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Zucchetti M, Severo IM, Echer IC, Borba DDSM, Nectoux CLS, Azzolin KDO. Validation of manual to complement the transition of care at discharge from intensive care. Rev Gaucha Enferm 2022; 43:e20220142. [DOI: 10.1590/1983-1447.2022.20220142.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022] Open
Abstract
ABSTRACT Objective To develop and validate an interprofessional manual for the transfer of care to critically ill adult patients. Method Methodological study, conducted from January to September 2019. The content of the manual was listed by the multidisciplinary team of an adult Intensive Care Unit, in southern Brazil. In the validation by the professionals, the content validity index (CVI) of the evaluation questions was calculated. Subsequently, a sample of 30 patients/caregivers evaluated the product, and the arithmetic mean of the questions was calculated. Results The manual addresses important information and care transition guidance for patients and caregivers, from admission to the intensive care to discharge to the inpatient unit. The professionals’ CVI ranged from 0.9 to 1. The arithmetic mean of 17 patients and 13 caregivers was 3.8. Final considerations The validated manual can be used as a complementary material for health education and qualify the transition of care.
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Zucchetti M, Severo IM, Echer IC, Borba DDSM, Nectoux CLS, Azzolin KDO. Validação de manual para complementar a transição de cuidados na alta da terapia intensiva. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20220142.pt] [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: 11/29/2022] Open
Abstract
RESUMO Objetivo Desenvolver e validar um manual interprofissional de transferência de cuidados ao paciente adulto crítico. Método Estudo metodológico, realizado de janeiro a setembro/2019. O conteúdo do manual foi elencado pela equipe multiprofissional de um Centro Terapia Intensiva adulto, do Sul do Brasil. Na validação pelos profissionais, foi calculado o índice de validade de conteúdo (IVC) das questões de avaliação. Posteriormente, amostra de 30 pacientes/cuidadores avaliou o produto, sendo calculada a média aritmética das questões. Resultados O manual aborda informações importantes e orientações de transição do cuidado, para pacientes e cuidadores, desde a admissão na terapia intensiva até a alta para unidade de internação. O IVC dos profissionais variou de 0,9 a 1. A média aritmética, de 17 pacientes e 13 cuidadores foi 3,8. Considerações finais O manual validado poderá ser utilizado como material complementar de educação em saúde e qualificar a transição de cuidados.
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Candido L, Alberghi C, Papa F, Ricapito I, Utili M, Venturini A, Zucchetti M. Experiments on the MHD Effect on the Drainage of a LiPb Channel and Supporting Numerical Computations with the Level Set Method. Fusion Science and Technology 2021. [DOI: 10.1080/15361055.2021.1893574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- L. Candido
- Politecnico di Torino, ESSENTIAL Group, Corso Duca degli Abruzzi 24, 10129 Torino, Italy
| | - C. Alberghi
- Politecnico di Torino, ESSENTIAL Group, Corso Duca degli Abruzzi 24, 10129 Torino, Italy
| | - F. Papa
- Sapienza University of Rome, Department of Astronautical, Electrical and Energy Engineering, Nuclear Section, Corso Vittorio Emanuele II 244, 00186 Roma, Italy
| | - I. Ricapito
- EU Commission Agency, Fusion for Energy (F4E), Aix-en-Provence, Provence-Alpes-Côte d’Azur, France
| | - M. Utili
- ENEA Centro Ricerche Brasimone, 40032 Camugnano (Bologna), Italy
| | - A. Venturini
- ENEA Centro Ricerche Brasimone, 40032 Camugnano (Bologna), Italy
| | - M. Zucchetti
- Politecnico di Torino, ESSENTIAL Group, Corso Duca degli Abruzzi 24, 10129 Torino, Italy
- Massachusetts Institute of Technology, Cambridge, Massachusetts
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Meschini S, Zucchetti M, Pagliuca E. Development of an Advanced-Fuel Nuclear Fusion Experiment. Fusion Science and Technology 2021. [DOI: 10.1080/15361055.2021.1921461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S. Meschini
- Politecnico di Torino, Department of Energy, Corso Duca Degli Abruzzi 24, 10129 Torino, Italy
| | - M. Zucchetti
- Politecnico di Torino, Department of Energy, Corso Duca Degli Abruzzi 24, 10129 Torino, Italy
- Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Enrico Pagliuca
- Politecnico di Torino, Department of Energy, Corso Duca Degli Abruzzi 24, 10129 Torino, Italy
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Bigini P, Gobbi M, Bonati M, Clavenna A, Zucchetti M, Garattini S, Pasut G. The role and impact of polyethylene glycol on anaphylactic reactions to COVID-19 nano-vaccines. Nat Nanotechnol 2021; 16:1169-1171. [PMID: 34732846 DOI: 10.1038/s41565-021-01001-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- P Bigini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - M Gobbi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - M Bonati
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - A Clavenna
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - M Zucchetti
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - S Garattini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - G Pasut
- Pharmaceutical and Pharmacological Sciences Department, University of Padova, Padua, Italy.
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Candido L, Alberghi C, Antonelli A, Bassini S, Piccioni M, Storai S, Testoni R, Utili M, Zucchetti M. HyPer-QuarCh II: A laboratory-scale device for hydrogen isotopes permeation experiments. Fusion Engineering and Design 2021. [DOI: 10.1016/j.fusengdes.2021.112920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bergonti M, Dello Russo A, Sicuso R, Ribatti V, Compagnucci P, Catto V, Gasperetti A, Zucchetti M, Cellucci S, Vettor G, Dessanai MA, Majocchi B, Moltrasio M, Russo E, Stronati G, Guerra F, Di Biase L, Natale A, Tondo C, Casella M. Long-Term Outcomes of Near-Zero Radiation Ablation of Paroxysmal Supraventricular Tachycardia: A Comparison With Fluoroscopy-Guided Approach. JACC Clin Electrophysiol 2021; 7:1108-1117. [PMID: 33933407 DOI: 10.1016/j.jacep.2021.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to assess the long-term outcomes of minimally fluoroscopic approach (MFA) compared with conventional fluoroscopic ablation (ConvA) in terms of recurrences of arrhythmia and long-term complications. BACKGROUND Catheter ablation (CA) of supraventricular tachycardia (SVT) with an MFA, under the guidance of electroanatomic mapping (EAM) systems, results in a significant reduction in exposure to ionizing radiations without impairing acute procedural success and complication rate. However, data regarding long-term outcomes of MFA compared with ConvA are lacking. METHODS This is a retrospective observational study. All patients undergoing MFA CA of SVT (atrioventricular nodal re-entrant tachycardia and atrioventricular re-entrant tachycardia) between 2010 and 2015 were enrolled and were compared with matched subjects (1 MFA: 2 ConvA) undergoing ConvA during the same period. The 2 co-primary outcomes were recurrence of arrhythmias and long-term complications. RESULTS Six-hundred eighteen patients (mean age 38 ± 15 years, 60% female) were enrolled. MFA included 206 patients, whereas 412 were treated with ConvA. Acute success (99% vs. 97%; p = 0.10) and acute complications (2.4% vs. 5.3%; p = 0.14) were similar in the 2 groups. During a median follow-up of 4.4 years, 5.9% of patients experienced recurrence of arrhythmias. At multivariate analysis, ConvA (hazard ratio [HR]: 3.03) and procedural success (HR: 0.10) were independently associated with recurrence of arrhythmias. Late complications (i.e., advance atrioventricular block and need for pacemaker implantation) occurred more frequently in ConvA (3.4% vs. 0.5%; p = 0.03) compared with MFA. CONCLUSIONS CA guided by EAM systems with MFA provided better long-term results and reduced risk of complications compared with ConvA.
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Affiliation(s)
- Marco Bergonti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy; Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
| | - Rita Sicuso
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Valentina Ribatti
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy; Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
| | - Valentina Catto
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Alessio Gasperetti
- Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
| | - Martina Zucchetti
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Selene Cellucci
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giulia Vettor
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Maria Antonietta Dessanai
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Benedetta Majocchi
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Massimo Moltrasio
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Eleonora Russo
- Department of Cardiovascular Disease, Division of Cardiac Surgery, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Giulia Stronati
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy; Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy; Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
| | - Luigi Di Biase
- Montefiore Medical Center, Albert-Einstein College of Medicine, Bronx, New York, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute (TCAI), St. David's Hospital, Austin, Texas, USA
| | - Claudio Tondo
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy; Department of Clinical, Special and Dental Sciences, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
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Matteo C, Dovrtelova G, Di Clemente A, Frapolli R, Passoni A, Ceruti T, Marsella G, Cervo L, Zucchetti M. HPLC-MS/MS measurement of lidocaine in rat skin and plasma. Application to study the release from medicated plaster. J Chromatogr B Analyt Technol Biomed Life Sci 2020; 1138:121942. [PMID: 31918305 DOI: 10.1016/j.jchromb.2019.121942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 10/18/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022]
Abstract
A simple, sensitive HPLC-MS/MS method was developed and validated for the determination of lidocaine in skin and plasma of rats. The methods were established and validated assessing lower limit of quantitation (LLOQ), linearity, intra and inter-day precision and accuracy, selectivity, recovery and matrix effect. Chromatography was done on a Gemini column embedded with C18 stationary phase (50 mm × 2.0 mm, 5 µm particle size), using a gradient with mobile phases consisting of 0.1% HCOOH in bidistilled water and 0.1% HCOOH in acetonitrile. The mass spectrometer worked with electrospray ionization in positive ion mode and selected reaction monitoring, using target ions m/z 235.10 for lidocaine and m/z 245.10 for lidocaine-d10, used as internal standard. RESULTS: The linearity of the method was in the ranges of lidocaine concentrations 10.0-200.0 ng/mL for skin homogenate (accuracy 94.1-105.5%; R2 ≥ 0.998) and 0.025-2 ng/mL for plasma (accuracy 96.2-104.8%; R2 ≥ 0.996). The intra- and inter-day precision and accuracy determined on three quality control samples (20, 75 and 170 ng/mL for skin and 0.075, 0.4 and 1.5 ng/mL for plasma) were ≤4.2% and 103.8-108.2% for skin and ≤12.4% and 95.5-101.4% for plasma. The LLOQ was 10 ng/mL in skin homogenate and 0.025 ng/mL in plasma. The applicability of the method was demonstrated by measuring lidocaine in skin and plasma after exposure to medicated patches containing 5% lidocaine.
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Affiliation(s)
- C Matteo
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - G Dovrtelova
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy; Department of Pharmacology, Faculty of Medicine, RECETOX Centre, Faculty of Science, Masaryk University and International Clinical Research Center, St. Anne's University Hospital Brno, Czech Republic
| | - A Di Clemente
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - R Frapolli
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - A Passoni
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - T Ceruti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - G Marsella
- Animal Care Unit, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - L Cervo
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - M Zucchetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
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Dello Russo A, Della Rocca D, Gasperetti A, Casella M, Basso C, Bianchini L, Fassini G, Riva S, Moltrasio M, Ribatti V, Tundo F, Zucchetti M, Carbucicchio C, Natale A, Tondo C. P3682Myocardial structural abnormalities in nonischemic patients presenting with ventricular arrhythmias. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The diagnosis of concealed cardiomyopathies in patients with ventricular arrhythmias (VAs) is one of the major challenging issues faced by physicians.
Purpose
We aimed at reporting the cardiomyopathic substrate in patients with recurrent arrhythmias of ventricular origin.
Methods
Consecutive patients with unexplained VAs underwent a complete diagnostic work-out, including endomyocardial biopsy (EMB).
Results
Ninety-seven patients were enrolled (76.3% male, age 39.7±13.3 yrs). The presenting arrhythmic manifestation was aborted cardiac arrest in 30 (30.9%) patients, sustained ventricular tachycardia (VT) in 9 (9.3%), nonsustained VT in 15 (15.5%) and frequent premature ventricular complexes in 43 (44.3%). Overall, 350 biopsies were collected (3.6/patient). The incidence of procedure-related complications was 5.1% (n=5): 4 major complications (1 rupture of a tricuspid chorda tendinea w/o hemodynamic impairment, 1 dissection of right external iliac artery treated with stent, 1 thrombotic occlusion of left superficial femoral artery which required surgical treatment, 1 TIA) and 1 minor complication (groin hematoma) occurred. The final diagnosis was arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) (n=41; 42.3%), followed by myocarditis (n=20; 20.6%), dilated cardiomyopathy (n=6; 6.2%), cardiac sarcoidosis (n=6; 6.2%), and myocarditis in ARVD/C (n=5; 5.1%). Among the 25 patients whose final diagnosis was consistent with myocarditis, an acute stage of the disease was documented in 7 (7.2%), while a chronic myocarditis in 18 (18.5%). Additionally, according to medical history and diagnostic workout, in 2 of the 6 patients the dilated cardiomyopathy had a likely post-inflammatory etiology. Absence of myocardial abnormalities was documented in 15 (15.5%) patients: this group included 1 case of methadone-induced torsade de pointes. The remaining 4 (4.1%) patients were diagnosed with a cardiac hypertrophy (n=2, 2.1%, secondary to exercise or Fabry disease), a dilated mitochondrial cardiomyopathy (n=1, 1.0%), a dilated cardiomyopathy in Emery-Dreifuss muscular dystrophy (n=1; 1.0%).
Conclusion
In our series, approximately 45% of patients with unexplained VAs had a final diagnosis of ARVD/C.
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Affiliation(s)
| | - D Della Rocca
- St. David's Medical Center, Austin, United States of America
| | | | - M Casella
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - C Basso
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - L Bianchini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Fassini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - S Riva
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Moltrasio
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - V Ribatti
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - F Tundo
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Zucchetti
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - A Natale
- St. Davids Medical Center, Texas Cardiac Arrhythmia Institute, Austin, United States of America
| | - C Tondo
- Cardiology Center Monzino IRCCS, Milan, Italy
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Dello Russo A, Gasperetti A, Riva S, Dessanai M, Pizzamiglio F, Casella M, Chihade F, Catto V, Majocchi B, Zucchetti M, Ribatti V, Andreini D, Basso C, Zeppilli P, Tondo C. P307Magnetic resonance, electroanatomical mapping, and endomyocardial biopsy to solve the diagnostic and sport eligibility dilemma in a cohort of competitive athletes with ventricular arrhythmias. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0142] [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: 11/12/2022] Open
Abstract
Abstract
Background
Ventricular arrhythmias (VAs) are a frequent finding in agonist athletes (athl) at routine sport medicine visits. VAs impact on sport eligibility, their management, and the sudden arrhythmic death risk evaluation in athletes currently represents one of the greatest challenges across both the cardiology and sport medicine field.
Purpose
To describe how an advanced multi-methodical evaluation allowed diagnosis, risk stratification, targeted therapy and sport eligibility reassessment in a competitive athl cohort with ventricular arrhythmias and pathological findings at magnetic resonance (MR).
Methods
All consecutive competitive athl with denied sport eligibility due to ventricular arrhythmias that underwent an advanced invasive evaluation at our institute were enrolled.
A baseline and stress ECG, and late gadolinium enhanced evaluation (LGE) at MR were performed prior to invasive evaluation in all athl.
Invasive evaluation performed in all athl comprised of an electrophysiological study (EPS) to assess arrhythmic inducibility, an endo-cavitary electro-anatomical mapping (EAM), and a EAM and MR guided endo-myocardial biopsy (EMB). A defined diagnosis was postulated in all cases, specific therapeutic interventions were started and sport eligibility status reassessed after 6 months from discharge.
Results
Thirty-two competitive athl were enrolled in our study (32±6 y.o.; 77% male; 4±1 1h-training session/week); 26 (81%) athl practiced a mixed aerobic-anaerobic, 5 (16%) a pure-aerobic, while only 1 (3%) a pure anaerobic sport.
Arrhythmic presentation leading to sport eligibility revoke was: in 13 (40%) athl frequent (>2000/day) premature ventricular contractions (PVCs) at rest, in 2 (6%) PVCs during stress ECG, in 6 (18%) non-sustained ventricular tachycardia (VT), in 8 (25%) sustained VT, and in 3 (11%) ventricular fibrillation/cardiac arrest during sport practice.
MR alterations were described in all cases, and LGE at MR was found in 31 (87%) athl; a definite radiological diagnosis was obtained in 13 (40%) athl.
A normal myocardium at EMB was found only in 3 (8%) pts; in 15 (45%) a leukocyte infiltrate pattern compatible with myocarditis, in 11 (39%) fibro-fatty replacement, in 2 (5%) a mitochondrial disease and in 1 (3%) a sarcoidosis were proven, and diagnosis were consequently postulated.
EPS showed complex VAs inducibility in 8 (25%) cases, while a trans catheter ablation was performed in 10 (31%) athl. A total of 9 (28%) implantable cardioverter devices (ICDs) were implanted, for primary or secondary prevention.
According to invasive diagnostic findings and sport medicine guidelines, 8 (25%) athl had their sport eligibility statuts re-instated.
Conclusion
An invasive multi-methodical assessment allowed in all cases to reach a diagnosis and to start a targeted therapy in a cohort of competitive athl with VA and a pathological MR, granting in a significant (25%) percentage sport eligibility status re-instatement.
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Affiliation(s)
| | | | - S Riva
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Dessanai
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - M Casella
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - F Chihade
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - V Catto
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - B Majocchi
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Zucchetti
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - V Ribatti
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - D Andreini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - C Basso
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - P Zeppilli
- Catholic University of the Sacred Heart, Sports Medicine Unit, Orthopedics, Aging and Rehabilitation Area, Rome, Italy
| | - C Tondo
- Cardiology Center Monzino IRCCS, Milan, Italy
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Segantin S, Testoni R, Hartwig Z, Whyte D, Zucchetti M. Exploration of a Fast Pathway to Nuclear Fusion: Thermal Analysis and Cooling Design Considerations for the ARC Reactor. Fusion Science and Technology 2019. [DOI: 10.1080/15361055.2019.1629252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- S. Segantin
- Politecnico di Torino, Dipartimento Energia, Italy
| | - R. Testoni
- Politecnico di Torino, Dipartimento Energia, Italy
| | - Z. Hartwig
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts
| | - D. Whyte
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts
| | - M. Zucchetti
- Politecnico di Torino, Dipartimento Energia, Italy
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts
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12
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Zucchetti M, Candido L, Hartwig Z, Po’ R, Segantin S, Testoni R, Whyte D. Neutronics Scoping Studies for Experimental Fusion Devices. Fusion Science and Technology 2019. [DOI: 10.1080/15361055.2019.1613141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- M. Zucchetti
- Politecnico di Torino, Department of Energy, Torino, Italy
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts
| | - L. Candido
- Politecnico di Torino, Department of Energy, Torino, Italy
| | - Z. Hartwig
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts
| | - R. Po’
- Eni SpA, Decarbonization & Environmental R&D Research & Technological Innovation, Novara, Italy
| | - S. Segantin
- Politecnico di Torino, Department of Energy, Torino, Italy
| | - R. Testoni
- Politecnico di Torino, Department of Energy, Torino, Italy
| | - D. Whyte
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts
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13
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Moltrasio M, Sicuso R, Fassini GM, Riva SI, Tundo F, Dello Russo A, Casella M, Majocchi B, Zucchetti M, Cellucci S, Tondo C. Acute outcome after a single cryoballoon ablation: Comparison between Arctic Front Advance and Arctic Front Advance PRO. Pacing Clin Electrophysiol 2019; 42:890-896. [DOI: 10.1111/pace.13718] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/22/2019] [Accepted: 04/29/2019] [Indexed: 12/31/2022]
Affiliation(s)
| | - Rita Sicuso
- Heart Rhythm CenterCentro Cardiologico Monzino, IRCCS Milano Italy
| | | | - Stefania I. Riva
- Heart Rhythm CenterCentro Cardiologico Monzino, IRCCS Milano Italy
| | - Fabrizio Tundo
- Heart Rhythm CenterCentro Cardiologico Monzino, IRCCS Milano Italy
| | | | - Michela Casella
- Heart Rhythm CenterCentro Cardiologico Monzino, IRCCS Milano Italy
| | | | | | - Selene Cellucci
- Heart Rhythm CenterCentro Cardiologico Monzino, IRCCS Milano Italy
| | - Claudio Tondo
- Heart Rhythm CenterCentro Cardiologico Monzino, IRCCS Milano Italy
- Department of Clinical Science and Community HealthUniversity of Milan Italy
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14
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Gasperetti A, Fassini G, Tundo F, Zucchetti M, Dessanai M, Tondo C. A left atrial appendage closure combined procedure review: Past, present, and future perspectives. J Cardiovasc Electrophysiol 2019; 30:1345-1351. [PMID: 31042321 DOI: 10.1111/jce.13957] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/17/2019] [Accepted: 04/23/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVE Atrial fibrillation (AF) represents the most common cardiac arrhythmia worldwide; it poses a great burden in terms of quality of life reduction and yearly stroke risk. Left atrial appendage closure (LAAC) is a stroke prevention strategy that has been proven a viable alternative to antithrombotic regimens in nonvalvular AF patients. LAAC can be performed as a standalone procedure or alongside a concomitant AF transcatheter ablation, in a procedure known as "Combined procedure". Aim of this study is to summarize the scientific evidence backing this combined strategy. METHODS We reviewed the whole Medline indexed combined procedure literature, to summarize all the combined procedure study data. RESULTS Nine published studies regarding combined procedure were found. Data, aims, and scientific rationales were reported and commented. CONCLUSION LAA combined procedure appears to be a safe and effective procedure; a careful patient selection is necessary to maximize its benefit.
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Affiliation(s)
- Alessio Gasperetti
- Heart Rhythm Center is the Department name; IRCCS, Centro Cardiologico Monzino is the name of the hospital, Milano, Italy
| | - Gaetano Fassini
- Heart Rhythm Center is the Department name; IRCCS, Centro Cardiologico Monzino is the name of the hospital, Milano, Italy
| | - Fabrizio Tundo
- Heart Rhythm Center is the Department name; IRCCS, Centro Cardiologico Monzino is the name of the hospital, Milano, Italy
| | - Martina Zucchetti
- Heart Rhythm Center is the Department name; IRCCS, Centro Cardiologico Monzino is the name of the hospital, Milano, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Mariantonietta Dessanai
- Heart Rhythm Center is the Department name; IRCCS, Centro Cardiologico Monzino is the name of the hospital, Milano, Italy
| | - Claudio Tondo
- Heart Rhythm Center is the Department name; IRCCS, Centro Cardiologico Monzino is the name of the hospital, Milano, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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15
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Zucchetti M, Chen Z, El-Guebaly L, Khripunov V, Kolbasov B, Maisonnier D, Someya Y, Subbotin M, Testoni R, Tobita K. Progress in International Radioactive Fusion Waste Studies. Fusion Science and Technology 2019. [DOI: 10.1080/15361055.2019.1602457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Z. Chen
- Chinese Academy of Sciences, Institute of Nuclear Energy Safety Technology, Hefei, Anhui, China
| | - L. El-Guebaly
- University of Wisconsin–Madison, Fusion Technology Institute, Madison, Wisconsin
| | - V. Khripunov
- National Research Center “Kurchatov Institute,”, Moscow, Russian Federation
| | - B. Kolbasov
- National Research Center “Kurchatov Institute,”, Moscow, Russian Federation
| | - D. Maisonnier
- European Commission Research and Innovation, Brussels, Belgium
| | - Y. Someya
- National Institutes for Quantum and Radiological Science and Technology, Rokkasho, Japan
| | - M. Subbotin
- National Research Center “Kurchatov Institute,”, Moscow, Russian Federation
| | | | - K. Tobita
- National Institutes for Quantum and Radiological Science and Technology, Rokkasho, Japan
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16
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Dello Russo A, Fassini GM, Casella M, Romanelli E, Pala S, Riva S, Catto V, Moltrasio M, Tundo F, Zucchetti M, Majocchi B, Dessanai MA, Pizzamiglio F, Vettor G, Ribatti V, Gasperetti A, Cellucci S, Negro G, Sicuso R, Carbucicchio C, Tondo C. Lesion index: a novel guide in the path of successful pulmonary vein isolation. J Interv Card Electrophysiol 2018; 55:27-34. [PMID: 30515625 DOI: 10.1007/s10840-018-0487-z] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/12/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE Previous studies indicate force time integral (FTI) as a radiofrequency (RF) lesion quality marker, while not considering power supply. Tacticath™ Quartz catheter provides Lesion index (LSI), a lesion quality marker derived by contact force (CF), power supply, and RF time combined. Our aim is to assess LSI and FTI correlation and a LSI-related cutoff of atrial fibrillation (AF) recurrences 12 months after pulmonary vein isolation (PVI). METHODS We retrospectively enrolled 37 patients who underwent RF ablation using Tacticath™ Quartz catheter. AF recurrence rate was evaluated 3, 6, and 12 months after PVI procedure. RESULTS AF recurrence was detected in 32% of patients. FTI mean value was significantly lower in left superior pulmonary vein (LSPV: 256 ± 86 gs vs 329 ± 117 gs, p = 0.05) and right inferior pulmonary vein (RIPV: 253 ± 128 gs vs 394 ± 123 gs p = 0.006) in patients with AF recurrences; no significant differences were found in right superior pulmonary vein (RSPV) and left inferior pulmonary vein (LIPV). LSI instead was significantly higher for all veins in patients without AF recurrences: LSPV (5.2 ± 0.7 vs 4.6 ± 0.8, p = 0.03), LIPV (5.0 ± 0.8 vs 4.5 ± 0.6, p = 0.04), RSPV (5.5 ± 0.6 vs 5.1 ± 0.6, p = 0.05), and RIPV (5.5 ± 0.7 vs 4.7 ± 0.8, p = 0.006). Receiver operator characteristic curve suggests 5.3 as LSI overall cutoff value predicting freedom from disease at 1-year follow-up. CONCLUSIONS Our preliminary data suggest that a LSI mean value higher than 5.3 can be considered a good predictor of AF freedom at 1-year follow-up.
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Affiliation(s)
- Antonio Dello Russo
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy.
| | - Gaetano M Fassini
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Michela Casella
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy
| | | | - Salvatore Pala
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Stefania Riva
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Valentina Catto
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Massimo Moltrasio
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Fabrizio Tundo
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Martina Zucchetti
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Benedetta Majocchi
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy
| | | | - Francesca Pizzamiglio
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Giulia Vettor
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Valentina Ribatti
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Alessio Gasperetti
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Selene Cellucci
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Gabriele Negro
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Rita Sicuso
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Corrado Carbucicchio
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy.,Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
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17
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Casella M, Dello Russo A, Russo E, Catto V, Pizzamiglio F, Zucchetti M, Majocchi B, Riva S, Vettor G, Dessanai MA, Fassini G, Moltrasio M, Tundo F, Vignati C, Conti S, Bonomi A, Carbucicchio C, Di Biase L, Natale A, Tondo C. X-Ray Exposure in Cardiac Electrophysiology: A Retrospective Analysis in 8150 Patients Over 7 Years of Activity in a Modern, Large-Volume Laboratory. J Am Heart Assoc 2018; 7:JAHA.117.008233. [PMID: 29789334 PMCID: PMC6015357 DOI: 10.1161/jaha.117.008233] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Only a few studies have systematically evaluated fluoroscopy data of electrophysiological and device implantation procedures. Aims of this study were to quantify ionizing radiation exposure for electrophysiological/device implantation procedures in a large series of patients and to analyze the x‐ray exposure trend over years and radiation exposure in patients undergoing atrial fibrillation ablation considering different technical aspects. Methods and Results We performed a retrospective analysis of all electrophysiological/device implantation procedures performed during the past 7 years in a modern, large‐volume laboratory. We reported complete fluoroscopy data on 8150 electrophysiological/device implantation procedures (6095 electrophysiological and 2055 device implantation procedures); for each type of procedure, effective dose and lifetime attributable risk of cancer incidence and mortality were calculated. Over the 7‐year period, we observed a significant trend reduction in fluoroscopy time, dose area product, and effective dose for all electrophysiological procedures (P<0.001) and a not statistically significant trend reduction for device implantation procedures. Analyzing 2416 atrial fibrillation ablations, we observed a significant variability of fluoroscopy time, dose area product and effective dose among 7 different experienced operators (P<0.0001) and a significant reduction of fluoroscopy use over time (P<0.0001) for all of them. Considering atrial fibrillation ablation techniques, fluoroscopy time was not different (P = 0.74) for radiofrequency catheter ablation in comparison with cryoablation, though cryoablation was still associated with higher dose area product and effective dose values (P<0.001). Conclusions Electrophysiological procedures involve a nonnegligible x‐ray use, leading to an increased risk of malignancy. Awareness of radiation‐related risk, together with technological advances, can successfully optimize fluoroscopy use.
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Affiliation(s)
- Michela Casella
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Eleonora Russo
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Valentina Catto
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Martina Zucchetti
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Stefania Riva
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giulia Vettor
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Gaetano Fassini
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Massimo Moltrasio
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Fabrizio Tundo
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Carlo Vignati
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Sergio Conti
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Alice Bonomi
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore Hospital, Bronx, NY.,Texas Cardiac Arrhythmia Institute, St Davis Medical Center, Austin, TX.,Department of Biomedical Engineering, University of Texas at Austin, TX.,Department of Cardiology, University of Foggia, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St Davis Medical Center, Austin, TX.,Department of Biomedical Engineering, University of Texas at Austin, TX.,Dell Medical School, University of Texas at Austin, TX.,California Pacific Medical Center, San Francisco, CA
| | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy.,Department of Clinical Science and Community Health, University of Milan, Italy
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18
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Affiliation(s)
- E.T. Cheng
- TSI Research, Inc. 225 Stevens Avenue Solana Beach, CA USA 92075
| | - P. Rocco
- European Commission - JRC Institute for Advanced Materials T.P.800, I-21020 Ispra (VA), Italy
| | - M. Zucchetti
- European Commission - JRC Institute for Advanced Materials T.P.800, I-21020 Ispra (VA), Italy
- Polytechnic of Torino, Energetics Department, C.so Duca degli Abruzzi 24, I-10129 Torino, Italy
| | - Y. Seki
- JAERI Mukouyama 801-1 Naka-machi, Naka-gun Ibaraki-ken 311-0102, Japan
| | - T. Tabara
- Sumitomo Atomic Energy Industries, Ltd., 2-10-14, Ryogoku, Sumidaku, Tokyo, 130 Japan
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19
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Zucchetti M, Riva M, Testoni R, Candido L, Coppi B. Neutron Generation in CANDOR, an Advanced-Fuel Fusion Experiment. Fusion Science and Technology 2017. [DOI: 10.1080/15361055.2017.1347462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M. Zucchetti
- Politecnico di Torino, DENERG, Italy
- Massachussetts Institute of Technology, Cambridge, Massachusetts
| | - M. Riva
- Politecnico di Torino, DENERG, Italy
- University of California, Los Angeles, California
| | | | | | - B. Coppi
- Massachussetts Institute of Technology, Cambridge, Massachusetts
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20
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Zucchetti M, Chang Z, El-Guebaly L, Han JH, Kolbasov B, Khripunov V, Riva M, Someya Y, Testoni R, Tobita K. Radioactive Waste Studies in the Frame of the IEA Cooperative Program on the Environmental, Safety, and Economic Aspects of Fusion Power. Fusion Science and Technology 2017. [DOI: 10.1080/15361055.2017.1350474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Z. Chang
- Chinese Academy of Sciences, Institute of Nuclear Energy Safety Technology, Hefei, Anhui, China
| | | | | | - B. Kolbasov
- National Research Center “Kurchatov Institute,” Moscow, Russia
| | - V. Khripunov
- National Research Center “Kurchatov Institute,” Moscow, Russia
| | - M. Riva
- Politecnico di Torino, Torino, Italy
- University of California at Los Angeles, Los Angeles, California
| | - Y. Someya
- National Institutes for Quantum and Radiological Science and Technology, Rokkasho, Japan
| | | | - K. Tobita
- National Institutes for Quantum and Radiological Science and Technology, Rokkasho, Japan
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21
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Zucchetti M, Ciampichetti A. Safety and Radioactive Waste Management Aspects of the Ignitor Fusion Experiment. Fusion Science and Technology 2017. [DOI: 10.13182/fst56-814] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- M. Zucchetti
- DENER, Politecnico di Torino Corso Duca degli Abruzzi, 24 – 10129 Torino (Italy)
| | - A. Ciampichetti
- DENER, Politecnico di Torino Corso Duca degli Abruzzi, 24 – 10129 Torino (Italy)
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22
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Zucchetti M, Di Pace L, El-Guebaly L, Kolbasov BN, Massaut V, Pampin R, Wilson P. The Back-End of Fusion Materials Cycle: Recycling, Clearance and Disposal. Fusion Science and Technology 2017. [DOI: 10.13182/fst09-a9004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- M. Zucchetti
- EURATOM/ENEA Fusion Association, Politecnico di Torino, Torino, Italy
| | - L. Di Pace
- EURATOM/ENEA Fusion Association, ENEA CRE Frascati, Rome, Italy
| | | | | | | | - R. Pampin
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, U.K
| | - P. Wilson
- University of Wisconsin-Madison, Madison, WI, U.S.A
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23
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Ricapito I, Ciampichetti A, Benamati G, Zucchetti M. Tritium Extraction Systems for the European HCLL/HCPB TBMs. Fusion Science and Technology 2017. [DOI: 10.13182/fst08-a1775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- I. Ricapito
- ENEA FPN-FISING, CR Brasimone, 40033 Camugnano (Bo), Italy
| | | | - G. Benamati
- ENEA FPN-FISING, CR Brasimone, 40033 Camugnano (Bo), Italy
| | - M. Zucchetti
- DENER, Politecnico di Torino, 10129 Torino, Italy
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24
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Zucchetti M, Pace LD, El-Guebaly L, Kolbasov BN, Massaut V, Pampin R, Wilson P. The Back End of the Fusion Materials Cycle. Fusion Science and Technology 2017. [DOI: 10.13182/fst09-12] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- M. Zucchetti
- EURATOM/ENEA Fusion Association, Politecnico di Torino, Torino, Italy
| | - L. Di Pace
- EURATOM/ENEA Fusion Association, ENEA CR Frascati, Rome, Italy
| | | | | | | | - R. Pampin
- EURATOM0UKAEA Fusion Association, Culham Science Centre, Abingdon, United Kingdom
| | - P. Wilson
- University of Wisconsin-Madison, Madison, Wisconsin
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25
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Zucchetti M, Bombarda F, Coppi B, Hartwig ZS. Compact Tokamak Neutron Sources as a First Step Towards Hybrid Fission-Fusion Reactors. Fusion Science and Technology 2017. [DOI: 10.13182/fst13-a19141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- M. Zucchetti
- Politecnico di Torino, Corso Duca degli Abruzzi 24, Torino, Italy
- Massachusetts Institute of Technology, MIT, 77 Mass Ave, Cambridge (MA), USA
| | | | - B. Coppi
- Massachusetts Institute of Technology, MIT, 77 Mass Ave, Cambridge (MA), USA
| | - Z. S. Hartwig
- Massachusetts Institute of Technology, MIT, 77 Mass Ave, Cambridge (MA), USA
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26
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Affiliation(s)
| | | | - A. Ying
- University of California Los Angeles, Los Angeles
| | - M. Abdou
- University of California Los Angeles, Los Angeles
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27
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Franza F, Ciampichetti A, Ricapito I, Zucchetti M. Sensitivity Study for Tritium Permeation in Helium-Cooled Lead-Lithium DEMO Blanket with the FUS-TPC Code. Fusion Science and Technology 2017. [DOI: 10.13182/fst13-a19162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- F. Franza
- Karlsruhe Institute of Technology, Eggenstein-Leopoldshafen, 76344, Germany
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28
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Affiliation(s)
- L. El-Guebaly
- University of Wisconsin, 1500 Engineering Dr., Madison, WI 53706, USA,
| | - M. Zucchetti
- Politecnico di Torino, Corso Duca degli Abruzzi 24 - 10129 Torino, Italy,
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29
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Casella M, Dello Russo A, Pelargonio G, Del Greco M, Zingarini G, Piacenti M, Di Cori A, Casula V, Marini M, Pizzamiglio F, Zucchetti M, Riva S, Russo E, Narducci ML, Soldati E, Panchetti L, Startari U, Bencardino G, Perna F, Santangeli P, Di Biase L, Cichocki F, Fattore G, Bongiorni M, Picano E, Natale A, Tondo C. Near zerO fluoroscopic exPosure during catheter ablAtion of supRavenTricular arrhYthmias: the NO-PARTY multicentre randomized trial. Europace 2016; 18:1565-1572. [PMID: 26559916 PMCID: PMC5072134 DOI: 10.1093/europace/euv344] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/13/2015] [Indexed: 11/17/2022] Open
Abstract
AIMS Aim of this study was to compare a minimally fluoroscopic radiofrequency catheter ablation with conventional fluoroscopy-guided ablation for supraventricular tachycardias (SVTs) in terms of ionizing radiation exposure for patient and operator and to estimate patients' lifetime attributable risks associated with such exposure. METHODS AND RESULTS We performed a prospective, multicentre, randomized controlled trial in six electrophysiology (EP) laboratories in Italy. A total of 262 patients undergoing EP studies for SVT were randomized to perform a minimally fluoroscopic approach (MFA) procedure with the EnSiteTMNavXTM navigation system or a conventional approach (ConvA) procedure. The MFA was associated with a significant reduction in patients' radiation dose (0 mSv, iqr 0-0.08 vs. 8.87 mSv, iqr 3.67-22.01; P < 0.00001), total fluoroscopy time (0 s, iqr 0-12 vs. 859 s, iqr 545-1346; P < 0.00001), and operator radiation dose (1.55 vs. 25.33 µS per procedure; P < 0.001). In the MFA group, X-ray was not used at all in 72% (96/134) of cases. The acute success and complication rates were not different between the two groups (P = ns). The reduction in patients' exposure shows a 96% reduction in the estimated risks of cancer incidence and mortality and an important reduction in estimated years of life lost and years of life affected. Based on economic considerations, the benefits of MFA for patients and professionals are likely to justify its additional costs. CONCLUSION This is the first multicentre randomized trial showing that a MFA in the ablation of SVTs dramatically reduces patients' exposure, risks of cancer incidence and mortality, and years of life affected and lost, keeping safety and efficacy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01132274.
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Affiliation(s)
- Michela Casella
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| | - Antonio Dello Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| | | | | | - Gianluca Zingarini
- Ospedale Santa Maria della Misericordia, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Marcello Piacenti
- CNR, Institute of Clinical Physiology, Fondazione G. Monasterio, Pisa, Italy
| | - Andrea Di Cori
- Second Division of Cardiovascular Diseases, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Victor Casula
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Radiology, University of Oulu, Oulu, Finland
| | | | - Francesca Pizzamiglio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| | - Martina Zucchetti
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| | - Stefania Riva
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| | - Eleonora Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| | | | - Ezio Soldati
- Second Division of Cardiovascular Diseases, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Luca Panchetti
- CNR, Institute of Clinical Physiology, Fondazione G. Monasterio, Pisa, Italy
| | - Umberto Startari
- CNR, Institute of Clinical Physiology, Fondazione G. Monasterio, Pisa, Italy
| | | | | | - Pasquale Santangeli
- Texas Cardiac Arrhythmia Institute at St Davis Medical Center, Austin, TX, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute at St Davis Medical Center, Austin, TX, USA
| | | | - Giovanni Fattore
- Department of Policy Analysis and Public Management and CERGAS, Università Bocconi, Milan, Italy
| | - Mariagrazia Bongiorni
- Second Division of Cardiovascular Diseases, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St Davis Medical Center, Austin, TX, USA
| | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
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Fassini G, Conti S, Moltrasio M, Maltagliati A, Tundo F, Riva S, Dello Russo A, Casella M, Majocchi B, Zucchetti M, Russo E, Marino V, Pepi M, Tondo C. Concomitant cryoballoon ablation and percutaneous closure of left atrial appendage in patients with atrial fibrillation. Europace 2016; 18:1705-1710. [PMID: 27402623 DOI: 10.1093/europace/euw007] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/04/2016] [Indexed: 11/14/2022] Open
Abstract
AIMS Pulmonary veins (PVs) isolation is the cornerstone of atrial fibrillation (AF) ablation and can be achieved either by conventional radiofrequency ablation or by cryoenergy. Left atrial appendage (LAA) closure has been proposed as alternative treatment to vitamin K antagonists (VKA). We aimed to evaluate the feasibility of combining cryoballoon (CB) ablation and LAA occlusion in patients with AF and a high thromboembolic risk or contraindication to antithrombotic therapy. METHODS AND RESULTS Thirty-five patients (28 males, 74 ± 2 years) underwent CB ablation. Left atrial appendage occlusion was carried out by using two occluder devices (Amplatz Cardiac Plug, ACP, St. Jude Medical, MN, USA, in 25 patients; Watchman, Boston Scientific, MA, USA, in 10 patients). Thirty patients (86%) had previous stroke/TIA episodes, 6 patients (17%) had major bleeding while on VKA therapy, and 7 patients (20%) had inherited bleeding disorders. Over the follow-up (24 ± 12 months), atrial arrhythmias recurred in 10 (28%) patients. Thirty patients (86%) had complete sealing; 5 patients (14%) showed a residual flow (<5 mm) at first transoesophageal echocardiography (TEE) check, while at 1-year TEE residual flow was detected in 3 patients. In 13 patients (37%), VKA therapy was immediately discontinued. Six patients (17%) received novel oral anticoagulants treatment and then discontinued 3 months thereafter. No device-related complications or clinical thromboembolic events occurred. CONCLUSION Combined CB ablation and LAA closure using different devices appears to be feasible in patients with non-valvular AF associated with high risk of stroke or contraindication to antithrombotic treatment.
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Affiliation(s)
- Gaetano Fassini
- Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy
| | - Sergio Conti
- Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy
| | - Massimo Moltrasio
- Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy
| | - Anna Maltagliati
- Imaging Department, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy
| | - Fabrizio Tundo
- Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy
| | - Stefania Riva
- Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy
| | - Antonio Dello Russo
- Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy
| | - Michela Casella
- Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy
| | - Benedetta Majocchi
- Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy
| | - Martina Zucchetti
- Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy
| | - Eleonora Russo
- Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy
| | - Vittoria Marino
- Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy
| | - Mauro Pepi
- Imaging Department, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy
| | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy
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Affiliation(s)
- M. Zucchetti
- Politecnico di Torino, Corso Duca degli Abruzzi 24 - 10129 Torino, Italy
- MIT – Massachusetts Institute of Technology, Cambridge (MA), US
| | - M. Riva
- Politecnico di Torino, Corso Duca degli Abruzzi 24 - 10129 Torino, Italy
| | - B. Coppi
- MIT – Massachusetts Institute of Technology, Cambridge (MA), US
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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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Zucchetti M, Casella M, Russo AD, Fassini G, Carbucicchio C, Russo E, Marino V, Catto V, Tondo C. Difficult case of a trans-septal puncture: Use of a “SafeSept” guidewire. World J Cardiol 2015; 7:499-503. [PMID: 26322190 PMCID: PMC4549784 DOI: 10.4330/wjc.v7.i8.499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/20/2015] [Accepted: 06/11/2015] [Indexed: 02/06/2023] Open
Abstract
A 69-year-old man was admitted to our center to undergo catheter ablation of paroxysmal atrial fibrillation refractory to antiarrhythmic drug therapy. This procedure required access to the left atrium through the interatrial septum. During hospitalization, the patient performed routinely pre-procedure transthoracic echocardiography and gadolinium-enhanced cardiac magnetic resonance showing a normal anatomy of both the fossa ovalis and the interatrial septum. Access to the left atrium proved difficult and several unsuccessful attempts to perform the trans-septal puncture were made under both fluoroscopy and intracardiac echocardiography guidance, even with radiofrequency energy delivery. Finally, trans-septal puncture was successfully carried out using a novel nitinol J-shaped “SafeSept” trans-septal guidewire, designed to cross the interatrial septum through the trans-septal needle thanks to a special sharp tip. Moreover, thanks to its rounded J shape that reduces the risk of atrial perforation, the “SafeSept” guidewire, when advanced into the left atrium, becomes atraumatic.
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Tondo C, Carbucicchio C, Dello Russo A, Majocchi B, Zucchetti M, Pizzamiglio F, Bologna F, Cattaneo F, Colombo D, Russo E, Casella M. Idiopathic Ventricular Tachycardia: Transcatheter Ablation or Antiarrhythmic Drugs? J Atr Fibrillation 2015; 7:1164. [PMID: 27957145 DOI: 10.4022/jafib.1164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 01/21/2015] [Accepted: 03/06/2015] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Ventricular tachycardia or frequent premature ventricular contractions (PVCs) can occur in the absence of any detectable structural heart disease. In this clinical setting, these arrhythmias are termed idiopathic. Usually, they carry a benign prognosis and any potential ablative intervention is carried out if patients are highly symptomatic or, more importantly, if frequent ventricular arrhythmias can lead to ventricular dysfunction. METHODS In this paper, different forms of idiopathic ventricular tachycardia are reviewed. Outflow tract ventricular tachycardia from the right ventricle is the most frequent form of the so-called idiopathic ventricular tachycardia. Other forms of idiopathic ventricular arrhythmias include ventricular tachycardia/PVCs arising from tricuspid annulus, from the mitral annulus, inter-fascicular ventricular tachycardia and papillary muscle ventricular tachycardia. When interventional treatment is deemed necessary, detailed mapping ( earliest activation during VT/PVC, pace mapping ) is crucial as to identify the successful ablation site. Catheter ablation more than antiarrhythmic drug treatment is usually highly effective in eliminating idiopathic ventricular arrhythmias and providing prevention of recurrence. CONCLUSIONS Idiopathic VTs are not considered life-threatening arrhythmias and, prevention of recurrences is often achieved by means of catheter ablation that provides an improvement of quality of life. The overall acute success rate of catheter ablation is about 85-90% with a long-term prevention of arrhythmia recurrence of about 75-80%. It is advisable that the procedure is carried out by electrophysiologists with expertise in VT catheter ablation and extensive knowledge of cardiac anatomy as to ensure a high success rate and reduce the likelihood of major complications.
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Affiliation(s)
- Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | - Corrado Carbucicchio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | - Antonio Dello Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | - Benedetta Majocchi
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | - Martina Zucchetti
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | - Francesca Pizzamiglio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | - Fabrizio Bologna
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | - Fabio Cattaneo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | - Daniele Colombo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | - Eleonora Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | - Michela Casella
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
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Soria JC, DeBraud F, Bahleda R, Adamo B, Andre F, Dienstmann R, Delmonte A, Cereda R, Isaacson J, Litten J, Allen A, Dubois F, Saba C, Robert R, D'Incalci M, Zucchetti M, Camboni MG, Tabernero J. Corrections to "Phase I/IIa study evaluating the safety, efficacy, pharmacokinetics, and pharmacodynamics of lucitanib in advanced solid tumors". Ann Oncol 2015; 26:445. [PMID: 32590894 DOI: 10.1093/annonc/mdu547] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J-C Soria
- Department of Drug Development, Gustave-Roussy Cancer Campus, Villejuif, France
| | - F DeBraud
- European Institute of Oncology, Milan, Italy
| | - R Bahleda
- Department of Drug Development, Gustave-Roussy Cancer Campus, Villejuif, France
| | - B Adamo
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F Andre
- Department of Drug Development, Gustave-Roussy Cancer Campus, Villejuif, France
| | - R Dienstmann
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain; Sage Bionetworks, Fred Hutchinson Cancer Research Center, Seattle
| | - A Delmonte
- European Institute of Oncology, Milan, Italy
| | - R Cereda
- Clovis Oncology, Inc., San Francisco; Clovis Oncology, Inc., Boulder, USA; Clovis Oncology, Inc., Milan, Italy
| | - J Isaacson
- Clovis Oncology, Inc., San Francisco; Clovis Oncology, Inc., Boulder, USA; Clovis Oncology, Inc., Milan, Italy
| | - J Litten
- Clovis Oncology, Inc., San Francisco; Clovis Oncology, Inc., Boulder, USA; Clovis Oncology, Inc., Milan, Italy
| | - A Allen
- Clovis Oncology, Inc., San Francisco; Clovis Oncology, Inc., Boulder, USA; Clovis Oncology, Inc., Milan, Italy
| | - F Dubois
- Institut de Recherche International Servier, Suresnes, France
| | - C Saba
- Institut de Recherche International Servier, Suresnes, France
| | - R Robert
- Institut de Recherche International Servier, Suresnes, France
| | - M D'Incalci
- Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa, Milan, Italy
| | - M Zucchetti
- Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa, Milan, Italy
| | - M G Camboni
- Clovis Oncology, Inc., San Francisco; Clovis Oncology, Inc., Boulder, USA; Clovis Oncology, Inc., Milan, Italy
| | - J Tabernero
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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Lin T, Conti S, Cipolletta L, Marino V, Zucchetti M, Russo E, Pizzamiglio F, AlMohani G, Pala S, Catto V, Biase LD, Natale A, Tondo C, Carbucicchio C. Right Ventricular Outflow Tract Arrhythmias: Benign Or Early Stage Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia? J Atr Fibrillation 2014; 7:1161. [PMID: 27957137 DOI: 10.4022/jafib.1161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 10/24/2014] [Accepted: 10/24/2014] [Indexed: 01/01/2023]
Abstract
Ventricular arrhythmias (VAs) arising from the right ventricular outflow tract (RVOT) are a common and heterogeneous entity. Idiopathic right ventricular arrhythmias (IdioVAs) are generally benign, with excellent ablation outcomes and long-term arrhythmia-free survival, and must be distinguished from other conditions associated with VAs arising from the right ventricle: the differential diagnosis with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is therefore crucial because VAs are one of the most important causes of sudden cardiac death (SCD) in young individuals even with early stage of the disease. Radiofrequency catheter ablation (RFCA) is a current option for the treatment of VAs but important differences must be considered in terms of indication, purposes and procedural strategies in the treatment of the two conditions. In this review, we comprehensively discuss clinical and electrophysiological features, diagnostic and therapeutic techniques in a compared analysis of these two entities.
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Affiliation(s)
- Tina Lin
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Sergio Conti
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Cipolletta
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Vittoria Marino
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Martina Zucchetti
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Eleonora Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Ghaliah AlMohani
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Salvatore Pala
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Valentina Catto
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Luigi Di Biase
- Texas Cardiac Arrhytmia Institute at St David's Medical Centre, Austin , TX, USA; Texas Cardiac Arrhytmia Institute at St David's Medical Centre, Austin , TX, USA; Texas Cardiac Arrhytmia Institute at St David's Medical Centre, Austin , TX, USA; Texas Cardiac Arrhytmia Institute at St David's Medical Centre, Austin , TX, USA
| | - Andrea Natale
- Texas Cardiac Arrhytmia Institute at St David's Medical Centre, Austin , TX, USA; Texas Cardiac Arrhytmia Institute at St David's Medical Centre, Austin , TX, USA; Texas Cardiac Arrhytmia Institute at St David's Medical Centre, Austin , TX, USA; Texas Cardiac Arrhytmia Institute at St David's Medical Centre, Austin , TX, USA; Texas Cardiac Arrhytmia Institute at St David's Medical Centre, Austin , TX, USA
| | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Corrado Carbucicchio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
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Dello Russo A, Conti S, Al-Mohani G, Casella M, Pizzamiglio F, Carbucicchio C, Riva S, Fassini G, Moltrasio M, Tundo F, Zucchetti M, Majocchi B, Russo E, Marino V, Bologna F, Biase LD, Natale A, Tondo C. New Imaging Technologies To Characterize Arrhythmic Substrate. J Atr Fibrillation 2014; 7:1137. [PMID: 27957131 DOI: 10.4022/jafib.1137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/09/2014] [Accepted: 10/27/2014] [Indexed: 11/10/2022]
Abstract
The cornerstone of the new imaging technologies to treat complex arrhythmias is the electroanatomic (EAM) mapping. It is based on tissue characterization and in particular on determination of low potential region and dense scar definition. Recently, the identification of fractionated isolated late potentials increased the specificity of the information derived from EAM. In addition, non-invasive tools and their integration with EAM, such as cardiac magnetic resonance imaging and computed tomography scanning, have been shown to be helpful to characterize the arrhythmic substrate and to guide the mapping and the ablation. Finally, intracardiac echocardiography, known to be useful for several practical uses in the setting of electrophysiological procedures, it has been also demonstrated to provide important informations about the anatomical substrate and may have potential to identify areas of scarred myocardium.
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Affiliation(s)
- Antonio Dello Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Sergio Conti
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Ghaliah Al-Mohani
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Michela Casella
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Francesca Pizzamiglio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Corrado Carbucicchio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Stefania Riva
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Gaetano Fassini
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Massimo Moltrasio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Fabrizio Tundo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Martina Zucchetti
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Benedetta Majocchi
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Eleonora Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Vittoria Marino
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Fabrizio Bologna
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Luigi Di Biase
- St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Andrea Natale
- St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
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Soria JC, DeBraud F, Bahleda R, Adamo B, Andre F, Dientsmann R, Delmonte A, Cereda R, Isaacson J, Litten J, Allen A, Dubois F, Saba C, Robert R, D'Incalci M, Zucchetti M, Camboni MG, Tabernero J. Phase I/IIa study evaluating the safety, efficacy, pharmacokinetics, and pharmacodynamics of lucitanib in advanced solid tumors. Ann Oncol 2014; 25:2244-2251. [PMID: 25193991 DOI: 10.1093/annonc/mdu390] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Lucitanib is a potent, oral inhibitor fibroblast growth factor receptor types 1 and 2 (FGFR), vascular endothelial growth factor receptor types 1, 2, and 3 (VEGFR), platelet-derived growth factor receptor types α and β (PGFRα/β), which are essential kinases for tumor growth, survival, migration, and angiogenesis. Several tumor types, including breast carcinoma, demonstrate amplification of fibroblast growth factor (FGF)-related genes. There are no approved drugs for molecularly defined FGF-aberrant (FGFR1- or FGF3/4/19-amplified) tumors. METHODS This open-label phase I/IIa study involved a dose-escalation phase to determine maximum tolerated dose (MTD), recommended dose (RD), and pharmacokinetics of lucitanib in patients with advanced solid tumors, followed by a dose-expansion phase to obtain preliminary evidence of efficacy in patients who could potentially benefit from treatment (i.e. with tumors harboring FGF-aberrant pathway or considered angiogenesis-sensitive). RESULTS Doses from 5 to 30 mg were evaluated with dose-limiting toxic effects dominated by vascular endothelial growth factor (VEGF) inhibition-related toxic effects at the 30 mg dose level (one case of grade 4 depressed level of consciousness and two cases of grade 3 thrombotic microangiopathy). The most common adverse events (all grades, all cohorts) were hypertension (91%), asthenia (42%), and proteinuria (57%). Exposure increased with dose and t½ was 31-40 h, suitable for once daily administration. Seventy-six patients were included. All but one had stage IV; 42% had >3 lines of previous chemotherapy. Sixty-four patients were assessable for response; 58 had measurable disease. Clinical activity was observed at all doses tested with durable Response Evaluation Criteria In Solid Tumors (RECIST) partial responses in a variety of tumor types. In the angiogenesis-sensitive group, objective RECIST response rate (complete response + partial response) was 26% (7 of 27) and progression-free survival (PFS) was 25 weeks. In assessable FGF-aberrant breast cancer patients, 50% (6 of 12) achieved RECIST partial response with a median PFS of 40.4 weeks for all treated patients. CONCLUSION Lucitanib has promising efficacy and a manageable side-effect profile. The spectrum of activity observed demonstrates clinical benefit in both FGF-aberrant and angiogenesis-sensitive populations. A comprehensive phase II program is planned.
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Affiliation(s)
- J-C Soria
- Department of Drug Development, Gustave-Roussy Cancer Campus, Villejuif, France.
| | - F DeBraud
- European Institute of Oncology, Milan, Italy
| | - R Bahleda
- Department of Drug Development, Gustave-Roussy Cancer Campus, Villejuif, France
| | - B Adamo
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F Andre
- Department of Drug Development, Gustave-Roussy Cancer Campus, Villejuif, France
| | - R Dientsmann
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain; Sage Bionetworks, Fred Hutchinson Cancer Research Center, Seattle
| | - A Delmonte
- European Institute of Oncology, Milan, Italy
| | - R Cereda
- Clovis Oncology, Inc., San Francisco; Clovis Oncology, Inc., Boulder,USA; Clovis Oncology, Inc., Milan, Italy
| | - J Isaacson
- Clovis Oncology, Inc., San Francisco; Clovis Oncology, Inc., Boulder,USA; Clovis Oncology, Inc., Milan, Italy
| | - J Litten
- Clovis Oncology, Inc., San Francisco; Clovis Oncology, Inc., Boulder,USA; Clovis Oncology, Inc., Milan, Italy
| | - A Allen
- Clovis Oncology, Inc., San Francisco; Clovis Oncology, Inc., Boulder,USA; Clovis Oncology, Inc., Milan, Italy
| | - F Dubois
- Institut de Recherche International Servier, Suresnes, France
| | - C Saba
- Institut de Recherche International Servier, Suresnes, France
| | - R Robert
- Institut de Recherche International Servier, Suresnes, France
| | - M D'Incalci
- Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa, Milan, Italy
| | - M Zucchetti
- Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa, Milan, Italy
| | - M G Camboni
- Clovis Oncology, Inc., San Francisco; Clovis Oncology, Inc., Boulder,USA; Clovis Oncology, Inc., Milan, Italy
| | - J Tabernero
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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39
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Casella M, Russo E, Pizzamiglio F, Conti S, Al-Mohani G, Colombo D, Casula V, D Alessandra Y, Biagioli V, Carbucicchio C, Riva S, Fassini G, Moltrasio M, Tundo F, Zucchetti M, Majocchi B, Marino V, Forleo G, Santangeli P, Di Biase L, Dello Russo A, Natale A, Tondo C. The Growing Culture Of A Minimally Fluoroscopic Approach In Electrophysiology Lab. J Atr Fibrillation 2014; 7:1104. [PMID: 27957101 DOI: 10.4022/jafib.1104] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 11/10/2022]
Abstract
Most of interventional procedures in cardiology are carried out under fluoroscopic imaging guidance. Besides other peri-interventional risks, radiation exposure should be considered for its stochastic (inducing malignancy) and deterministic effects on health (tissue reactions like erythema, hair loss and cataracts). In this article we analized the radiation risk from cardiovascular imaging to both patients and medical staff and discusses how customize the X-ray system and how to implement shielding measures in the cath lab. Finally, we reviewed the most recent developments and the latest findings in catheter navigation and 3D electronatomical mapping systems that may help to reduce patient and operator exposure.
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Affiliation(s)
- Michela Casella
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Eleonora Russo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | | | - Sergio Conti
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Ghaliah Al-Mohani
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Daniele Colombo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Victor Casula
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu
| | - Yuri D Alessandra
- Laboratory of immunology and functional genomics, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Viviana Biagioli
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Corrado Carbucicchio
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Stefania Riva
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Gaetano Fassini
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Massimo Moltrasio
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Fabrizio Tundo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Martina Zucchetti
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Benedetta Majocchi
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Vittoria Marino
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Giovanni Forleo
- Division of Cardiology, Policlinico Tor Vergata, Rome, Italy
| | - Pasquale Santangeli
- Cardiac Arrhythmia Service, Stanford University School of Medicine, 300 Pasteur Drive H 2146, Stanford, CA, 94305, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute at St David?s Medical Center, Austin, TX, USA
| | - Antonio Dello Russo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Andrea Natale
- Cardiac Arrhythmia Service, Stanford University School of Medicine, 300 Pasteur Drive H 2146, Stanford, CA, 94305, USA
| | - Claudio Tondo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
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40
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Cesca M, Morosi L, Zucchetti M, Frapolli R, Giordano S, Richter P, Dirsch O, Bernd A, Giavazzi R. 671: Inhibition of angiogenesis promotes a homogeneous intra-tumor distribution of chemotherapy associated with better antitumor response. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)50591-6] [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: 10/25/2022]
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41
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Dello Russo A, Fassini G, Casella M, Bologna F, Al-Nono O, Colombo D, Biagioli V, Santangeli P, Di Biase L, Zucchetti M, Majocchi B, Marino V, Gallinghouse JJ, Natale A, Tondo C. Simultaneous assessment of contact pressure and local electrical coupling index using robotic navigation. J Interv Card Electrophysiol 2014; 40:23-31. [DOI: 10.1007/s10840-014-9882-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/29/2014] [Indexed: 11/29/2022]
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42
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Franza F, Boccaccini L, Ciampichetti A, Zucchetti M. Tritium transport analysis in HCPB DEMO blanket with the FUS-TPC code. Fusion Engineering and Design 2013. [DOI: 10.1016/j.fusengdes.2013.05.045] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zucchetti M, Di Pace L, El-Guebaly L, Han JH, Kolbasov B, Massaut V, Someya Y, Tobita K, Desecures M. Recent advances in fusion radioactive material studies. Fusion Engineering and Design 2013. [DOI: 10.1016/j.fusengdes.2013.02.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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44
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Carbucicchio C, Ahmad Raja N, Di Biase L, Volpe V, Dello Russo A, Trivedi C, Bartoletti S, Zucchetti M, Casella M, Russo E, Santangeli P, Moltrasio M, Tundo F, Fassini G, Natale A, Tondo C. High-density substrate-guided ventricular tachycardia ablation: role of activation mapping in an attempt to improve procedural effectiveness. Heart Rhythm 2013; 10:1850-8. [PMID: 24055940 DOI: 10.1016/j.hrthm.2013.09.059] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 07/17/2013] [Indexed: 01/29/2023]
Abstract
BACKGROUND Advanced techniques of electroanatomical mapping efficiently guide ventricular tachycardia (VT) ablation strategies; in this context, the adjunctive value of combining activation mapping (AMap) to improve accuracy has not been elucidated. OBJECTIVE To investigate whether conventional AMap further contributes to the identification of critical sites of VT reentry and whether this translates into a more effective ablation outcome in a cohort of patients undergoing VT ablation. METHODS We prospectively enrolled 126 patients (mean age 65.3 ± 10.5 years; left ventricular ejection fraction 33.3% ± 7.2%) with ischemic (n = 89) or idiopathic (n = 37) dilated cardiomyopathy undergoing endocardial (n = 105) or endo-epicardial (n = 21) electroanatomical mapping and ablation. A substrate-guided strategy targeting surrogate markers of reentry was accomplished in all patients, but the feasibility and efficacy of AMap was preliminarily assessed for all induced VTs focusing on early VT suppression obtained during radiofrequency delivery. VT-free survival was assessed by ICD interrogation. RESULTS AMap successfully guided ablation in 62 of 104 (59.6%) patients with inducible VT(s). At 1 year, 6 of 126 (4.8%) patients died; VT recurred in 28 of 126 (22.2%) patients. No significant difference in VT recurrence rate was observed between patients in whom AMap proved effective versus those in whom substrate-guided ablation was not corroborated by AMap (16 of 62 [25.8%] vs 12 of 64 [18.8%]; log-rank test, P = .3). CONCLUSIONS Our findings support the efficacy of a substrate-guided strategy targeting specific markers of arrhythmogenicity identified during sinus rhythm. AMap proves highly efficient acutely but does not improve overall VT-free survival, suggesting that in patients with advanced cardiac disease, life-threatening arrhythmias can be successfully treated by ablation in sinus rhythm, thus limiting procedural risks.
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Affiliation(s)
- Corrado Carbucicchio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
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45
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Dello Russo A, Russo E, Fassini G, Casella M, Innocenti E, Zucchetti M, Cefalu C, Solimene F, Mottola G, Colombo D, Bologna F, Majocchi B, Santangeli P, Riva S, Di Biase L, Fiorentini C, Tondo C. Role of Intracardiac echocardiography in Atrial Fibrillation Ablation. J Atr Fibrillation 2013; 5:786. [PMID: 28496830 DOI: 10.4022/jafib.786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 02/27/2013] [Accepted: 03/04/2013] [Indexed: 12/18/2022]
Abstract
In the recent years, several new evidences support catheter-based ablation as a treatment modality of atrial fibrillation (AF). Based on a plenty of different applications, intracardiac echocardiography (ICE) is now a well-established technology in complex electrophysiological procedures, in particular in AF ablation. ICE contributes to improve the efficacy and safety of such procedures defining the anatomical structures involved in ablation procedures and monitoring in real time possible complications. In particular ICE allows: a correct identification of the endocardial structures; a guidance of transseptal puncture; an assessment of accurate placement of the circular mapping catheter; an indirect evaluation of evolving lesions during radiofrequency (RF) energy delivery via visualization of micro and macrobubbles tissue heating; assessment of catheter contact with cardiac tissues. Recently, also the feasibility of the integration of electroanatomical mapping (EAM) and intracardiac echocardiography has been demonstrated, combining accurate real time anatomical information with electroanatomical data. As a matter of fact, different techniques and ablation strategies have been developed throughout the years. In the setting of balloon-based ablation systems, recently adopted by an increasing number of centers, ICE might have a role in the choice of appropriate balloon size and to confirm accurate occlusion of pulmonary veins. Furthermore, in the era of minimally fluoroscopic ablation, ICE has successfully provided a contribute in reducing fluoroscopy time. The purpose of this review is to summarize the current applications of ICE in catheter based ablation strategies of atrial fibrillation, focusing-on electronically phased-array ICE.
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Affiliation(s)
- Antonio Dello Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Eleonora Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gaetano Fassini
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Michela Casella
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Ester Innocenti
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Martina Zucchetti
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Claudia Cefalu
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | - Daniele Colombo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Fabrizio Bologna
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Benedetta Majocchi
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Stefania Riva
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Cesare Fiorentini
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
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46
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Di Biase L, Santangeli P, Burkhardt DJ, Bai R, Mohanty P, Carbucicchio C, Dello Russo A, Casella M, Mohanty S, Pump A, Hongo R, Beheiry S, Pelargonio G, Santarelli P, Zucchetti M, Horton R, Sanchez JE, Elayi CS, Lakkireddy D, Tondo C, Natale A. Endo-epicardial homogenization of the scar versus limited substrate ablation for the treatment of electrical storms in patients with ischemic cardiomyopathy. J Am Coll Cardiol 2012; 60:132-41. [PMID: 22766340 DOI: 10.1016/j.jacc.2012.03.044] [Citation(s) in RCA: 314] [Impact Index Per Article: 26.2] [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: 10/31/2011] [Revised: 02/27/2012] [Accepted: 03/12/2012] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This study investigated the impact on recurrences of 2 different substrate approaches for the treatment of these arrhythmias. BACKGROUND Catheter ablation of electrical storms (ES) for ventricular arrhythmias (VAs) has shown moderate long-term efficacy in patients with ischemic cardiomyopathy. METHODS Ninety-two consecutive patients (81% male, age 62 ± 13 years) with ischemic cardiomyopathy and ES underwent catheter ablation. Patients were treated either by confining the radiofrequency lesions to the endocardial surface with limited substrate ablation (Group 1, n = 49) or underwent endocardial and epicardial ablation of abnormal potentials within the scar (homogenization of the scar, Group 2, n = 43). Epicardial access was obtained in all Group 2 patients, whereas epicardial ablation was performed in 33% (14) of these patients. RESULTS Mean ejection fraction was 27 ± 5. During a mean follow-up of 25 ± 10 months, the VAs recurrence rate of any ventricular tachycardia (VTs) was 47% (23 of 49 patients) in Group 1 and 19% (8 of 43 patients) in Group 2 (log-rank p = 0.006). One patient in Group 1 and 1 patient in Group 2 died at follow-up for noncardiac reasons. CONCLUSIONS Our study demonstrates that ablation using endo-epicardial homogenization of the scar significantly increases freedom from VAs in ischemic cardiomyopathy patients.
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Affiliation(s)
- Luigi Di Biase
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX 78705, USA
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47
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Russo AD, Casella M, Pieroni M, Pelargonio G, Bartoletti S, Santangeli P, Zucchetti M, Innocenti E, Di Biase L, Carbucicchio C, Bellocci F, Fiorentini C, Natale A, Tondo C. Drug-Refractory Ventricular Tachycardias After Myocarditis. Circ Arrhythm Electrophysiol 2012; 5:492-8. [DOI: 10.1161/circep.111.965012] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [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: 12/27/2022]
Abstract
Background—
Ventricular tachycardia (VT) is a significant therapeutic challenge in patients with myocarditis. This study aimed to assess the efficacy and safety of radiofrequency catheter ablation (RFCA) of VT in patients with myocarditis.
Methods and Results—
We enrolled 20 patients (15 men; age, 42 [28–52] years) with a history of biopsy-proven viral myocarditis and drug-refractory VT; 5 patients presented with electrical storm. The median left ventricular ejection fraction was 55% (45–60%). All patients underwent endocardial RFCA with an irrigated catheter, using contact electroanatomic mapping. Recurrence of sustained VT after endocardial RFCA was treated with additional epicardial RFCA. Endocardial RFCA was acutely successful in 14 patients (70%) while in the remaining 6 (30%) clinical VT was successfully ablated by epicardial RFCA. In 1 patient, hemodynamic instability required an intra-aortic balloon pump to complete RFCA. No major complication occurred during or after RFCA. Over a median follow-up time of 28 (11–48) months, 18 patients (90%) remained free of sustained VT; 2 patients (10%, both with baseline left ventricular ejection fraction ≤35%) died of acute heart failure unrelated to ventricular arrhythmias.
Conclusions—
In patients with myocarditis, RFCA of drug-refractory VT is feasible, safe, and effective. Epicardial RFCA should be considered as an important therapeutic option to increase success rate.
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Affiliation(s)
- Antonio Dello Russo
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Michela Casella
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Maurizio Pieroni
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Gemma Pelargonio
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Stefano Bartoletti
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Pasquale Santangeli
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Martina Zucchetti
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Ester Innocenti
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Luigi Di Biase
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Corrado Carbucicchio
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Fulvio Bellocci
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Cesare Fiorentini
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Andrea Natale
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
| | - Claudio Tondo
- From the Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy (A.D.R., M.C., S.B., M.Z., E.I., C.C., C.F., C.T.); the Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy (M.P., G.P., F.B.); Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX (P.S., L.D.B., A.N.); University of Foggia, Foggia, Italy (L.D.B.); the Department of Biomedical Engineering, University of Texas, Austin, TX (L.D.B., A.N.); and the
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Santangeli P, Dello Russo A, Pieroni M, Casella M, Di Biase L, Burkhardt JD, Sanchez J, Lakkireddy D, Carbucicchio C, Zucchetti M, Pelargonio G, Themistoclakis S, Camporeale A, Rossillo A, Beheiry S, Hongo R, Bellocci F, Tondo C, Natale A. Fragmented and delayed electrograms within fibrofatty scar predict arrhythmic events in arrhythmogenic right ventricular cardiomyopathy: results from a prospective risk stratification study. Heart Rhythm 2012; 9:1200-6. [PMID: 22465294 DOI: 10.1016/j.hrthm.2012.03.057] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [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: 12/30/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Islets of myocytes within fibrofatty scars represent the substrate for reentrant ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy (ARVC). Electroanatomic mapping can reliably identify such areas. OBJECTIVE To prospectively test the association between late and fragmented electrograms within scar and arrhythmic events in patients with ARVC. METHODS High-density right ventricle electroanatomic mapping was performed in 32 patients with ARVC without history of cardiac arrest or sustained ventricular arrhythmias. Standard definitions of electroanatomic scars and fragmented, isolated, and very late potentials were used. All patients received an implantable cardioverter-defibrillator for the primary prevention of sudden death. RESULTS After a mean follow-up of 25 ± 7 months, 12 (38%) patients received appropriate implantable cardioverter-defibrillator shock for sustained ventricular arrhythmias. With the exception of a higher rate of previous syncope (P = .053), patients with arrhythmic events at follow-up did not differ from those who remained free from arrhythmic events in terms of other clinical variables, including cardiac magnetic resonance findings. Electroanatomic scars were present in all patients. The distribution and extent of electroanatomic scars were similar in the 2 groups (38 ± 25 cm(2) vs 33 ± 20 cm(2); P = .51). However, patients with implantable cardioverter-defibrillator shock had a higher prevalence of fragmented electrograms (92% vs 20%; P <.001), of isolated late potentials (75% vs 20%; P = .004), and of very late potentials (67% vs 25%; P = .030). Fragmented electrograms were the only variable independently associated with arrhythmic events at follow-up (hazard ratio 21; P = .015). CONCLUSION The presence of fragmented and delayed electrograms within the scar predicts arrhythmic events in ARVC.
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Affiliation(s)
- Pasquale Santangeli
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas 78705, USA
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49
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Bombarda F, Coppi B, Franza F, Hartwig ZS, Ramogida G, Zucchetti M. A High Field Tokamak Neutron Source Facility. Fusion Science and Technology 2012. [DOI: 10.13182/fst12-a13403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - B. Coppi
- Massachusetts Institute of Technology, MIT, Cambridge (MA), USA
| | | | - Z. S. Hartwig
- Massachusetts Institute of Technology, MIT, Cambridge (MA), USA
| | | | - M. Zucchetti
- Massachusetts Institute of Technology, MIT, Cambridge (MA), USA
- Politecnico di Torino, Italy,
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Affiliation(s)
- M. Zucchetti
- Politecnico di Torino, Italy,
- Massachusetts Institute of Technology, MIT, Cambridge (MA), USA
| | | | - B. Coppi
- Massachusetts Institute of Technology, MIT, Cambridge (MA), USA
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