tricase, Italy
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Conti S, Pala S, Biagioli V, Del Giorno G, Zucchetti M, Russo E, Marino V, Dello Russo A, Casella M, Pizzamiglio F, Catto V, Tondo C, Carbucicchio C. Electrical storm: A clinical and electrophysiological overview. World J Cardiol 2015; 7:555-61. [PMID: 26413232 PMCID: PMC4577682 DOI: 10.4330/wjc.v7.i9.555] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/04/2015] [Accepted: 07/29/2015] [Indexed: 02/06/2023] Open
Abstract
Electrical storm (ES) is a clinical condition characterized by three or more ventricular arrhythmia episodes leading to appropriate implantable cardioverter-defibrillator (ICD) therapies in a 24 h period. Mostly, arrhythmias responsible of ES are multiple morphologies of monomorphic ventricular tachycardia (VT), but polymorphic VT and ventricular fibrillation can also result in ES. Clinical presentation is very dramatic in most cases, strictly related to the cardiac disease that may worsen electrical and hemodynamic decompensation. Therefore ES management is challenging in the majority of cases and a high mortality is the rule both in the acute and in the long-term phases. Different underlying cardiomyopathies provide significant clues into the mechanism of ES, which can arise in the setting of structural arrhythmogenic cardiomyopathies or rarely in patients with inherited arrhythmic syndrome, impacting on pharmacological treatment, on ICD programming, and on the opportunity to apply strategies of catheter ablation. This latter has become a pivotal form of treatment due to its high efficacy in modifying the arrhythmogenic substrate and in achieving rhythm stability, aiming at reducing recurrences of ventricular arrhythmia and at improving overall survival. In this review, the most relevant epidemiological and clinical aspects of ES, with regard to the acute and long-term follow-up implications, were evaluated, focusing on these novel therapeutic strategies of treatment.
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Affiliation(s)
- Sergio Conti
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Salvatore Pala
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Viviana Biagioli
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Giuseppe Del Giorno
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Martina Zucchetti
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Eleonora Russo
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Vittoria Marino
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Antonio Dello Russo
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Michela Casella
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Francesca Pizzamiglio
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Valentina Catto
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Claudio Tondo
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Corrado Carbucicchio
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
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Dello Russo A, Fassini G, Casella M, Di Monaco A, Riva S, Romano V, Moltrasio M, Tundo F, De Martino G, Majocchi B, Marino V, Russo E, Pizzamiglio F, Del Giorno G, Pelargonio G, Di Biase L, Natale A, Tondo C. Usefulness of intracardiac echocardiography during pulmonary vein isolation with the novel multipolar irrigated ablation catheter (nMARQTM). J Interv Card Electrophysiol 2015; 44:39-45. [DOI: 10.1007/s10840-015-0026-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
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13
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Palmisano P, Ammendola E, D'Onofrio A, Accogli M, Calò L, Ruocco A, Rapacciuolo A, Del Giorno G, Bianchi V, Malacrida M, Valsecchi S, Gronda E. Evaluation of synergistic effects of resynchronization therapy and a β-blocker up-titration strategy based on a predefined patient-management program: the RESTORE study. Clin Cardiol 2015; 38:2-7. [PMID: 25580847 DOI: 10.1002/clc.22352] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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] [Received: 07/24/2014] [Revised: 09/22/2014] [Accepted: 09/29/2014] [Indexed: 11/10/2022] Open
Abstract
Prior studies have suggested that a substantial number of eligible heart failure (HF) patients fail to receive β-blocker therapy, or receive it at a suboptimal dose. The aim of this study is to assess the benefit of a predefined management program designed for β-blocker up-titration, evaluating the synergistic effect of cardiac resynchronization therapy (CRT) and β-blockers in a HF population. The Resynchronization Therapy and β-Blocker Titration (RESTORE) study is a prospective, case-control, multicenter cohort study designed to test the hypothesis that a β-blocker up-titration strategy based on a predefined management program maximizes the beneficial effect of CRT, increasing the number of patients reaching the target dose of β-blockers and improving their clinical outcome. All study patients receive an implantable defibrillator for CRT delivery in accordance with current guidelines. Enrollments started in December 2011 and are scheduled to end in December 2014. Approximately 250 consecutive patients will be prospectively enrolled in 6 Italian centers and followed up for 24 months after implantation. The primary endpoint is to demonstrate that CRT may allow titration of β-blockers until the optimal dose, or at least to the effective dose, in patients with HF. This study might provide important information about the benefit of a predefined management program for β-blocker up-titration in patients receiving CRT. Moreover, assessment of health-care utilization and the consumption of resources will allow estimating the potential utility of remote monitoring by means of an automated telemedicine system in facilitating the titration of β-blockers in comparison with a standard in-hospital approach.
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14
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D'Alessandro R, Masarone D, Buono A, Gravino R, Rea A, Salerno G, Golia E, Ammendola E, Del Giorno G, Santangelo L, Russo MG, Calabrò R, Bossone E, Pacileo G, Limongelli G. Natriuretic peptides: molecular biology, pathophysiology and clinical implications for the cardiologist. Future Cardiol 2014; 9:519-34. [PMID: 23834693 DOI: 10.2217/fca.13.32] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Natriuretic peptides (NPs) counter the effects of volume overload or adrenergic activation of the cardiovascular system. They are able to induce arterial vasodilatations, natriuresis and diuresis, and they reduce the activities of the renin-angiotensin-aldosterone system and the sympathetic nervous system. However, in addition to wall stress, other factors have been associated with elevated natriuretic peptide levels. Since 2000, because of their characteristics, NPs have become quantitative plasma biomarkers of heart failure. Nowadays, NPs play an important role not only in the diagnosis of heart failure, but also for a prognostic purpose and a guide to medical therapy. Finally, a new drug that modulates the NP system or recombinant analogs of NPs are now available in patients with heart failure.
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15
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Masarone D, Limongelli G, Ammendola E, Del Giorno G, Colimodio F, D’Andrea A, Pacileo G, Santangelo L, Lambiase PD. Cardiac resynchronization therapy in cardiomyopathies. J Cardiovasc Med (Hagerstown) 2014; 15:92-9. [DOI: 10.2459/jcm.0b013e3283637ff2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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