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Russo V, Antonini G, Massa R, Casali C, Mauriello A, Martino AM, Marconi R, Garibaldi M, Franciosa P, Zecchin M, Gaudio C, D'Andrea A, Strano S. Comprehensive Cardiovascular Management of Myotonic Dystrophy Type 1 Patients: A Report from the Italian Neuro-Cardiology Network. J Cardiovasc Dev Dis 2024; 11:63. [PMID: 38392277 PMCID: PMC10889677 DOI: 10.3390/jcdd11020063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024] Open
Abstract
Myotonic dystrophy is a hereditary disorder with systemic involvement. The Italian Neuro-Cardiology Network-"Rete delle Neurocardiologie" (INCN-RNC) is a unique collaborative experience involving neurology units combined with cardio-arrhythmology units. The INCN facilitates the creation of integrated neuro-cardiac teams in Neuromuscular Disease Centers for the management of cardiovascular involvement in the treatment of myotonic dystrophy type 1 (MD1).
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Affiliation(s)
- Vincenzo Russo
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli"-"Monaldi" Hospital, 80126 Naples, Italy
| | - Giovanni Antonini
- Neuromuscular Disease Centre, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, "Sant'Andrea" Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Roberto Massa
- Neuromuscular Diseases Unit, Department of Systems Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Carlo Casali
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00196 Rome, Italy
| | - Alfredo Mauriello
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli"-"Monaldi" Hospital, 80126 Naples, Italy
- Department of Cardiology, "Umberto I" Hospital, 84014 Nocera Inferiore, Italy
| | | | - Roberto Marconi
- Unit of Neurology, Cardio-Thoracic-Neuro-Vascular Department, "Misericordia" Hospital, 58100 Grosseto, Italy
| | - Matteo Garibaldi
- Neuromuscular Disease Centre, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, "Sant'Andrea" Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Pasquale Franciosa
- Department of Internal, Anesthesiological and Cardiovascular Clinical Sciences, Sapienza University of Rome, 00196 Rome, Italy
| | - Massimo Zecchin
- Cardiothoracovascular Department, "Cattinara" Hospital, ASUGI and University of Trieste, 34149 Trieste, Italy
| | - Carlo Gaudio
- Department of Internal, Anesthesiological and Cardiovascular Clinical Sciences, Sapienza University of Rome, 00196 Rome, Italy
| | - Antonello D'Andrea
- Department of Cardiology, "Umberto I" Hospital, 84014 Nocera Inferiore, Italy
| | - Stefano Strano
- Department of Internal, Anesthesiological and Cardiovascular Clinical Sciences, Sapienza University of Rome, 00196 Rome, Italy
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Zecchin M, Ciminello E, Mari V, Proclemer A, D'Onofrio A, Zanotto G, De Ponti R, Capovilla TM, Laricchiuta P, Biondi A, Sampaolo L, Pascucci S, Sinagra G, Boriani G, Carrani E, Torre M. A global analysis of implants and replacements of pacemakers and cardioverter-defibrillators before, during, and after the COVID-19 pandemic in Italy. Intern Emerg Med 2024; 19:107-114. [PMID: 37934343 PMCID: PMC10827813 DOI: 10.1007/s11739-023-03450-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/03/2023] [Indexed: 11/08/2023]
Abstract
At the beginning of the COVID-19 emergency, non-urgent surgical procedures had to be deferred, but also emergencies were reduced. To assess the global trend of pacemaker (PM) and implantable cardiac-defibrillator (ICD) procedures performed in Italy before, during, and after the first COVID-19 emergency, all the Italian hospital discharge records related to PM/ICD procedures performed between 2012 and 2021, sent to the National Institute of Health, were reviewed. Compared to 2019, in 2020, there was a reduction of first PM implants (52,216 to 43,962, -16%; p < 0.01), but not replacements (16,591 to 17,331, + 4%; p = 0.16). In particular, in April 2020, there was a drop of first implants (- 53,4% vs the average value of April 2018 and April 2019; p < 0.01), while the reduction of replacements was less evident (-32.6%; p = NS). In 2021, PM procedures increased to values similar to the pre-pandemic period. A reduction of ICD procedures was observed in 2020 (22,355, -7% toward 2019), mainly in April 2020 (- 46% vs April 2018/April 2019; p = 0.03). In 2021, the rate of ICD procedures increased (+ 14% toward 2020). A non-significant reduction of "urgent" procedures (complete atrioventricular block for PM and ventricular fibrillation for ICD), even in April 2020, was observed. In 2020, there was a reduction of first PM implants and ICDs, offset by increased activity in 2021. No decrease in PM replacements was observed, and the drop in "urgent" PM and ICD procedures was not statistically significant.
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Affiliation(s)
- Massimo Zecchin
- Cardiothoracovascular Department, Cattinara Hospital, ASUGI and University of Trieste, Trieste, Italy
| | | | | | | | | | | | | | - Teresa Maria Capovilla
- Cardiothoracovascular Department, Cattinara Hospital, ASUGI and University of Trieste, Trieste, Italy
| | | | | | | | | | - Gianfranco Sinagra
- Cardiothoracovascular Department, Cattinara Hospital, ASUGI and University of Trieste, Trieste, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
| | | | - Marina Torre
- Italian National Institute of Health, Rome, Italy
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Pezzato A, Fabris E, Gregorio C, Cittar M, Contessi S, Carriere C, Lardieri G, Zecchin M, Perkan A, Sinagra G. Implantable-cardioverter-defibrillator after ST-elevation myocardial infarction: when and how frequently is it implanted and what is the rate of appropriate interventions? Insight from Trieste registry. J Cardiovasc Med (Hagerstown) 2023; 24:871-879. [PMID: 37851355 DOI: 10.2459/jcm.0000000000001565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND There are limited data on implantable-cardioverter-defibrillator (ICD) implantation after ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Therefore, we evaluated when and how frequently an ICD is implanted after pPCI, the rate of appropriate ICD interventions, and predictors of ICD implantation. METHODS We analyzed STEMI patients treated with pPCI at the University Hospital of Trieste, Italy, between January 2010 and December 2019. We cross-matched patients' data with those present in the Trieste ICD registry. RESULTS Among 1805 consecutive patients treated with pPCI, 3.6% underwent ICD implantation during a median follow-up of 6.7 [interquartile range (IQR) 4.3-9.2] years. At 12 months, the mean number of ICD implantations was 2.3/100 patients [95% confidence interval (95% CI) 1.7-3.1] and remained stable over time (at 24 months: 2.5/100 patients, 95% CI 2.0-3.5 and at 36 months: 2.6/100 patients, 95% CI 2.3-3.8); 83.1% of ICDs were implanted for primary prevention, and more than half (55%) were implanted in patients with ejection fraction more than 35% at the moment of STEMI discharge. The rate of appropriate ICD interventions was 16.9% at a median follow-up of 5.7 years (IQR 3.3-8.3 years) after ICD implantation. At 12 months, the mean number of appropriate ICD interventions was 5/100 patients and 7/100 patients after 24 months. In patients with ejection fraction more than 35% at STEMI discharge (median ejection fraction 43%; IQR 40-48), independent predictors of ICD implantation were male sex, anterior STEMI and troponin peak more than 100 000 ng/dl. CONCLUSION The rate of ICD implantations after pPCI is low; however, the rate of appropriate ICD interventions is high. A relevant subgroup of patients received ICD implantations at follow-up despite a nonsevere ejection fraction at discharge after STEMI. Among these patients, those with high troponin release deserve strict follow-up and full optimal medical treatment.
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Affiliation(s)
| | | | - Caterina Gregorio
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste
- MOX - Modeling and Scientific Computing Laboratory, Department of Mathematics, Politecnico di Milano, Milan
| | | | | | | | - Gerardina Lardieri
- Emergency Department, Division of Cardiology, Gorizia & Monfalcone Hospital, ASUGI, Trieste, Italy
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Proclemer A, Zecchin M, Zanotto G, Gregori D, De Ponti R, D'Onofrio A. [The Pacemaker and Implantable Cardioverter-Defibrillator Registry of the Italian Association of Arrhythmology and Cardiac Pacing - Report 2022]. G Ital Cardiol (Rome) 2023; 24:844-848. [PMID: 37767838 DOI: 10.1714/4100.40986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND The Pacemaker (PM) and Implantable Cardioverter-Defibrillator (ICD) Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) collects information about demographics, clinical characteristics, main indications for PM/ICD therapy and device types from the voluntary Italian collaborating centers. METHODS For the year 2022 main data about national PM and ICD implantation activity were obtained on the basis of European Cards and subsequently analyzed to create a standard report. RESULTS PM Registry: data about 17 800 PM implantations were collected (14 191 first implants and 3609 replacements). The number of collaborating centers was 152. Median age of treated patients was 81 years (75 quartile I; 86 quartile III). Main ECG indications included atrioventricular conduction disorders in 46.0% of first PM implants, sick sinus syndrome in 17.7%, atrial fibrillation plus bradycardia in 7.7%, other unspecified ECG and electrophysiological abnormalities in 43.0%. For first PM implants, pacing in DDDR mode was reported in 42.2%, followed by DDD mode (20.6%), VVIR mode (25.1%), VVI mode (11.1%) and finally VDD-VDDR (5.1%). Median value of longevity of explanted PMs was 8.3 years. ICD Registry: data about 5210 ICD implantations were obtained (3656 first implants and 1554 replacements). The number of collaborating centers was 301. Median age of treated patients was 72 years (63 quartile I; 79 quartile III). Primary prevention indication was reported in 72.4% of first implants, secondary prevention in 27.6% (cardiac arrest in 4.6% of records). A single-chamber ICD was used in 30.3% of first implants, dual-chamber ICD in 30.0% and biventricular ICD in 39.7%. Median value of longevity of explanted ICDs was 7.0 years. CONCLUSIONS In the calendar year 2022, the Italian PM Registry showed stable electrocardiographic and symptom indications, with an important prevalence of dual-chamber pacing. The ICD Registry documented a large use of prophylactic and biventricular ICDs, reflecting a favorable adherence in clinical practice to trials and guidelines. The ICD longevity and the number of recalls demonstrated a favorable trend.
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Affiliation(s)
| | - Massimo Zecchin
- S.O.C. Cardiologia, Azienda Sanitaria Universitaria Isontino-Giuliana, Trieste
| | | | - Dario Gregori
- Dipartimento di Medicina Ambientale e Salute Pubblica, Università degli Studi, Padova
| | - Roberto De Ponti
- Clinica di Cardiologia, Università dell'Insubria, Ospedale di Circolo, Varese
| | - Antonio D'Onofrio
- U.O.S.D. Aritmologia, A.O.R.N. dei Colli, Ospedale "V. Monaldi", Napoli
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Mangano G, Ceramicola S, Alves TM, Zecchin M, Civile D, Del Ben A, Critelli S. A new large-scale gravitational complex discovered in the Gulf of Squillace (central Mediterranean): tectonic implications. Sci Rep 2023; 13:14695. [PMID: 37679479 PMCID: PMC10485043 DOI: 10.1038/s41598-023-40947-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023] Open
Abstract
Seismic reflection (2D/3D), borehole and bathymetric data are used to recognize a new gravitational complex in the Gulf of Squillace, Southern Italy, named the Squillace Complex. The complex has a NE-striking headwall connected to a basal detachment formed between Messinian evaporites and Tortonian shales. Its sense of movement changes to a W-E direction in the toe region. In plan view, the Squillace Complex is marked by the presence of sinuous and continuous seafloor scarps, just a few kilometers offshore, over an elongated morphological high. Seismic-well ties reveal that the complex was initiated in the Zanclean (~ 4 Ma) and continued its movement into the Gelasian (~ 2.1 Ma) at an average rate of 1.9 mm/year. Movement slowed down in the Calabrian (middle Pleistocene) and continued until the present day at a lower rate of 0.1 mm/year. Gravitational collapse of the Squillace Complex correlates with discrete contractional/transpressional events affecting the Calabrian region, which caused basin shortening and the temporary arrest of Calabrian Arc migration. These episodes resulted in tectonic uplift in the study area after 0.45 Ma (Late Pleistocene). Conversely, the complex's slower movement recorded since the Calabrian (middle Pleistocene) is associated with slab rollback of the Ionian plate under the Calabrian Arc.
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Affiliation(s)
- Giacomo Mangano
- Department of Environmental Engineering, University of Calabria, 87036, Arcavacata di Rende, CS, Italy.
- National Institute of Oceanography and Applied Geophysics - OGS, 34010, Sgonico, TS, Italy.
| | - Silvia Ceramicola
- National Institute of Oceanography and Applied Geophysics - OGS, 34010, Sgonico, TS, Italy
| | - Tiago M Alves
- 3D Seismic Laboratory - School of Earth and Environmental Sciences, Cardiff University, Cardiff, CF10 3AT, UK
| | - Massimo Zecchin
- National Institute of Oceanography and Applied Geophysics - OGS, 34010, Sgonico, TS, Italy
| | - Dario Civile
- National Institute of Oceanography and Applied Geophysics - OGS, 34010, Sgonico, TS, Italy
| | - Anna Del Ben
- Department of Mathematics and Geosciences, University of Trieste, 341227, Trieste, Italy
| | - Salvatore Critelli
- Department of Environmental Engineering, University of Calabria, 87036, Arcavacata di Rende, CS, Italy
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Zecchin M, Trevisan B, Baggio C, Bessi R, Saitta M, Salvatore L, Cappelletto C, Gregorio C, Bianco E, Longaro F, Carriere C, Zorzin-Fantasia A, Piccinin F, Dal Monte G, Sinagra G. Short- and long-term survival in patients over 90 years old undergoing pacemaker implantation. J Cardiovasc Med (Hagerstown) 2023; 24:625-630. [PMID: 37605954 DOI: 10.2459/jcm.0000000000001527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
AIMS In Italy, 12-month survival in the general population between 90 and 94 years old is 26%. In very old patients, the benefit of pacemaker implantation in terms of quality and duration of life is unclear. The aim of our study was to analyse clinical characteristics, outcome and factors associated with survival in patients at least 90 years old at the time of the first pacemaker implant. METHODS Clinical parameters, device characteristics, survival and predictors of outcome in patients at least 90 years old treated with a pacemaker in our centre in 2019-2020 were evaluated. RESULTS Among the 554 patients undergoing pacemaker implantation in our centre during the study interval, 69 (12%) were at least 90 years old; a complete/advanced atrioventricular block was present in 65%. A cardiological comorbidity (excluding atrial fibrillation) was present in 22 patients (32%). Oncological, pulmonary and neurological comorbidities were present in 12 (17%), 19 (28%) and 32 (46%), respectively. Renal impairment was present in 25 patients (36%). After pacemaker implantation, a pneumothorax developed in two patients and lead dislodgment in one. During follow-up (median 17 months, interquartile range: 13-24), 32 patients died (46%), with a 12-month mortality probability of 24.6%. At multivariate analysis, the presence of oncological (hazard ratio (HR) 5.31; P < 0.001) and neurological (HR 6.44; P < 0.001) comorbidities was associated with mortality. Truncating the outcome at 6 months, renal impairment (HR 8.01; P = 0.003), anticoagulant therapy (HR 8.14; P = 0.003), oncological comorbidities (HR 14.1; P < 0.001) and left ventricular function (5% increase of left ventricular ejection fraction: HR 0.66; P < 0.001) were significantly associated with outcome. CONCLUSION At our centre, patients at least 90 years old underwent pacemaker implantation mainly for advanced atrioventricular block. One-year survival was excellent, even better than expected in the general population.
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Affiliation(s)
- Massimo Zecchin
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina, University of Trieste, Trieste, Italy
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Boriani G, Imberti JF, Bonini N, Carriere C, Mei DA, Zecchin M, Piccinin F, Vitolo M, Sinagra G. Remote multiparametric monitoring and management of heart failure patients through cardiac implantable electronic devices. Eur J Intern Med 2023; 115:1-9. [PMID: 37076404 DOI: 10.1016/j.ejim.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Abstract
In this review we focus on heart failure (HF) which, as known, is associated with a substantial risk of hospitalizations and adverse cardiovascular outcomes, including death. In recent years, systems to monitor cardiac function and patient parameters have been developed with the aim to detect subclinical pathophysiological changes that precede worsening HF. Several patient-specific parameters can be remotely monitored through cardiac implantable electronic devices (CIED) and can be combined in multiparametric scores predicting patients' risk of worsening HF with good sensitivity and moderate specificity. Early patient management at the time of pre-clinical alerts remotely transmitted by CIEDs to physicians might prevent hospitalizations. However, it is not clear yet which is the best diagnostic pathway for HF patients after a CIED alert, which kind of medications should be changed or escalated, and in which case in-hospital visits or in-hospital admissions are required. Finally, the specific role of healthcare professionals involved in HF patient management under remote monitoring is still matter of definition. We analyzed recent data on multiparametric monitoring of patients with HF through CIEDs. We provided practical insights on how to timely manage CIED alarms with the aim to prevent worsening HF. We also discussed the role of biomarkers and thoracic echo in this context, and potential organizational models including multidisciplinary teams for remote care of HF patients with CIEDs.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy.
| | - Jacopo F Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolò Bonini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy
| | - Cosimo Carriere
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Davide A Mei
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy
| | - Massimo Zecchin
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Francesca Piccinin
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
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Pio Loco detto Gava C, Merlo M, Paldino A, Korcova R, Massa L, Porcari A, Zecchin M, Perotto M, Rossi M, Sinagra G. New perspectives in diagnosis and risk stratification of non-ischaemic dilated cardiomyopathy. Eur Heart J Suppl 2023; 25:C137-C143. [PMID: 37125318 PMCID: PMC10132605 DOI: 10.1093/eurheartjsupp/suad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Dilated cardiomyopathy is a primitive heart muscle condition, characterized by structural and functional abnormalities, in the absence of a specific cause sufficient to determine the disease. It is, though, an 'umbrella' term that describes the final common pathway of different pathogenic processes and gene-environment interactions. Performing an accurate diagnostic workup and appropriate characterization of the patient has a direct impact on the patient's outcome. The physician should adapt a multiparametric approach, including a careful anamnesis and physical examination and integrating imaging data and genetic testing. Aetiological characterization should be pursued, and appropriate arrhythmic risk stratification should be performed. Evaluations should be repeated thoroughly at follow-up, as the disease is dynamical over time and individual risk might evolve. The goal is an all-around characterization of the patient, a personalized medicine approach, in order to establish a diagnosis and therapy tailored for the individual patient.
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Affiliation(s)
| | - Marco Merlo
- Cardiothoracovascular Department, Cardiology, Giuliano Isontina University Health Authority (ASUGI), European Reference Network for rare, low-prevalence, or complex diseases of the Heart (ERN GUARD-Heart), University of Trieste, Via Pietro Valdoni, 7, 34149 Trieste (TS), Italy
| | - Alessia Paldino
- Cardiothoracovascular Department, Cardiology, Giuliano Isontina University Health Authority (ASUGI), European Reference Network for rare, low-prevalence, or complex diseases of the Heart (ERN GUARD-Heart), University of Trieste, Via Pietro Valdoni, 7, 34149 Trieste (TS), Italy
| | - Renata Korcova
- Cardiothoracovascular Department, Cardiology, Giuliano Isontina University Health Authority (ASUGI), European Reference Network for rare, low-prevalence, or complex diseases of the Heart (ERN GUARD-Heart), University of Trieste, Via Pietro Valdoni, 7, 34149 Trieste (TS), Italy
| | - Laura Massa
- Cardiothoracovascular Department, Cardiology, Giuliano Isontina University Health Authority (ASUGI), European Reference Network for rare, low-prevalence, or complex diseases of the Heart (ERN GUARD-Heart), University of Trieste, Via Pietro Valdoni, 7, 34149 Trieste (TS), Italy
| | - Aldostefano Porcari
- Cardiothoracovascular Department, Cardiology, Giuliano Isontina University Health Authority (ASUGI), European Reference Network for rare, low-prevalence, or complex diseases of the Heart (ERN GUARD-Heart), University of Trieste, Via Pietro Valdoni, 7, 34149 Trieste (TS), Italy
| | - Massimo Zecchin
- Cardiothoracovascular Department, Cardiology, Giuliano Isontina University Health Authority (ASUGI), European Reference Network for rare, low-prevalence, or complex diseases of the Heart (ERN GUARD-Heart), University of Trieste, Via Pietro Valdoni, 7, 34149 Trieste (TS), Italy
| | - Maria Perotto
- Cardiothoracovascular Department, Cardiology, Giuliano Isontina University Health Authority (ASUGI), European Reference Network for rare, low-prevalence, or complex diseases of the Heart (ERN GUARD-Heart), University of Trieste, Via Pietro Valdoni, 7, 34149 Trieste (TS), Italy
| | - Maddalena Rossi
- Cardiothoracovascular Department, Cardiology, Giuliano Isontina University Health Authority (ASUGI), European Reference Network for rare, low-prevalence, or complex diseases of the Heart (ERN GUARD-Heart), University of Trieste, Via Pietro Valdoni, 7, 34149 Trieste (TS), Italy
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Rodio G, Iacopino S, Pisanò EC, Calvi V, Rovaris G, Marini M, Giammaria M, Caravati F, Maglia G, Zanotto G, Della Bella P, Biffi M, Curnis A, Maines M, Orsida D, Santamaria M, Bisignani G, Baroni M, Lissoni F, Duca A, Forleo GB, Piemontese C, De Salvia A, Miracapillo G, Celentano E, Zecchin M, Luzzi G, Giacopelli D, Gargaro A, D'Onofrio A. Temporal association between drops in thoracic impedance and malignant ventricular arrhythmia: A longitudinal analysis of remote monitoring trends. J Cardiovasc Electrophysiol 2023; 34:947-956. [PMID: 36709469 DOI: 10.1111/jce.15834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/23/2022] [Accepted: 01/22/2023] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Thoracic impedance (TI) drops measured by implantable cardioverter-defibrillators (ICDs) have been reported to correlate with ventricular tachycardia/fibrillation (VT/VF). The aim of our study was to assess the temporal association of decreasing TI trends with VT/VF episodes through a longitudinal analysis of daily remote monitoring data from ICDs and cardiac resynchronization therapy defibrillators (CRT-Ds). METHODS AND RESULTS Retrospective data from 2384 patients were randomized 1:1 into a derivation or validation cohort. The TI decrease rate was defined as the percentage of rolling weeks with a continuously decreasing TI trend. The derivation cohort was used to determine a TI decrease rate threshold for a ≥99% specificity of arrhythmia prediction. The associated risk of VT/VF episodes was estimated in the validation cohort by dividing the available follow-up into 60-day assessment intervals. Analyses were performed separately for 1354 ICD and 1030 CRT-D patients. During a median follow-up of 2.0 years, 727 patients (30.4%) experienced 3298 confirmed VT/VF episodes. In the ICD group, a TI decrease rate of >60% was associated with a higher risk of VT/VF episode in a 60-day assessment interval (stratified hazard ratio, 1.42; 95% confidence interval (CI), 1.05-1.92; p = .023). The TI decrease preceded (40.8%) or followed (59.2%) the VT/VF episodes. In the CRT-D group, no association between TI decrease and VT/VF episodes was observed (p = .84). CONCLUSION In our longitudinal analysis, TI decrease was associated with VT/VF episodes only in ICD patients. Preventive interventions may be difficult since episodes can occur before or after TI decrease.
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Affiliation(s)
- Giovanna Rodio
- Division of Cardiology, Ospedale Santissima Annunziata, Taranto, Italy
| | | | | | - Valeria Calvi
- Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco", Catania, Italy
| | | | | | | | | | | | | | | | - Mauro Biffi
- Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | | | | | - Matteo Baroni
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | | | | | | | | | | | | | | | - Giovanni Luzzi
- Division of Cardiology, Ospedale Santissima Annunziata, Taranto, Italy
| | - Daniele Giacopelli
- Biotronik Italia S.P.A., Vimodrone, Italy
- University of Padova, Padua, Italy
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10
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Proclemer A, Zecchin M, Zanotto G, Gregori D, D'Onofrio A, De Ponti R. [The Pacemaker and Implantable Cardioverter-Defibrillator Registry of the Italian Association of Arrhythmology and Cardiac Pacing - Report 2021]. G Ital Cardiol (Rome) 2023; 24:245-249. [PMID: 36853163 DOI: 10.1714/3980.39629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND The Pacemaker (PM) and Implantable Cardioverter-Defibrillator (ICD) Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) collects information about demographics, clinical characteristics, main indications for PM/ICD therapy and device types from the voluntary Italian collaborating centers. METHODS For the year 2021 main data about national PM and ICD implantation activity were obtained on the basis of European Cards and subsequently analyzed to create a standard report. RESULTS PM Registry: data about 18 631 PM implantations were collected (15879 first implants and 2752 replacements). The number of collaborating centers was 121. Median age of treated patients was 82 years (76 quartile I; 87 quartile III). Main ECG indications included atrioventricular conduction disorders in 26.8% of first PM implants, sick sinus syndrome in 12.2%, atrial fibrillation plus bradycardia in 9.6%, other unspecified ECG and electrophysiological abnormalities in 43.0%. For first PM implants, pacing in DDDR mode was reported in 46.5%, followed by DDD mode (20.6%), VVIR mode (15.0%), VVI mode (9.0%) and finally VDD-VDDR (5.8%). Median value of longevity of explanted PMs was 8.9 years. ICD Registry: data about 6878 ICD implantations were obtained (4708 first implants and 2170 replacements). The number of collaborating centers was 345. Median age of treated patients was 72 years (70 quartile I; 75 quartile III). Primary prevention indication was reported in 86.3% of first implants, secondary prevention in 13.7% (cardiac arrest in 4.4% of records). A single-chamber ICD was used in 32.1% of first implants, dual-chamber ICD in 30.3% and biventricular ICD in 37.6%. Median value of longevity of explanted ICDs was 6.9 years. CONCLUSIONS In the calendar year 2021, the Italian PM Registry showed stable electrocardiographic and symptom indications, with an important prevalence of dual-chamber pacing. The ICD Registry documented a large use of prophylactic and biventricular ICDs, reflecting a favorable adherence in the clinical practice to trials and guidelines. The ICD longevity and the number of recalls demonstrated a favorable trend. In order to increase and optimize the cooperation of Italian PM and ICD implanting centers, the online data entry (https://www.aiac.it/riprid) should be adopted at large scale.
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Affiliation(s)
| | - Massimo Zecchin
- S.O.C. Cardiologia, Azienda Sanitaria Universitaria Isontino-Giuliana, Trieste
| | | | - Dario Gregori
- Dipartimento di Medicina Ambientale e Salute Pubblica, Università degli Studi, Padova
| | - Antonio D'Onofrio
- U.O.S.D. Aritmologia, A.O.R.N. dei Colli, Ospedale "V. Monaldi", Napoli
| | - Roberto De Ponti
- Clinica di Cardiologia, Università dell'Insubria, Ospedale di Circolo, Varese
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11
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Pezzato A, Zecchin M, Sinagra G. [The ECG as a "red flag" and potential prognostic predictor (2)]. G Ital Cardiol (Rome) 2023; 24:92. [PMID: 36735306 DOI: 10.1714/3963.39415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Andrea Pezzato
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) e Università degli Studi di Trieste, Trieste
| | - Massimo Zecchin
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) e Università degli Studi di Trieste, Trieste
| | - Gianfranco Sinagra
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) e Università degli Studi di Trieste, Trieste
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12
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Malavasi VL, Imberti JF, Tosetti A, Romiti GF, Vitolo M, Zecchin M, Mazzeo E, Giuseppina DM, Lohr F, Lopez-Fernandez T, Boriani G. A systematic review and meta-analysis on oncological radiotherapy in patients with a cardiac implantable electronic device: Prevalence and predictors of device malfunction in 3121 patients. Eur J Clin Invest 2023; 53:e13862. [PMID: 36004486 PMCID: PMC10078179 DOI: 10.1111/eci.13862] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The number of patients with cardiac implantable electronic devices (CIEDs) undergoing radiotherapy (RT) for cancer treatment is growing. At present, prevalence and predictors of RT-induced CIEDs malfunctions are not defined. METHODS Systematic review and meta-analysis conducted following the PRISMA recommendations. PubMed, Scopus and Google Scholar were searched from inception to 31/01/2022 for studies reporting RT-induced malfunctions in CIEDs patients. Aim was to assess the prevalence of RT-induced CIEDs malfunctions and identify potential predictors. RESULTS Thirty-two out of 3962 records matched the inclusion criteria and were included in the meta-analysis. A total of 135 CIEDs malfunctions were detected among 3121 patients (6.6%, 95% confidence interval [CI]: 5.1%-8.4%). The pooled prevalence increased moving from pacemaker (PM) to implantable cardioverter defibrillator (ICD), and cardiac resynchronization therapy and defibrillator (CRT-D) groups (4.1%, 95% CI: 2.9-5.8; 8.2% 95% CI: 5.9-11.3; and 19.8%, 95% CI: 11.4-32.2 respectively). A higher risk ratio (RR) of malfunctions was found when neutron-producing energies were used as compared to non-neutron-producing energies (RR 9.98, 95% CI: 5.09-19.60) and in patients with ICD/CRT-D as compared to patients with PM/CRT-P (RR 2.07, 95% CI: 1.40-3.06). On the contrary, no association was found between maximal radiation dose at CIED >2 Gy and CIEDs malfunctions (RR 0.93; 95% CI: 0.31-2.76). CONCLUSIONS Radiotherapy related CIEDs malfunction had a prevalence ranging from 4% to 20%. The use of neutron-producing energies and more complex devices (ICD/CRT-D) were associated with higher risk of device malfunction, while the radiation dose at CIED did not significantly impact on the risk unless higher doses (>10 Gy) were used.
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Affiliation(s)
- Vincenzo Livio Malavasi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Jacopo Francesco Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Alberto Tosetti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Translational and Precision Medicine, Sapienza-University of Rome, Rome, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Massimo Zecchin
- Cardiovascular Department, Ospedali Riuniti, University of Trieste, Trieste, Italy
| | - Ercole Mazzeo
- Radiotherapy Division, Department of Oncology, Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - De Marco Giuseppina
- Radiotherapy Division, Department of Oncology, Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Frank Lohr
- Radiotherapy Division, Department of Oncology, Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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13
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Pezzato A, De Luca A, Radesich C, Saro R, Korcova R, Pagnan L, Dore F, Altinier A, Massa L, Zecchin M, Perkan A, Bussani R, Merlo M, Sinagra G. 941 SARCOIDOSIS: THE IMPORTANCE OF MULTIMODALITY IMAGING. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
A 55-years old sporty man, without any cardiovascular risk factors nor previously known cardiological history, presented for a cardiological evaluation due to extra-systolic palpitations and dyspnea. The ECG documented a new onset of right bundle branch block, left anterior fascicular block and first degree of atrio-ventricular block. Echocardiography revealed severe left ventricular (LV) systolic dysfunction (LV ejection fraction -EF- 34%), showing also right ventricular (RV) dilatation and disfunction. A 24-hour Holter monitoring did not show any significant arrhythmias and maximal stress test did not reveal any ECG changes nor arrhythmias. Cardiac magnetic resonance (CMR) confirmed the presence of severe biventricular dysfunction; multiple areas of edema and late gadolinium enhancement (LGE) were observed, with ischemic and nonischemic pattern and extensive involvement of the RV and the interventricular septum. In the suspicion of cardiac sarcoidosis a 18-fluorodeoxyglucose positron emission tomography (PET) was performed, confirming the presence of an inflammatory cardiomyopathy in an active phase. A subsequent endomyocardial biopsy was performed, which demonstrated the presence of non-caseating granulomas, signs of inflammation and fibrosis, consistent with the diagnosis of cardiac sarcoidosis. No signs of extra-cardiac involvement were present.
The patient started anti-inflammatory therapy with Prednisone and Metotrexate, along with anti-neurohormonal therapy. However, due to a significant increase in ventricular arrhythmic burden, an implantable cardioverter defibrillator was placed during early follow-up, and Amiodarone therapy was started.
After 5 months of medical therapy, PET scan showed a marked reduction of cardiac inflammation and echocardiography showed a significant LVEF improvement (from 34% to 43%). After slow tapering of steroid therapy Prednisone was stopped, whereas Metotrexate, Amiodarone and anti-neurohormonal therapy were maintained. Follow-up is still ongoing without clinical events.
Sarcoidosis is a systemic inflammatory disease characterized by the presence of non-caseating granulomas in multiple organs. Cardiac involvement is associated with higher incidence of heart failure, ventricular arrhythmias and all-cause mortality. Isolated cardiac involvement is rare but associated with worse prognosis. Multimodality imaging is of paramount importance for the diagnosis and monitoring therapy.
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Affiliation(s)
- Andrea Pezzato
- Cardiovascular Department, University Of Trieste , Trieste , Italy
| | - Antonio De Luca
- Cardiovascular Department, University Of Trieste , Trieste , Italy
| | - Cinzia Radesich
- Cardiovascular Department, University Of Trieste , Trieste , Italy
| | - Riccardo Saro
- Cardiovascular Department, University Of Trieste , Trieste , Italy
| | - Renata Korcova
- Cardiovascular Department, University Of Trieste , Trieste , Italy
| | - Lorenzo Pagnan
- Department Of Radiology, University Of Trieste , Trieste , Italy
| | - Franca Dore
- Department Of Nuclear Medicine, University Of Trieste , Trieste , Italy
| | | | - Laura Massa
- Cardiovascular Department, University Of Trieste , Trieste , Italy
| | - Massimo Zecchin
- Cardiovascular Department, University Of Trieste , Trieste , Italy
| | - Andrea Perkan
- Cardiovascular Department, University Of Trieste , Trieste , Italy
| | - Rossana Bussani
- Institute Of Pathological Anatomy And Histology, University Of Trieste , Trieste , Italy
| | - Marco Merlo
- Cardiovascular Department, University Of Trieste , Trieste , Italy
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14
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Pezzato A, Fabris E, Gregorio C, Cittar M, Contessi S, Carriere C, Lardieri G, Zecchin M, Perkan A, Sinagra G. 480 ICD AFTER STEMI: WHEN AND HOW FREQUENTLY IS IMPLANTED AND WHICH IS THE RATE OF APPROPRIATE INTERVENTIONS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
there are limited data of implantable-cardioverter-defibrillator (ICD) implantation after STEMI treated with primary percutaneous coronary intervention (pPCI). This study sought to evaluate when and how frequently is ICD implanted after STEMI, the rate of appropriate ICD-interventions, and the independent predictors of ICD implantation.
Methods
We analyzed STEMI patients treated with pPCI at the University Hospital of Trieste, Italy, between January 2010 and December 2019. We cross-matched patients data with those present in the Trieste ICD registry.
Results
1805 consecutive patients treated with pPCI were analyzed. During a median follow-up of 6.7 (IQR 4.3-9.2) years, the probability of ICD implantation at 12 months was 2.3% (95%CI: 1.7-3.1) and it remained stable overtime (at 24 months: 2.5%, 95%CI 2.0-3.5 and at 36 months: 2.6%, 95%CI 2.3-3.8). Mean time before ICD implantation was 35.5 months (95%CI: 34.8-36) . 83.1% of implanted ICD were for primary prevention, and more than half (55%) were implanted in patients with ejection fraction (EF)>35% at the moment of STEMI discharge. During a median follow-up of 5.7 (IQR 3.3-8.3) years after ICD implantation, the probability of appropriate ICD intervention was 9% and 11% after 12 and 24 months respectively. In patients with EF>35% at STEMI discharge (median EF 43%; IQR 40-48), predictors of ICD implantation were male sex, anterior STEMI and troponin peak >100.000 ng/dl.
Conclusions
The rate of ICD implantation after pPCI is low, however the rate of appropriate ICD interventions is high. A relevant subgroup of patients received ICD implantation at follow-up despite a non-severe EF at discharge after STEMI. Among these patients those with high troponin release deserve strict follow-up and full optimal medical treatment.
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Affiliation(s)
- Andrea Pezzato
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Enrico Fabris
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Caterina Gregorio
- Biostatistics Unit, Department Of Medical Sciences, University Of Trieste , Trieste , Italy
- Mox - Modeling And Scientific Computing Laboratory, Department Of Mathematics , Politecnico Di Milano, Milano , Italy
| | - Marco Cittar
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Stefano Contessi
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Cosimo Carriere
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Gerardina Lardieri
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Massimo Zecchin
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Andrea Perkan
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Gianfranco Sinagra
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
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15
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D'Errico S, Bergamini PR, Fattorini P, Zanconati F, Bussani R, Cova MA, Pagnan L, Belgrano M, Gasparini P, Girotto G, Lenarduzzi S, Addobbati R, Rakar S, Aleksova A, Dal Ferro M, Zecchin M, Sinagra G. [The Regional Registry of Sudden Cardiac Death of Friuli Venezia Giulia. Protocols, best practices and results of a multidisciplinary project]. G Ital Cardiol (Rome) 2022; 23:827-835. [PMID: 36300386 DOI: 10.1714/3900.38822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
With the regional law n. 26 of December 30, 2020, the Friuli Venezia Giulia Region wanted to promote the establishment of the Regional Register of Sudden Cardiac Death, with the aim of favoring the study of all those deaths that occurred suddenly and unexpectedly under the age of 50 years in which it is not possible to trace the cause of death with certainty. Such dramatic events, difficult to quantify considering the complexity of data collection, are often accepted with resignation without any further investigation of the possible causes. The Regional Register of Sudden Cardiac Deaths of Friuli Venezia Giulia was born from this premise and from the awareness of the importance of going back with a rigorous scientific methodology and through a multidisciplinary approach, to the diagnosis of hereditary heart diseases which, when determined, allow the enrollment of relatives in a cardiological screening process and, therefore, primary prevention of potentially fatal events. The authors describe the operating procedures feeding the Regional Register and present the results of the first year of activity on 26 cases.
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Affiliation(s)
- Stefano D'Errico
- SC UCO Medicina Legale, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Pier Riccardo Bergamini
- SC UCO Medicina Legale, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Paolo Fattorini
- Dipartimento di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Fabrizio Zanconati
- SC UCO Anatomia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Rossana Bussani
- SC UCO Anatomia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Maria Assunta Cova
- SC UCO Diagnostica per Immagini, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Lorenzo Pagnan
- SC UCO Diagnostica per Immagini, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Manuel Belgrano
- SC UCO Diagnostica per Immagini, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Paolo Gasparini
- Dipartimento dei Servizi e di Diagnostica Avanzata, IRCCS Materno Infantile Burlo Garofolo, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Giorgia Girotto
- Dipartimento dei Servizi e di Diagnostica Avanzata, IRCCS Materno Infantile Burlo Garofolo, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Stefania Lenarduzzi
- Dipartimento dei Servizi e di Diagnostica Avanzata, IRCCS Materno Infantile Burlo Garofolo, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Riccardo Addobbati
- Dipartimento dei Servizi e di Diagnostica Avanzata, IRCCS Materno Infantile Burlo Garofolo, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Serena Rakar
- SC Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Rete Europea Malattie Cardiache Rare (ERN Guard-Heart), Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Aneta Aleksova
- SC Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Rete Europea Malattie Cardiache Rare (ERN Guard-Heart), Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Matteo Dal Ferro
- SC Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Rete Europea Malattie Cardiache Rare (ERN Guard-Heart), Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Massimo Zecchin
- SC Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Rete Europea Malattie Cardiache Rare (ERN Guard-Heart), Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Gianfranco Sinagra
- SC Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Rete Europea Malattie Cardiache Rare (ERN Guard-Heart), Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
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16
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Bessi R, Dal Ferro M, Gregorio C, Paldino A, De Angelis G, De Bellis A, Mase M, Zaffalon D, Gigli M, Stolfo D, Merlo M, Zecchin M, Sinagra G. Cardiac resynchronization therapy: association between genetically determinated dilated cardiomyopathy and dissinchronopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.828] [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
Patients with non-ischemic dilated cardiomyopathy (DCM) and left bundle branch block (LBBB) often undergoes cardiac resynchronization therapy (CRT). Despite CRT only a small group of patients restore normal left ventricular geometry and function. Many predictors of response to CRT have been described, but there are still insufficient data on the role of genetic mutations in sarcomere, cytoskeletal or desmosomal genes.
Purpose
To asses the role of genetic background as predictor of response after CRT in patient DCM and LBBB.
Methods
We retrospectively analyzed DCM patients with successful CRT implantation and available genetic testing consecutively included in the CRT-Registry of our Institution. DCM was defined by the presence of left ventricular or biventricular dilatation and systolic dysfunction in the absence of abnormal loading conditions or coronary artery disease sufficient to cause global systolic impairment. Changes in main echocardiographic parameters: left ventricular ejection fraction (LVEF), LV End Systolic and End Diastolic Volume (LVESV and LVEDV), where compared between basal and 24–48 months of follow up. LV remodeling was defined by relative changes (Δ) in LV End Systolic Volume (LVESV) [(follow-up LVESV − PRE LVESV) / PRE LVESV × 100)]. Patients were considered super-responders (SR) if LVEF at 24–48 months was>50%.
Genetic testing was done by Next Generation DNA and all variants were validated with bidirectional Sanger sequencing. Variants of uncertain significance (VUS) were excluded from the analysis. Patients being carrier of pathogenic (P) or likely pathogenic (LP) variants were considered affected by genetic DCM (GEN+ DCM). Patients non carrier of P/LP variants and with no evidence of familial disease were considered affected by non-genetically determined DCM (GEN− DCM).
Results
73 patients met the inclusion criteria, 23 patients were GEN+ DCM, the remaining 50 patients had negative genetic test and no family history of DCM. Baseline characteristics were similar between groups. GEN− group was characterized by a greater improvement in LVEF (39±12 vs 29±12, p=0,006) and a greater relative reduction in LVESV (ΔLVESV 43% vs 18%, p=0,007). GEN− patients had a 33 ml higher mean LVESV reduction at 24–48 months after CRT, indipendently of their respective baseline values. 20 patients (27% of the total population) suffered of heart failure related death, heart transplantation or left ventricular assistance device implantation during follow up and the prevalence was significantly higher in GEN+ group (43% vs 20%, p=0,037). Coherently, patients in the GEN+ group showed a lower prevalence of super responders (4%, vs 24%, p=0,02) after CRT.
Conclusions
Non-genetically determined DCM DCM is associated with a better clinical and instrumental response to CRT and a higher probability of being super responders. Furthermore, our data support the hypothesis about dyssyncronopathy as a specific clinical entity inside DCM diseases.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Bessi
- Cattinara Hospital , Trieste , Italy
| | | | | | - A Paldino
- Cattinara Hospital , Trieste , Italy
| | | | | | - M Mase
- Cattinara Hospital , Trieste , Italy
| | | | - M Gigli
- Cattinara Hospital , Trieste , Italy
| | - D Stolfo
- Cattinara Hospital , Trieste , Italy
| | - M Merlo
- Cattinara Hospital , Trieste , Italy
| | - M Zecchin
- Cattinara Hospital , Trieste , Italy
| | - G Sinagra
- Cattinara Hospital , Trieste , Italy
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17
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Zecchin M, Trevisan B, Bessi R, Baggio C, Salvatore L, Cappelletto C, Gregorio C, Bianco E, Carriere C, Longaro F, Zorzin-Fantasia A, Saitta M, Piccinin F, Dal Monte G, Sinagra G. Medium term survival in patients over ninety years-old undergoing pacemaker implantation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
According to the Italian National Statistical Institute, the 12-month probability of survival in the general population between 90 and 94 years-old is 26%. Pacemaker (PM) implantation is often an urgent and necessary intervention, but in these patients the benefit in terms of quality and duration of life is unclear.
Purpose
To analyze characteristics, outcome and factors associated with survival in patients who had turned 90 at the time of PM implant.
Methods
All the PM implants performed in patients ≥90 from 1/1/2019 to 12/31/2020 were analyzed. Clinical parameters, device characteristics and follow-up data were extrapolated from the SuitEstensa Ebit reporting system; the exitus was verified by analyzing data from the Regional Health System.
Results
During the study interval, among the 554 patients undergoing PM implantation in our Center, 69 (12%) were ≥90 years-old (mean age 92±2 years, 46% male; complete/advanced AV block in 76%). Twenty-six (38%) patients had history of atrial fibrillation and 19 (28%) ischemic heart disease. A cardiological co-morbidity (excluding AF) was present in 23 patients (33%). Oncological, pneumological and neurological comorbidities were present in 12 (18%), 19 (28%) and 32 (46%) respectively. Renal impairment was present in 25 patients (36%). In 47 patients (68%) there were at least 2 co-morbidities. After implantation (single-chamber in 36, dual-chamber in 25 and VDD single-lead dual-chamber in 8 patients) complications occurred in 3 patients (2 pneumothorax and 1 lead dislodgment). Remote monitoring was activated in 57 patients (83%).
Within August 31st 2021 (mean follow-up 288±193 days) 24 patients died (35%, 219±241 days after implant). Five patients (19% of patients implanted in 2019) died within 12 months. No patients died for device malfunction. Three patients died because of COVID-19 pneumonia.
Renal dysfunction (Hazard Ratio-HR 8.05, p=0.002) and the presence of 2 or more co-morbidities (HR 6.03; p=0.015) were associated with a higher risk of death at univariate analysis; other significant variables were diabetes (HR 2.34; p=0.038), left ventricular ejection fraction (LVEF) (HR 0.70 for 5% variation; p=0.005), walking impairment (HR 2.99, p=0.006), the presence of oncological (HR 2.21; p=0.003), pneumological (HR 2.55; p=0.024) and neurological (HR 1.90, p=0.007) comorbidities. At multivariable analysis the only significant parameter associated with survival was LVEF (0.76 for 5% difference; p=0.043)
Conclusions
At our Center, patients ≥90 years-old undergo PM implantation mainly for advanced AVB. The good survival in the medium term, even better than expected in the general population, does not justify a too conservative attitude especially, but exclusively, in patients with less comorbidities.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Zecchin
- Cattinara Hospital , Trieste , Italy
| | | | - R Bessi
- Cattinara Hospital , Trieste , Italy
| | - C Baggio
- Cattinara Hospital , Trieste , Italy
| | | | | | | | - E Bianco
- Cattinara Hospital , Trieste , Italy
| | | | - F Longaro
- Cattinara Hospital , Trieste , Italy
| | | | - M Saitta
- Cattinara Hospital , Trieste , Italy
| | | | | | - G Sinagra
- Cattinara Hospital , Trieste , Italy
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18
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Boriani G, Diemberger I, Pisano' ECL, Pieragnoli P, Locatelli A, Capucci A, Talarico A, Zecchin M, Rapacciuolo A, Piacenti M, Indolfi C, Arias MA, Checchinato C, D'Onofrio A. Influence of obesity and overweight on the association between sleep-disordered breathing and atrial fibrillation: the DASAP-HF study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The association between sleep apnea (SA) and atrial fibrillation (AF) has been well described. However, it remains unclear whether the association is causative or primarily dependent on shared comorbidities such as obesity. The Respiratory Disturbance Index (RDI) computed by an implantable cardioverter defibrillator (ICD) algorithm accurately identifies severe SA, whether central or obstructive in origin.
Purpose
In the present analysis we studied in patients with heart failure the contribution of obesity in the relationship between SA, measured by RDI, and AF.
Methods
Patients with ejection fraction ≤35% implanted with an ICD endowed with an algorithm (ApneaScan) that calculates the RDI each night, were enrolled and followed-up for 24 months. The weekly mean RDI value was considered, as calculated during the entire follow-up period. The endpoint was daily AF burden of ≥6 hours.
Results
164 patients (age 67±10 years, 75% male, ejection fraction 29±5%) had usable RDI values during the entire follow-up period. Body mass index (BMI) was <25 kg/m2 in 62 patients (normal), 25.0–29.9 kg/m2 in 66 patients (overweight), ≥ 30 kg/m2 in 36 patients (obese). When compared with normal patients (31±11 episodes/h), the average RDI value calculated during the entire follow-up period did not differ in overweight patients (35±13 episodes/h, p=0.114), but was significantly higher in obese patients (39±12 episodes/h, p=0.002). During follow-up, AF burden ≥6 hours/day was documented in 48 (29%) patients (BMI ≥ versus <25 kg/m2; HR: 1.47, 95% CI: 0.83–2.60, p=0.197; BMI ≥ versus <30 kg/m2; HR: 0.98, 95% CI: 0.46–2.09, p=0.963). Based on the ROC curve analysis, average RDI ≥37 episodes/h maximized sensitivity and specificity for the prediction of AF (Area under the curve: 0.63, 95% CI: 0.55–0.70, p=0.011). Device-detected RDI ≥37 episodes/h was associated with the occurrence of AF on univariate analysis (HR: 3.88, 95% CI: 2.02–7.44, p<0.001), as well as after correction for either BMI ≥25 kg/m2 (HR: 3.76, 95% CI: 1.94–7.26, p<0.001), or BMI ≥30 kg/m2 (HR: 4.15, 95% CI: 2.15–8.04, p<0.001).
Conclusions
In heart failure patients, we confirmed the association between ICD-detected SA and AF, an association that persisted independent of patient body habitus.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The study is supported by a research grant from Boston Scientific
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Affiliation(s)
- G Boriani
- Modena Polyclinic Modena University Hospital , Modena , Italy
| | - I Diemberger
- Institute of Cardiology, Univ. of Bologna , Bologna , Italy
| | | | | | | | - A Capucci
- Marche Polytechnic University of Ancona , Ancona , Italy
| | | | - M Zecchin
- University of Trieste , Trieste , Italy
| | | | - M Piacenti
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - C Indolfi
- Magna Graecia University of Catanzaro , Catanzaro , Italy
| | - M A Arias
- Hospital Virgen de la Salud , Toledo , Spain
| | - C Checchinato
- Santa Croce Hospital of Moncalieri , Moncalieri , Italy
| | - A D'Onofrio
- AO dei Colli - Monaldi Hospital , Naples , Italy
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19
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Boriani G, Diemberger I, Pisanò EC, Pieragnoli P, Locatelli A, Capucci A, Talarico A, Zecchin M, Rapacciuolo A, Piacenti M, Indolfi C, Arias MA, Checchinato C, La Rovere MT, Sinagra G, Emdin M, Ricci RP, D'Onofrio A. Association between implantable defibrillator-detected sleep apnea and atrial fibrillation: the DASAP-HF study. J Cardiovasc Electrophysiol 2022; 33:1472-1479. [PMID: 35499267 DOI: 10.1111/jce.15506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/02/2022] [Accepted: 04/15/2022] [Indexed: 11/29/2022]
Abstract
AIM The Respiratory Disturbance Index (RDI) computed by an implantable cardioverter defibrillator (ICD) algorithm accurately identifies severe sleep apnea (SA). In the present analysis we tested the hypothesis that RDI could also predict AF burden. METHODS Patients with ejection fraction ≤35% implanted with an ICD were enrolled and followed-up for 24 months. One month after implantation, patients underwent a polysomnographic study. The weekly mean RDI value was considered, as calculated during the entire follow-up period and over a 1-week period preceding the sleep study. The endpoints were: daily AF burden of ≥5 minutes, ≥6 hours, ≥23 hours. RESULTS 164 patients had usable RDI values during the entire follow-up period. Severe SA (RDI≥30 episodes/h) was diagnosed in 92 (56%) patients at the time of the sleep study. During follow-up, AF burden ≥5 minutes/day was documented in 70 (43%), ≥6 hours/day in 48 (29%), and ≥23 hours/day in 33 (20%) patients. Device-detected RDI≥30 episodes/h at the time of the polygraphy, as well as the polygraphy-measured apnea hypopnea index ≥30 episodes/h, were not associated with the occurrence of the endpoints, using a Cox regression model. However, using a time-dependent model, continuously measured weekly mean RDI≥30episodes/h was independently associated with AF burden ≥5 minutes/day (HR:2.13, 95%CI:1.24-3.65, p=0.006), ≥6 hours/day (HR:2.75, 95%CI:1.37-5.49, p=0.004), and ≥23 hours/day (HR:2.26, 95%CI:1.05-4.86, p=0.037). CONCLUSIONS In heart failure patients, ICD-diagnosed severe SA on follow-up data review identifies patients who are from two- to three-fold more likely to experience an AF episode, according to various thresholds of daily AF burden. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Igor Diemberger
- University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | | | | | | | | | | | | | | | - Marcello Piacenti
- Institute of Life Science, Scuola Superiore Sant'Anna and Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Ciro Indolfi
- Division of Cardiology, "Magna Graecia" University, Catanzaro, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | | | | | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico di Montescano, Montescano, Pavia
| | | | - Michele Emdin
- Institute of Life Science, Scuola Superiore Sant'Anna and Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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20
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Nesti M, Calvanese R, Pignalberi C, Mascioli G, China P, Sgarito G, Bardari S, Zecchin M. [Management of infections in patients with cardiac implantable electronic devices]. G Ital Cardiol (Rome) 2022; 23:328-335. [PMID: 35578956 DOI: 10.1714/3796.37815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Implantation of pacemakers and cardiac defibrillators is a life-saving treatment but can put our patients at risk of infections, increasing morbidity and mortality and prolonging hospitalization with a significant financial healthcare burden. A preventive strategy is crucial but, while several strategies such as administration of intravenous antibiotic therapy before implantation are well recognized, other uncertainties remain. The main gaps regard the use of periprocedural measures, including antibacterial envelope to prevent device infection, the appropriate management of antithrombotic therapy before and after device implantation and timing of device reimplantation. To address these issues, some important randomized clinical trials and a European Heart Rhythm Association consensus document have recently been published. The aim of this article is to review current knowledge on the management of infections in patients with cardiac implantable electronic devices to help not only electrophysiologists, but also physicians in their daily practice.
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21
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Iacoviello M, Cipriani M, Valente S, Marini M, Ammirati E, Benvenuto M, Cassaniti LR, De Maria R, Gori M, Municinò A, Navazio A, Amodeo V, Aspromonte N, Barili F, Casolo G, Clemenza F, Di Eusanio M, Di Lenarda A, Di Tano G, Domenicucci S, Faggian G, Francese GM, Frongillo D, Gilardi R, Iacovoni A, Imazio M, Livi U, Maiello C, Milano A, Mondino M, Moreo AM, Mortara A, Murrone A, Palmieri V, Pelenghi S, Pini D, Pistono M, Porcu M, Potena L, Rinaldi M, Romanò M, Roncon L, Rossini R, Russo CF, Scotto di Uccio F, Urbinati S, Zecchin M, Caldarola P, Oliveti A, Frigerio M, Musumeci F, Gulizia MM, Oliva F, Gabrielli D, Colivicchi F. [ANMCO Position paper: Care pathway for advanced heart failure patients candidate for heart transplantation/ventricular assist device]. G Ital Cardiol (Rome) 2022; 23:340-378. [PMID: 35578958 DOI: 10.1714/3796.37817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Heart failure is a complex clinical syndrome with a severe prognosis, despite therapeutic progress. The management of the advanced stages of the syndrome is particularly complex in patients who are referred to palliative care as well as in those who are candidates for cardiac replacement therapy. For the latter group, a prompt recognition of the transition to the advanced stage as well as an early referral to the centers for cardiac replacement therapy are essential elements to ensure that patients follow the most appropriate diagnostic-therapeutic pathway. The aim of this document is to focus on the main diagnostic and therapeutic aspects related to the advanced stages of heart failure and, in particular, on the management of patients who are candidates for cardiac replacement therapy.
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Affiliation(s)
| | | | | | - Marco Marini
- S.O.D. Cardiologia-Emodinamica-UTIC, A.O.U. Ospedali Riuniti, Ancona
| | - Enrico Ammirati
- Cardiologia 2-Insufficienza Cardiaca e Trapianti, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Manuela Benvenuto
- U.O.C. Cardiologia-UTIC-Emodinamica, Presidio Ospedaliero "G. Mazzini", Teramo
| | - Leonarda Rosaria Cassaniti
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | - Renata De Maria
- Istituto di Fisiologia Clinica CNR, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Mauro Gori
- U.O.C. Cardiologia 1, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | - Annamaria Municinò
- Dipartimento di Cardiologia, Ospedale Andrea Gallino, ASL3 Genovese, Genova
| | - Alessandro Navazio
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia
| | - Vincenzo Amodeo
- U.O.C. Cardiologia-UTIC, Ospedale Santa Maria degli Ungheresi, Polistena (RC)
| | - Nadia Aspromonte
- U.O.S. Scompenso Cardiaco, Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma
| | - Fabio Barili
- S.C. Cardiochirurgia, Ospedale Santa Croce e Carle, Cuneo
| | - Giancarlo Casolo
- U.O.C. Cardiologia, Ospedale Versilia, Azienda USL Toscana Nord-Ovest, Lido di Camaiore (LU)
| | - Francesco Clemenza
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT) - IRCCS, Palermo
| | | | - Andrea Di Lenarda
- S.C. Cardiovascolare e Medicina dello Sport, Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Giuseppe Di Tano
- U.O. di Cardiologia-UTIC, Ospedale Civile Oglio Po, Casalmaggiore (CR)
| | | | - Giuseppe Faggian
- Divisione di Cardiochirurgia, Azienda Ospedaliera Universitaria Integrata Verona, Verona
| | - Giuseppina Maura Francese
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | - Doriana Frongillo
- U.O.C. Cardiologia, Ospedale San Sebastiano Martire, ASL Roma 6, Frascati (RM)
| | - Rossella Gilardi
- S.C. Cardiochirurgia, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Attilio Iacovoni
- U.O.C. Cardiologia 1, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | - Massimo Imazio
- Cardiologia, Dipartimento Cardiotoracico, Ospedale Santa Maria della Misericordia, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine
| | - Ugolino Livi
- Cardiochirurgia, Dipartimento Cardiotoracico, Ospedale Santa Maria della Misericordia, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine
| | - Ciro Maiello
- Dipartimento di Cardiochirurgia e dei Trapianti, A.O.R.N. Ospedale dei Colli - P.O. Monaldi, Napoli
| | - Aldo Milano
- Cardiochirurgia, A.O.U. Consorziale Policlinico di Bari, Bari
| | - Michele Mondino
- Anestesia e Rianimazione 3, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Antonella Maurizia Moreo
- Cardiologia 4-Diagnostica e Riabilitativa, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Andrea Mortara
- Dipartimento di Cardiologia Clinica, Policlinico di Monza, Monza
| | - Adriano Murrone
- S.C. Cardiologia-UTIC, Ospedali di Città di Castello e di Gubbio-Gualdo Tadino, AUSL Umbria 1, Perugia
| | - Vittorio Palmieri
- Dipartimento di Cardiochirurgia e dei Trapianti, A.O.R.N. Ospedale dei Colli - P.O. Monaldi, Napoli
| | - Stefano Pelenghi
- U.O.C. Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Daniela Pini
- U.O. Cardiologia Clinica, Istituto Clinico Humanitas, Rozzano (MI)
| | - Massimo Pistono
- Cardiologia, I.C.S. Maugeri - IRCCS Sede di Veruno, Gattico-Veruno (NO)
| | | | - Luciano Potena
- IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Mauro Rinaldi
- S.C. Cardiochirurgia, A.O.U. Città della Salute e della Scienza di Torino, Torino
| | - Massimo Romanò
- Comitato Ordinatore, Master Universitario di II Livello in Cure Palliative, Università degli Studi, Milano
| | - Loris Roncon
- U.O.C. Cardiologia, Ospedale Santa Maria della Misericordia, Rovigo
| | | | - Claudio Francesco Russo
- S.C. Cardiochirurgia, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | | | | | - Massimo Zecchin
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Università di Trieste
| | | | | | - Maria Frigerio
- Cardiologia 2-Insufficienza Cardiaca e Trapianti, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Francesco Musumeci
- U.O. Cardiochirurgia e Centro Trapianti di Cuore, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera Ospedale S. Camillo Forlanini, Roma
| | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania - Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Unità di Cure Intensive Cardiologiche, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
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22
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Proclemer A, Zecchin M, Zanotto G, Gregori D, D'Onofrio A, Ricci RP, De Ponti R. [The Pacemaker and Implantable Cardioverter-Defibrillator Registry of the Italian Association of Arrhythmology and Cardiac Pacing - Report 2020]. G Ital Cardiol (Rome) 2022; 23:309-313. [PMID: 35343483 DOI: 10.1714/3766.37541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The Pacemaker (PM) and Implantable Cardioverter-Defibrillator (ICD) Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) collects information about demographics, clinical characteristics, main indications for PM/ICD therapy and device types from the Italian collaborating centers. METHODS For the year 2020, the main data about national PM and ICD implantation activity were obtained on the basis of European Cards and subsequently analyzed to create a standard report. RESULTS PM Registry: data about 22 080 PM implantations were collected (18 027 first implants and 3803 replacements). The number of collaborating centers was 142. Median age of treated patients was 82 years (75 quartile I; 87 quartile III). ECG indications included atrioventricular conduction disorders in 31.0% of first PM implants, sick sinus syndrome in 13.8%, atrial fibrillation plus bradycardia in 9.9%, other unspecified ECG and electrophysiological abnormalities in 36.6%. Use of single-chamber PMs was reported in 29.0% of first implants, of dual-chamber PMs in 68.2%, of PM with cardiac resynchronization therapy (CRT) in 2.7%. ICD Registry: data about 11 931 ICD implantations were obtained (8266 first implants and 3665 replacements). The number of collaborating centers was 330. Median age of treated patients was 72 years [63 quartile I; 79 quartile III]. Primary prevention indication was reported in 85.0% of first implants, secondary prevention in 15.0% (cardiac arrest in 4.2%). A single-chamber ICD was used in 30.2% of first implants, dual-chamber ICD in 31.2% and biventricular ICD in 38.6%. CONCLUSIONS In the calendar year 2020, the Italian PM Registry showed stable ECG and symptom indications, with an important prevalence of dual-chamber pacing. The ICD Registry documented a large use of prophylactic and biventricular ICDs, reflecting a favorable adherence in clinical practice to trials and guidelines. The ICD longevity and the number of recalls demonstrated a favorable trend. In order to increase and optimize the cooperation of Italian PM and ICD implanting centers, the online data entry (https://www.aiac.it/riprid) should be adopted at large scale.
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Affiliation(s)
| | - Massimo Zecchin
- S.O.C. Cardiologia, Azienda Sanitaria Universitaria Isontino-Giuliana, Trieste
| | - Gabriele Zanotto
- S.O.C. Cardiologia, S.O.S. Elettrostimolazione, Ospedale "Mater Salutis", Legnago (VR)
| | - Dario Gregori
- Dipartimento di Medicina Ambientale e Salute Pubblica, Università degli Studi, Padova
| | - Antonio D'Onofrio
- U.O.S.D. Aritmologia A.O.R.N. dei Colli, Ospedale "V. Monaldi", Napoli
| | | | - Roberto De Ponti
- Clinica di Cardiologia, Università dell'Insubria, Ospedale di Circolo, Varese
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23
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Zaffalon D, Pagura L, Cannatà A, Barbati G, Gregorio C, Finocchiaro G, Vitali-Serdoz L, Zecchin M, Fabris E, Merlo M, Sinagra G. Corrigendum to 'Supraventricular Tachycardia Causing Left Ventricular Dysfunction'[The American Journal of Cardiology 159 (2021) 72-78]. Am J Cardiol 2022; 164:147. [PMID: 34838289 DOI: 10.1016/j.amjcard.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Denise Zaffalon
- Cardiovascular Department, "Azienda Sanitaria Universitaria Giu- liano-Isontina", Trieste, Italy
| | - Linda Pagura
- Cardiovascular Department, "Azienda Sanitaria Universitaria Giu- liano-Isontina", Trieste, Italy
| | - Antonio Cannatà
- Cardiovascular Department, "Azienda Sanitaria Universitaria Giu- liano-Isontina", Trieste, Italy; Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Giulia Barbati
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Caterina Gregorio
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Gherardo Finocchiaro
- Cardiothoracic Centre, Guy's and St Thomas' Hospital, King's College London, London, UK
| | - Laura Vitali-Serdoz
- Division of Cardiac Electrophysiology, Department of Cardiology, Klinikum Fuerth, Fuerth, Germany
| | - Massimo Zecchin
- Cardiovascular Department, "Azienda Sanitaria Universitaria Giu- liano-Isontina", Trieste, Italy
| | - Enrico Fabris
- Cardiovascular Department, "Azienda Sanitaria Universitaria Giu- liano-Isontina", Trieste, Italy
| | - Marco Merlo
- Cardiovascular Department, "Azienda Sanitaria Universitaria Giu- liano-Isontina", Trieste, Italy.
| | - Gianfranco Sinagra
- Cardiovascular Department, "Azienda Sanitaria Universitaria Giu- liano-Isontina", Trieste, Italy
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24
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Merlo M, Grilli G, Cappelletto C, Masé M, Porcari A, Ferro MD, Gigli M, Stolfo D, Zecchin M, De Luca A, Mestroni L, Sinagra G. The Arrhythmic Phenotype in Cardiomyopathy. Heart Fail Clin 2022; 18:101-113. [PMID: 34776072 DOI: 10.1016/j.hfc.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In the wide phenotypic spectrum of cardiomyopathies, sudden cardiac death (SCD) has always been the most visible and devastating disease complication. The introduction of implantable cardioverter-defibrillators for SCD prevention by the late 1980s has moved the question from how to whom we should protect from SCD, leaving clinicians with a measure of uncertainty regarding the most reliable option to guide identification of the highest-risk patients. In this review, we will go through all the available evidence in the field of arrhythmic expression and arrhythmic risk stratification in the different phenotypes of cardiomyopathies to provide practical suggestions in daily clinical management.
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Affiliation(s)
- Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy.
| | - Giulia Grilli
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Chiara Cappelletto
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Marco Masé
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Aldostefano Porcari
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Matteo Dal Ferro
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Marta Gigli
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Davide Stolfo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Massimo Zecchin
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Antonio De Luca
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
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Zaffalon D, Pagura L, Cannatà A, Barbati G, Gregorio C, Finocchiaro G, Serdoz LV, Zecchin M, Fabris E, Merlo M, Sinagra G. Supraventricular Tachycardia Causing Left Ventricular Dysfunction. Am J Cardiol 2021; 159:72-78. [PMID: 34656315 DOI: 10.1016/j.amjcard.2021.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022]
Abstract
There is limited evidence on characterization and natural history of supraventricular tachycardia (SVT)-induced left ventricular (LV) dysfunction. The aim of this work was to characterize clinical features and long-term evolution of SVT-induced LV dysfunction. Patients consecutively admitted with sustained SVT and heart rate >100 bpm as the only known cause of a new onset LV systolic dysfunction (i.e., LV ejection fraction [EF] <50%) were analyzed. Patients were then revaluated periodically. Recovered LVEF (i.e., ≥50%) and a composite of death, heart transplant or first episode of major ventricular arrhythmias were evaluated as study end-points. We enrolled 83 patients. After SVT therapy, 56 (67%) showed a recovered LVEF at the last follow-up of median 54 (interquartile range 36 to 87) months. Seventeen (30%) of those patients had a temporary new drop in LVEF during follow-up associated to high-rate SVT relapse. At presentation, patients with recovered LVEF were younger (52 vs 67 years respectively, p <0.001) and had higher LVEF (34% vs 27% respectively, p = 0.005) compared to non-recovered LVEF patients. Finally, 4% of recovered LVEF patients vs 26% of nonrecovered LVEF patients experienced death/heart transplant/major ventricular arrhythmias during follow-up (p = 0.004). In conclusion, after almost 5 years of follow-up, two-thirds of patients with high-rate SVT causing a newly diagnosed LV systolic dysfunction recovered and maintained normal LV function after SVT control, with a subsequent benign outcome. Long term individual surveillance is required in those patients, as arrhythmic recurrences and new drops in LVEF are common in the long term.
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26
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Boriani G, Pisano' E, Pieragnoli P, Locatelli A, Capucci A, Talarico A, Zecchin M, Rapacciuolo A, Piacenti M, Indolfi C, Arias M, Diemberger I, Checchinato C, D'Onofrio A. Implantable defibrillator-computed respiratory disturbance index predicts new-onset atrial fibrillation: the DASAP-HF study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Sleep apnea (SA), as measured by polysomnography, is a risk factor for atrial fibrillation (AF). The DASAP-HF study previously demonstrated that the Respiratory Disturbance Index (RDI) computed by an implantable cardioverter defibrillator (ICD) algorithm accurately identifies severe SA, is associated with cardiovascular events, and independently predicts death.
Purpose
In the present analysis we tested the hypothesis that device-detected RDI could also predict AF burden.
Methods
Patients with left ventricular ejection fraction ≤35% implanted with an ICD were enrolled and followed-up for 24 months. One month after implantation, patients underwent a polysomnographic study. The weekly average RDI value was considered, as calculated by the algorithm during the entire follow-up period and over a 1 week period preceding the sleep study, and patients were stratified according to an RDI value ≥ or <30 episodes/hour. The endpoints were: daily AF burden of ≥5 minutes, ≥6 hours, ≥23 hours.
Results
164 enrolled patients had usable RDI values during the entire follow-up period. Severe SA (RDI≥30 episodes/h) was diagnosed in 92 (56%) patients at the time of the polysomnographic study. During a median follow-up of 25 months, AF burden ≥5 minutes/day was documented in 70 (43%), ≥6 hours/day in 48 (29%), and ≥23 hours/day in 33 (20%) patients. Device-detected RDI≥30 episodes/h at the time of the polysomnographic study, as well as the polysomnography-measured apnea hypopnea index ≥30 episodes/h, were not associated with the occurrence of the endpoints, using a Cox regression model. However, using time-dependent Cox model continuously measured weekly average RDI≥30episodes/h was independently associated with AF burden ≥5 minutes/day (HR: 2.13, 95% CI: 1.24–3.65, p=0.006), ≥6 hours/day (HR: 2.75, 95% CI: 1.37–5.49, p=0.004), and ≥23 hours/day (HR: 2.26, 95% CI: 1.05–4.86, p=0.037), after correction for history of AF, left atrial diameter, and gender.
Conclusions
In heart failure patients implanted with an ICD, device-diagnosed severe SA is associated with a higher risk of AF. In particular, severe SA on follow-up data review identifies patients who are from two- to three-fold more likely to experience an AF episode, according to various thresholds of daily AF burden.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Promoted by the Italian Heart Rhythm Society (AIAC).Supported by a research grant from Boston Scientific.
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Affiliation(s)
- G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
| | | | | | | | - A Capucci
- Marche Polytechnic University of Ancona, Ancona, Italy
| | | | - M Zecchin
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | | | - M Piacenti
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - C Indolfi
- Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - M.A Arias
- Hospital Virgen de la Salud, Toledo, Spain
| | - I Diemberger
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - C Checchinato
- Santa Croce Hospital of Moncalieri, Moncalieri, Italy
| | - A D'Onofrio
- AO dei Colli-Monaldi Hospital, Naples, Italy
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Sanna GD, De Bellis A, Zecchin M, Beccu E, Carta P, Moccia E, Canonico ME, Parodi G, Sinagra G, Merlo M. Prevalence, clinical and instrumental features of left bundle branch block-induced cardiomyopathy: the CLIMB registry. ESC Heart Fail 2021; 8:5589-5593. [PMID: 34510787 PMCID: PMC8712772 DOI: 10.1002/ehf2.13568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/13/2021] [Accepted: 08/04/2021] [Indexed: 01/08/2023] Open
Abstract
AIMS Although increasingly recognized as a distinct pathological entity, left bundle branch block-induced cardiomyopathy (LBBB-ICMP) is not included among the possible aetiologies of acquired dilated cardiomyopathies (DCM). While diagnostic criteria have been proposed, its recognition remains principally retrospective, in the presence of clinical and instrumental red flags. We aimed to assess the prevalence and clinical and instrumental features of LBBB-ICMP in a large cohort of patients with DCM. METHODS AND RESULTS We analysed a cohort of 242 DCM patients from a two-centre registry. Inclusion criteria were age > 18, non-ischaemic or non-valvular DCM, and LBBB on electrocardiogram. LBBB-ICMP was defined according to previously proposed diagnostic criteria: (i) neither family history nor clinically identifiable potential causes for DCM; (ii) negative genetic testing; (iii) echocardiographic features including non-severe chamber dilation, normal absolute and relative wall thickness, marked dyssynchrony, and normal right ventricular function; and (iv) absence of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR). From the entire cohort, we identified 30 subjects (similar in terms of New York Heart Association class I or II in 80% vs. 75%, P = 0.56; QRS width of 150 ± 22 vs. 151 ± 24 ms, P = 0.82; and cardiac remodelling of baseline end-diastolic diameter 66 ± 8 vs. 65 ± 10 mm, P = 0.53) with a comprehensive dataset including CMR and genetic testing, required to verify the presence of the diagnostic criteria proposed for LBBB-ICMP. The main characteristics of this subgroup were 73% males, age 45 ± 13 years, left ventricular ejection fraction (LVEF) 30 ± 10%, LGE in 38% of patients, and QRS complex of 150 ± 22 ms. Patients were under guideline-directed medical therapy, and 57% of them were treated with cardiac resynchronization therapy (CRT). Two patients (6.67%, 50% males, age 53 ± 13 years) fulfilled the diagnostic criteria proposed for LBBB-ICMP. After a follow-up of 44 (12-76) months, LVEF was normal and QRS width significantly reduced (from 154 ± 25 to 116 ± 52 ms) in patients with LBBB-ICMP. Both patients were under optimal medical treatment, and one was implanted with CRT-D. Neither of the two patients experienced death, malignant ventricular arrhythmia, or heart failure hospitalization at follow-up. CONCLUSIONS Left bundle branch block-induced cardiomyopathy emerges as a distinct pathological entity, promptly identifiable in a minority but not negligible proportion of patients with newly diagnosed DCM and LBBB, using a series of diagnostic criteria including CMR and genetic testing. Further studies are needed to better elucidate the clinical course of LBBB-ICMP.
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Affiliation(s)
- Giuseppe D Sanna
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico De Nicola, Sassari, 07100, Italy
| | - Annamaria De Bellis
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste, Trieste, Italy
| | - Massimo Zecchin
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste, Trieste, Italy
| | - Eleonora Beccu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - Patrizia Carta
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - Eleonora Moccia
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - Mario E Canonico
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - Guido Parodi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste, Trieste, Italy
| | - Marco Merlo
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste, Trieste, Italy
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Biffi M, Aspromonte N, Bongiorni MG, Clemenza F, D'Onofrio A, De Ferrari GM, Giallauria F, Grimaldi M, Oliva F, Senni M, Tondo C, Zecchin M, Cappannoli L, Giannotti Santoro M, Ziacchi M, Porcari A, Sinagra G. [Cardiac contractility modulation in heart failure with reduced ejection fraction: critical review of evidence and application perspectives]. G Ital Cardiol (Rome) 2021; 22:727-741. [PMID: 34463682 DOI: 10.1714/3660.36450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This critical review illustrates the pathophysiological aspects and available scientific evidence about cardiac contractility modulation therapy. A useful algorithm dealing with the essential decisional knots to consider for device implantation in patients with heart failure in NYHA class >II and ejection fraction ≤45% is presented. The present review paves the way for the development of an Italian registry aiming at analyzing the characteristics of implanted patients based on a multiparametric approach, including cardiac biomarkers, to identify clinical profiles and predictors of response to therapy. The "Answers and Questions" section provides useful insights into pathophysiology, technical specifications, clinically relevant scenarios and future perspectives.
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Affiliation(s)
- Mauro Biffi
- Policlinico Sant'Orsola, Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Nadia Aspromonte
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma
| | - Maria Grazia Bongiorni
- U.O. Cardiologia 2 SSN, Dipartimento Cardiovascolare, Ospedale Cisanello, Azienda Ospedaliero-Universitaria, Pisa
| | | | | | | | - Francesco Giallauria
- U.O. Medicina Interna ad Indirizzo Metabolico e Riabilitativo, Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli "Federico II", Napoli
| | - Massimo Grimaldi
- U.O.C. Cardiologia, Ospedale "F. Miulli", Acquaviva delle Fonti (BA)
| | - Fabrizio Oliva
- Dipartimento Cardiovascolare, ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Michele Senni
- Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | - Claudio Tondo
- Centro Cardiologico Monzino, IRCCS, Dipartimento di Scienze Biochimiche, Chirurgiche e Odontoiatriche, Università degli Studi, Milano
| | - Massimo Zecchin
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) e Università degli Studi di Trieste, Trieste
| | - Luigi Cappannoli
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma
| | - Mario Giannotti Santoro
- U.O. Cardiologia 2 SSN, Dipartimento Cardiovascolare, Ospedale Cisanello, Azienda Ospedaliero-Universitaria, Pisa
| | - Matteo Ziacchi
- Policlinico Sant'Orsola, Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Aldostefano Porcari
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) e Università degli Studi di Trieste, Trieste
| | - Gianfranco Sinagra
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) e Università degli Studi di Trieste, Trieste
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D'Onofrio A, Solimene F, Calò L, Calvi V, Viscusi M, Melissano D, Russo V, Rapacciuolo A, Campana A, Caravati F, Bonfanti P, Zanotto G, Gronda E, Vado A, Calzolari V, Botto GL, Zecchin M, Bontempi L, Giacopelli D, Gargaro A, Padeletti L. Combining Home Monitoring temporal trends from implanted defibrillators and baseline patient risk profile to predict heart failure hospitalizations: results from the SELENE HF study. Europace 2021; 24:234-244. [PMID: 34392336 PMCID: PMC8824514 DOI: 10.1093/europace/euab170] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/18/2021] [Indexed: 11/15/2022] Open
Abstract
AIMS We developed and validated an algorithm for prediction of heart failure (HF) hospitalizations using remote monitoring (RM) data transmitted by implanted defibrillators. METHODS AND RESULTS The SELENE HF study enrolled 918 patients (median age 69 years, 81% men, median ejection fraction 30%) with cardiac resynchronization therapy (44%), dual-chamber (38%), or single-chamber defibrillators with atrial diagnostics (18%). To develop a predictive algorithm, temporal trends of diurnal and nocturnal heart rates, ventricular extrasystoles, atrial tachyarrhythmia burden, heart rate variability, physical activity, and thoracic impedance obtained by daily automatic RM were combined with a baseline risk-stratifier (Seattle HF Model) into one index. The primary endpoint was the first post-implant adjudicated HF hospitalization. After a median follow-up of 22.5 months since enrolment, patients were randomly allocated to the algorithm derivation group (n = 457; 31 endpoints) or algorithm validation group (n = 461; 29 endpoints). In the derivation group, the index showed a C-statistics of 0.89 [95% confidence interval (CI): 0.83-0.95] with 2.73 odds ratio (CI 1.98-3.78) for first HF hospitalization per unitary increase of index value (P < 0.001). In the validation group, sensitivity of predicting primary endpoint was 65.5% (CI 45.7-82.1%), median alerting time 42 days (interquartile range 21-89), and false (or unexplained) alert rate 0.69 (CI 0.64-0.74) [or 0.63 (CI 0.58-0.68)] per patient-year. Without the baseline risk-stratifier, the sensitivity remained 65.5% and the false/unexplained alert rates increased by ≈10% to 0.76/0.71 per patient-year. CONCLUSION With the developed algorithm, two-thirds of first post-implant HF hospitalizations could be predicted timely with only 0.7 false alerts per patient-year.
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Affiliation(s)
- Antonio D'Onofrio
- Cardiology Department - Electrophysiology and Cardiac Pacing Unit A.O.R.N. V. Monaldi, Via L. Bianchi, Naples, Italy
| | - Francesco Solimene
- Electrophysiology, Montevergine Clinic, Viale S. Modestino 8, 83013 Mercogliano, Italy
| | - Leonardo Calò
- Cardiology Division, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Valeria Calvi
- Cardiology Department, Policlinico G. Rodolico, AOU Policlinico V. Emanuele, Via S. Sofia 78, 95125 Catania, Italy
| | - Miguel Viscusi
- Cardiology Division, Sant'Anna and San Sebastiano Hospital, Via F. Palasciano, 81100 Caserta, Italy
| | - Donato Melissano
- Cardiology Division, F. Ferrari Hospital, Viale F. Ferrari 1, 73042 Casarano (LE), Italy
| | - Vitantonio Russo
- Cardiology Division, SS. Annunziata Hospital, Via F. Bruno 1, 74121 Taranto, Italy
| | - Antonio Rapacciuolo
- Cardiology Department of Advanced Biomedical Sciences, Corso Umberto I 40, 80138 Federico II University of Naples, Italy
| | - Andrea Campana
- Cardiology Division, A.O.U. San Giovanni di Dio e Ruggi D'Aragona, Via San Leonardo 1, 84131 Salerno, Italy
| | - Fabrizio Caravati
- Division of Cardiology, ASST Settelaghi, Di Circolo Hospital, Via L. Borri 57, 21100 Varese, Italy
| | - Paolo Bonfanti
- Cardiology Division, Rho Civil Hospital, Corso Europa 250, 20017 Rho (MI), Italy
| | - Gabriele Zanotto
- Cardiology Division, Mater Salutis Hospital, Via C. Gianella 1, 37045 Legnago, Italy
| | - Edoardo Gronda
- Department of Medicine and Medical Specialties, I.R.C.C.S. Foundation Ca' Granda, Via M. Fanti 6, 20122 Milano, Italy
| | - Antonello Vado
- Cardiology Division, S. Croce e Carle Hospital, Via M. Coppino 26, 12100 Cuneo, Italy
| | - Vittorio Calzolari
- Cardiology Division, Santa Maria di Ca' Foncello Hospital, Piazzale dell'Ospedale 1, 31100 Treviso, Italy
| | - Giovanni Luca Botto
- Cardiology Division, Rho Civil Hospital, Corso Europa 250, 20017 Rho (MI), Italy
| | - Massimo Zecchin
- Cardiology Department, Cattinara University Hospital, Strada di Fiume 447, 34149 Trieste, Italy
| | - Luca Bontempi
- Cardiology Division, Spedali Civili , Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | | | - Alessio Gargaro
- BIOTRONIK Italia, Via delle Industrie 11, 20090 Vimodrone (MI), Italy
| | - Luigi Padeletti
- Cardiology Department, I.R.C.C.S. MultiMedica, Via Milanese 300, 20099 Sesto San Giovanni, Milano, Italy
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Zecchin M, Calvanese R, Pignalberi C, Mascioli G, Bardari S, China P, Sgarito G, Nesti M. [Arrhythmias and sudden death in neuromuscular disorders]. G Ital Cardiol (Rome) 2021; 22:466-479. [PMID: 34037591 DOI: 10.1714/3612.35931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Neuromuscular diseases (NMD) are a broadly defined group of disorders that all involve injury or dysfunction of peripheral nerves, neuromuscular junction or muscle, often with dominant or recessive pattern of inheritance. Cardiac involvement is uncommon, in particular with cardiomyopathies and brady/tachyarrhythmias. The causes of cardiac involvement are unclear: replacement fibrosis, alteration of membrane permeability, sympathetic hyperactivity, or accumulation of toxic metabolites can play a role in the pathogenesis of cardiac disorders. The early diagnosis is of pivotal importance to prevent evolution of the disease: electrocardiographic alterations and arrhythmias, particularly if associated with family history for cardiomyopathy or sudden death, can be an early signal of cardiomyopathy associated with NMD. Genetic analysis can improve prognostic stratification, particularly related to arrhythmic risk, and guide to a tailored therapy.
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31
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Albani S, Rocotti A, Berchialla P, Bongioanni S, Mabritto B, Luceri S, Parrini I, Tommasello A, Pizzuti A, Bianchi F, Buongiorno A, De Luca A, Grilli G, Pinamonti B, Merlo M, Zecchin M, Grossi S, Sinagra G, Musumeci G. PROGNOSTIC IMPACT OF TRANS-CATHETER ATRIAL FIBRILLATION ABLATION ON HYPERTROPHIC CARDIOMYOPATHY OUTCOME: A MULTICENTER RETROSPECTIVE LONG-TERM FOLLOW UP STUDY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01699-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Zecchin M, Torre M, Carrani E, Sampaolo L, Ciminello E, Ortis B, Ricci R, Proclemer A, Sinagra G, Boriani G. Seventeen-year trend (2001-2017) in pacemaker and implantable cardioverter-defibrillator utilization based on hospital discharge database data: An analysis by age groups. Eur J Intern Med 2021; 84:38-45. [PMID: 32933841 DOI: 10.1016/j.ejim.2020.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
AIMS To analyze temporal trends (2001 -2017) of Pacemakers (PM) and Implantable Cardioverter-Defibrillators (ICD) procedures in Italy, according to the national Hospital Discharge Database (HDD). METHODS Frequency and implant rate (IR) in the Italian population were analyzed by age groups (<50, 50-79, ≥80 years). RESULTS From 2001 (2009 for Cardiac Resynchronization Therapy-Defibrillator - CRT-D) to 2017, first PM implants (1stPM) increased from 36,823 (637/million inhabitants) to 49,716 (820/million), ICD implants from 3,141 (54/million) to 24,255 (400/million) and CRT-D from 2,915 (49/million, 16.5% of ICD) to 8,595 (142/million, 35.4% of ICD). ICD implants due to ventricular tachycardia or ventricular fibrillation decreased from 55.6% to 13.5% and from 15.9% to 4.5% respectively, while the proportion increased among patients with heart failure (from 22.9% to 46.8%), hypertension (from 11.1% to 15.0%), diabetes (from 6.5% to 10.9%), and renal insufficiency (from 4.4% to 7.6%). Both PM and ICD procedures markedly increased in patients ≥80 years old. However, while IR for ICDs increased from 82/million to 1,038/million inhabitants, IR of 1stPM only changed from 6,111/million to 6,212/million as the population in this age group nearly doubled in Italy. CONCLUSION Since 2001, the increase of 1stPM in Italy was mainly due to the ultra-octogenarian population growth. No differences were observed for IR in each PM age group, while the absolute number and IR increased in all groups (especially ≥80 years old) for ICDs and CRT-Ds. An increase in comorbidities and a reduction in implants for secondary prevention were observed in the ICD population.
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Affiliation(s)
- Massimo Zecchin
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.
| | | | | | | | - Enrico Ciminello
- Istituto Superiore di Sanità, Roma, Italy; "La Sapienza" University of Rome, Italy
| | - Benedetta Ortis
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Renato Ricci
- Associazione Italiana Aritmologia e Cardiostimolazione, Roma, Italy
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33
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Merlo M, Cappelletto C, De Angelis G, Porcari A, Caiffa T, Lardieri G, Pagnan L, Severini GM, Dal Ferro M, Stolfo D, Vitrella G, De Luca A, Korkova R, Massa L, Tavcˇar I, Aleksova A, Barbati G, Zanchi C, Ramani F, Di Lenarda A, Perkan A, Mestroni L, Zecchin M, Pinamonti B, Bussani R, Sinagra G. [Diagnostic work-up and clinical management of cardiomyopathies: the operative protocol from the Cardiothoracovascular Department of Trieste, Italy]. G Ital Cardiol (Rome) 2020; 21:935-953. [PMID: 33231213 DOI: 10.1714/3472.34548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cardiomyopathies are primary myocardial disorders, genetically determined, with clinical onset between the third and the fifth decade of life. They represent the main causes of sudden cardiac death and heart failure in the youth. The more common myocardial diseases in clinical practice are dilated cardiomyopathy, arrhythmogenic cardiomyopathy and hypertrophic cardiomyopathy. Next generation sequencing techniques, recently available for genetics researches, together with the diffusion of advanced imaging techniques, permitted in the last years a deeper knowledge of these pathologies. Nevertheless, diagnosis, etiology and several aspects of patients' clinical management remain complex and controversial. This review paper aims to propose some operative flow-charts, derived from scientific evidences and the internal protocol of the Cardiothoracovascular Department of Trieste Hospital, Italian referral Center for cardiomyopathies and heart failure, with more than 30 years of experience in diagnosis and management of patients who suffer from primary myocardial disorders.
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Affiliation(s)
- Marco Merlo
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Chiara Cappelletto
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Giulia De Angelis
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Aldostefano Porcari
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Thomas Caiffa
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Gerardina Lardieri
- Cardiologia, Ospedale di Gorizia e Monfalcone, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Lorenzo Pagnan
- S.C. Radiologia Diagnostica ed Interventistica, Dipartimento di Diagnostica per Immagini, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | | | - Matteo Dal Ferro
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste - Centro di Cardiologia Traslazionale, Laboratorio di Cardiologia Molecolare, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Davide Stolfo
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Giancarlo Vitrella
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Antonio De Luca
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Renata Korkova
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Laura Massa
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Irena Tavcˇar
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Aneta Aleksova
- Centro di Cardiologia Traslazionale, Laboratorio di Cardiologia Molecolare, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Giulia Barbati
- Unità di Biostatistica, Dipartimento di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste
| | - Cristiana Zanchi
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Federica Ramani
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Andrea Di Lenarda
- Centro Cardiovascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Andrea Perkan
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Massimo Zecchin
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Bruno Pinamonti
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Rossana Bussani
- S.S. Patologia Cardiovascolare, Anatomia e Istologia Patologica, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Gianfranco Sinagra
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
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34
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Cipriani M, Merlo M, Gabrielli D, Ammirati E, Autore C, Basso C, Caforio A, Caldarola P, Camici P, Di Lenarda A, Frustaci A, Imazio M, Oliva F, Pedrotti P, Perazzolo Marra M, Rapezzi C, Urbinati S, Zecchin M, Filardi PP, Colivicchi F, Indolfi C, Frigerio M, Sinagra G. [ANMCO/SIC Consensus document on the management of myocarditis]. G Ital Cardiol (Rome) 2020; 21:969-989. [PMID: 33231216 DOI: 10.1714/3472.34551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Myocarditis is an inflammatory heart disease that can occur acutely, as in acute myocarditis, or persistently, as in chronic myocarditis or chronic inflammatory cardiomyopathy. Different agents can induce myocarditis, with viruses being the most common triggers. Generally, acute myocarditis affects relatively young people and men more than women. Myocarditis has a broad spectrum of clinical presentations and evolution trajectories, although most cases resolve spontaneously. Patients with reduced left ventricular ejection fraction, heart failure symptoms, advanced atrioventricular block, sustained ventricular arrhythmias or cardiogenic shock (the latter known as fulminant myocarditis) are at increased risk for death and heart transplantation. The presentation of chronic inflammatory cardiomyopathy may be more subtle, with progressive symptoms of heart failure or appearance of rhythm disturbance, not rarely preceded by an infective episode. Autoimmune disorder or systemic inflammatory conditions can be another significant predisposing substrate of myocarditis, especially in women. Emerging causes of myocarditis are drug-related like the new anticancer therapies, the immune checkpoint inhibitors. In this Italian Association of Hospital Cardiologists (ANMCO) and Italian Society of Cardiology (SIC) expert consensus document on myocarditis, we propose diagnostic strategies for identifying possible causes of the disease and factors associated with increased risk. Finally, we propose potential treatments and when referring patients to tertiary centers, especially for high-risk patients. Even if endomyocardial biopsy is the invasive diagnostic tool for making definitive diagnosis and differentiation of histological subtypes (i.e., lymphocytic vs eosinophilic vs giant cell myocarditis), it is not always readily available in all centers. Thus, we propose when this exam is mandatory or when it can be postponed or substituted by cardiac magnetic resonance imaging. This document reflects the Italian perspective on managing patients with myocarditis and their follow-up, considering also current US and European scientific position statements.
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Affiliation(s)
- Manlio Cipriani
- Cardiologia 2-Insufficienza Cardiaca e Trapianti, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Marco Merlo
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Università di Trieste
| | - Domenico Gabrielli
- A.S.U.R. Marche - Area Vasta 4 Fermo, Ospedale Civile Augusto Murri, Fermo
| | - Enrico Ammirati
- Cardiologia 2-Insufficienza Cardiaca e Trapianti, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Camillo Autore
- Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma; Unità di Terapia Intensiva Cardiologica, Ospedale Sant'Andrea, Roma
| | - Cristina Basso
- U.O.C. Patologia Cardiovascolare, Azienda Ospedaliera, Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Padova
| | - Alida Caforio
- Clinica Cardiologica, Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Padova
| | | | - Paolo Camici
- Centro di Ricerca Cardiovascolare, Ospedale San Raffaele e Università Vita-Salute, Milano
| | - Andrea Di Lenarda
- S.C. Cardiovascolare e Medicina dello Sport, Ospedale Maggiore di Trieste, ASUI Trieste
| | - Andrea Frustaci
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza Università di Roma; IRCCS Istituto Nazionale per le Malattie Infettive "L. Spallanzani", Roma
| | - Massimo Imazio
- Cardiologia, Presidio Molinette, AOU Città della Salute e della Scienza, Torino
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Unità di Cure Intensive Cardiologiche, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Patrizia Pedrotti
- Cardiologia 4-Diagnostica e Riabilitativa, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Martina Perazzolo Marra
- Clinica Cardiologica, Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Padova
| | - Claudio Rapezzi
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Università degli Studi, Ferrara
| | | | - Massimo Zecchin
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Università di Trieste
| | | | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Ciro Indolfi
- U.O. Cardiologia, Emodinamica e UTIC, Università degli Studi "Magna Graecia", Catanzaro; Cardiocentro Mediterranea, Napoli
| | - Maria Frigerio
- Cardiologia 2-Insufficienza Cardiaca e Trapianti, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Gianfranco Sinagra
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Università di Trieste
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35
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Boriani G, Pisanò ECL, Pieragnoli P, Locatelli A, Capucci A, Talarico A, Zecchin M, Rapacciuolo A, Piacenti M, Indolfi C, Arias MA, Diemberger I, Checchinato C, La Rovere MT, Sinagra G, Emdin M, Ricci RP, D'Onofrio A. Prognostic value of implantable defibrillator-computed respiratory disturbance index: The DASAP-HF study. Heart Rhythm 2020; 18:374-381. [PMID: 33283757 DOI: 10.1016/j.hrthm.2020.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/01/2020] [Accepted: 10/22/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sleep apnea, as measured by polysomnography, is associated with adverse outcomes in heart failure. The DASAP-HF (Diagnosis and Treatment of Sleep Apnea in Patient With Heart Failure) study previously demonstrated that the respiratory disturbance index (RDI) computed by the ApneaScan algorithm (Boston Scientific) accurately identifies severe sleep apnea in implantable cardioverter-defibrillator (ICD) patients. OBJECTIVE The purpose of the long-term study phase was to assess the incidence of clinical events after 24 months and investigate the association with RDI values. METHODS Patients with left ventricular ejection fraction ≤35% implanted with an ICD were enrolled and followed-up for 24 months. The RDI calculated at 1 month after implantation was used to stratify patients (below or above 30 episodes/h). The endpoints were all-cause death and a combination of all-cause death or cardiovascular hospitalization. RESULTS Of the 265 enrolled patients, 224 had usable RDI values. Severe sleep apnea (RDI ≥30 episodes/h) was diagnosed in 115 patients (51%). These patients were more frequently male (84% vs 72%; P = .030) and had higher creatinine levels. During median follow-up of 25 months, 19 patients (8%) died. Cardiovascular hospitalizations were reported in 19 patients (8%). The risk of all-cause death was higher in patients with RDI ≥30 episodes/h (hazard ratio [HR] 3.33; 95% confidence interval [CI] 1.35-8.21; P = .023), as well as the risk of all-cause death or cardiovascular hospitalization (HR 1.94; 95% CI 1.01-3.76; P = .048). At multivariate analysis, independent predictors of death were RDI ≥30 episodes/h (HR 4.02; 95% CI 1.16-13.97; P = .029) and creatinine levels (HR 2.36; 95% CI 1.26-4.42; P = .008). CONCLUSION In heart failure patients implanted with an ICD, higher RDI values are associated with death and cardiovascular hospitalizations. Device-detected severe sleep apnea independently predicts death.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Igor Diemberger
- University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | | | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico di Montescano, Montescano, Pavia
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36
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Nuzzi V, Cannatà A, Manca P, Castrichini M, Barbati G, Aleksova A, Fabris E, Zecchin M, Merlo M, Boriani G, Sinagra G. Atrial fibrillation in dilated cardiomyopathy: Outcome prediction from an observational registry. Int J Cardiol 2020; 323:140-147. [PMID: 32853666 DOI: 10.1016/j.ijcard.2020.08.062] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Little is known about the role of different types of atrial fibrillation (AF) in dilated cardiomyopathy (DCM). We investigated the epidemiological and prognostic impact of different types of AF in DCM during long-term follow-up. METHOD We evaluated consecutive DCM patients enrolled in the Trieste Muscle Heart Disease Registry. Uni- and multivariable, extended Kaplan-Meier and propensity score-matching analyses were performed for a composite outcome including death/heart transplantation/ventricular-assist device implantation. RESULTS Out of 1181 DCM patients (71% males, age 49 ± 15 years, left ventricular ejection fraction 33 ± 11%), 46 (3.9%) had baseline permanent AF (permAF), while 66 (5.6%) had a history of paroxysmal/persistent AF. Compared with sinus rhythm (SR) patients, permAF patients were older (48 ± 15 vs. 61 ± 11 respectively, p = 0.001), were more frequently in NYHA class III-IV (18% vs. 30%, p = 0.002) and had larger left atrium diameter (40 ± 8 vs. 50 ± 10 mm, respectively). Paroxysmal/persistent AF patients had intermediate characteristics between permAF and SR. During a median follow-up of 135 (75-210) months, 63 patients developed permAF (0.45 new cases/100patients/year). At multivariable analysis, permAF as a time-dependent variable was an independent outcome predictor (HR 2.45; 95% C.I. 2.61-3.63, p < 0.001), together with creatinine, NYHA class, restrictive filling pattern and moderate-severe mitral regurgitation, while paroxysmal/persistent AF was neutral. Propensity score-matching analysis confirmed the higher rate of primary outcome events in patients with baseline or incident permAF versus patients without permAF during a very long-term follow-up (70% vs. 20%, p < 0.001). CONCLUSIONS PermAF in a large DCM cohort had low prevalence and incidence but had a relevant. prognostic role on hard outcomes.
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Affiliation(s)
- Vincenzo Nuzzi
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - Antonio Cannatà
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - Paolo Manca
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - Matteo Castrichini
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - Giulia Barbati
- Department of Medical Sciences, Biostatistics Unit, University of Trieste, Trieste, Italy
| | - Aneta Aleksova
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - Enrico Fabris
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - Massimo Zecchin
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy.
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
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37
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Pastoricchio M, Dell’Antonio A, Zecchin M, Bianco E, Zucca A, Biloslavo A, Bortul M. An uncommon case of inferior vena cava injury during atrial fibrillation ablation. J Surg Case Rep 2020; 2020:rjaa201. [PMID: 32855791 PMCID: PMC7443344 DOI: 10.1093/jscr/rjaa201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/30/2020] [Indexed: 12/30/2022] Open
Abstract
A 64-year-old man underwent catheter ablation (CA) of atrial fibrillation with intracardiac echocardiography (ICE) assistance. As the probe was advanced toward the right atrium, sudden abdominal pain was felt by the patient with hypotension and tachycardia requiring fluids and vasopressors for hemodynamic stabilization. The inferior vena cava (IVC) was injured by the passing probe and open repair was then performed. To our knowledge, this is the first reported case of symptomatic IVC laceration by the probe used for ICE during CA.
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Affiliation(s)
- Manuela Pastoricchio
- Correspondence address. Division of Clinical Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara University Hospital, Strada di Fiume 447, Trieste 34149, Italy. Tel: +39-040-3994152; Fax: +39-040-3994261; E-mail:
| | - Andrea Dell’Antonio
- Division of Clinical Surgery, Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, Trieste 34149, Italy
| | - Massimo Zecchin
- Cardiovascular Department, Cattinara University Hospital, Trieste 34149, Italy
| | - Elisabetta Bianco
- Cardiovascular Department, Cattinara University Hospital, Trieste 34149, Italy
| | - Annalisa Zucca
- Division of Clinical Surgery, Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, Trieste 34149, Italy
| | - Alan Biloslavo
- Division of Clinical Surgery, Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, Trieste 34149, Italy
| | - Marina Bortul
- Division of Clinical Surgery, Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, Trieste 34149, Italy
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38
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Gulizia MM, Zecchin M, Colivicchi F, Francese GM, Murrone A, Caldarola P, Di Lenarda A, Valente S, Roncon L, Amodeo E, Aspromonte N, Cipriani MG, Domenicucci S, Imazio M, Scotto di Uccio F, Urbinati S, Gabrielli D. ANMCO POSITION PAPER: The management of suspect or confirmed COVID-19 patients needing urgent electrophysiology and/or electrostimulation procedures. Eur Heart J Suppl 2020; 22:G211-G216. [PMID: 38626248 PMCID: PMC7499581 DOI: 10.1093/eurheartj/suaa109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The aim of this document is the management and organization of patients in need of urgent access to electrophysiology (EP) and pacing procedures during the COVID-19 emergency. Specifically, non-deferrable procedures or irreplaceable with a drug therapy prior to the resolution of the COVID-19 virus emergency [pacemaker (PM) implant/replacement/urgent defibrillator (implantable cardioverter-defibrillator, ICD) or arrhythmic storm or other indication of non-deferrable ablation]. The pacing and electrophysiological procedures urgent as they may be, less and less frequently represent situations of emergency, therefore for almost all cases, it is possible to perform a swab test to determine the positivity to COVID-19 of the patient. In cases where this is not possible, due to situations of emergency, the recommendations and procedures we have indicated are advisable, if not mandatory, in order to avoid the spreading of the virus to healthcare personnel and other patients.
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Affiliation(s)
- Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
- Fondazione per il Tuo cuore, Firenze – Heart Care Foundation Onlus, Italy
| | | | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Rome, Italy
| | - Giuseppina Maura Francese
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Adriano Murrone
- Cardiology-ICU Department, Ospedali di Città di Castello e Gubbio - Gualdo Tadino Azienda USL Umbria 1, Perugia, Perugia
| | | | - Andrea Di Lenarda
- Cardiovascular and Sports Medicine Department, A.S.U. Integrata di Trieste, Italy
| | - Serafina Valente
- Clinical-Surgical Cardiology and ICU Department, A.O.U. Senese Ospedale Santa Maria alle Scotte, Siena, Italy
| | - Loris Roncon
- Cardiology Department, Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | - Enzo Amodeo
- Cardiology-ICU Department, Ospedale Santa Maria degli Ungheresi, Polistena, RC, Italy
| | - Nadia Aspromonte
- Heart Failure Unit, Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Manlio Gianni Cipriani
- Cardiology 2-Cardiac Failure and Transplantation Unit, Cardiotoracovascular Department “A. De Gasperis”, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Massimo Imazio
- Cardiology Department, Presidio Molinette, A.O.U. Città della Salute e della Scienza in Turin, Italy
| | | | - Stefano Urbinati
- Cardiology Department, Ospedale Bellaria, AUSL di Bologna, Bologna, Italy
| | - Domenico Gabrielli
- Cardiology Department, Ospedale Civile Augusto Murri, Fermo, Italy
- Italian Association of Hospital Cardiologists, Florence, Italy
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39
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Merlo M, Cannatà A, Pio Loco C, Stolfo D, Barbati G, Artico J, Gentile P, De Paris V, Ramani F, Zecchin M, Gigli M, Pinamonti B, Korcova R, Di Lenarda A, Giacca M, Mestroni L, Camici PG, Sinagra G. Contemporary survival trends and aetiological characterization in non‐ischaemic dilated cardiomyopathy. Eur J Heart Fail 2020; 22:1111-1121. [DOI: 10.1002/ejhf.1914] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/23/2020] [Accepted: 05/22/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Marco Merlo
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Antonio Cannatà
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine King's College London London UK
| | - Carola Pio Loco
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Davide Stolfo
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | | | - Jessica Artico
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Piero Gentile
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Valerio De Paris
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Federica Ramani
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Massimo Zecchin
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Marta Gigli
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Bruno Pinamonti
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Renata Korcova
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Andrea Di Lenarda
- Cardiovascular Centre Azienda Sanitaria Universitaria Integrata of Trieste (ASUITS), University of Trieste Trieste Italy
| | - Mauro Giacca
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine King's College London London UK
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Paolo G. Camici
- Vita Salute University and San Raffaele Hospital Milan Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
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Zecchin M, Solimene F, D"onofrio A, Zanotto G, Iacopino S, Pignalberi C, Calvi V, Maglia G, Della Bella P, Quartieri F, Curnis A, Biffi M, Giacopelli D, Gargaro A, Pisano" E. 853Could baseline electrical parameters be a marker of arrhythmia occurrence and poorer prognosis in implantable cardioverter defibrillator patients? Europace 2020. [DOI: 10.1093/europace/euaa162.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Background/Introduction: Parameters routinely measured during cardiac devices implantation also depend on bioelectrical properties of the myocardial tissue.
Purpose
To explore the potential association of electrical parameters with clinical outcomes in implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillators (CRT-D) recipients.
Methods
In the framework of the Home Monitoring Expert Alliance, baseline electrical parameters for all implanted leads were compared by occurrence of all-cause mortality, adjudicated ventricular arrhythmia (VA) and atrial high rate episode lasting ≥7 days (7day-AHRE).
Results
In a cohort of 2,976 patients (58.1% ICD) with a median follow-up of 25 months, events rates were 3.1/100 patient-years for all-cause mortality, 18.1/100 patient-years for VA and 8.9/100 patient-years for 7day-AHRE.
At univariate analysis baseline shock impedance was consistently lower in groups with events than in those without, with a 40 Ohm cut-off better identifying patients at high risk, but at multivariable analysis the adjusted-hazard ratios (HRs) lost statistical significance for any endpoint.
Baseline atrial sensing amplitude during sinus rhythm was lower in patients with 7-day AHRE as compared to those without (2.40 [IQ: 1.62-3.71] Vs 3.50 [IQ: 2.35-4.66] mV, p < 0.01). The adjusted-HR for 7-day AHRE in patients with atrial sensing >1.5 mV versus those with values ≤1.5 mV was 0.44 (95% CI:0.27-0.72), p = 0.001.
Conclusion
Despite in patients with events a lower baseline shock impedance was observed at univariate analysis, the association lost statistical significance at multivariable analysis. Conversely, low sinus rhythm atrial sensing (≤1.5 mV) measured with standard transvenous leads could identify subjects at high risk of long-lasting atrial arrhythmia.
Abstract Figure. AHRE occurrence by atrial sensing
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Affiliation(s)
- M Zecchin
- Azienda Sanitaria Universitaria Integrata di Trieste, Cardiology, Trieste, Italy
| | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - A D"onofrio
- AO dei Colli-Monaldi Hospital, Cardiology, Naples, Italy
| | - G Zanotto
- Mater Salutis Hospital, Legnago, Italy
| | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
| | | | - V Calvi
- Ferrarotto Hospital, Catania, Italy
| | - G Maglia
- Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | | | - F Quartieri
- Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - A Curnis
- Civil Hospital of Brescia, Brescia, Italy
| | - M Biffi
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
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41
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Stolfo D, Albani S, Savarese G, Barbati G, Ramani F, Gigli M, Biondi F, Dal Ferro M, Zecchin M, Merlo M, Sinagra G. Risk of sudden cardiac death in New York Heart Association class I patients with dilated cardiomyopathy: A competing risk analysis. Int J Cardiol 2020; 307:75-81. [DOI: 10.1016/j.ijcard.2020.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/05/2020] [Accepted: 02/09/2020] [Indexed: 12/27/2022]
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42
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Gulizia MM, Zecchin M, Colivicchi F, Francese GM, Murrone A, Caldarola P, Di Lenarda A, Valente S, Roncon L, Amodeo E, Aspromonte N, Cipriani MG, Domenicucci S, Imazio M, Scotto Di Uccio F, Urbinati S, Gabrielli D. [ANMCO Position paper: Guidance for the management of suspected or confirmed COVID-19 patients requiring urgent electrophysiological procedures]. G Ital Cardiol (Rome) 2020; 21:336-340. [PMID: 32310918 DOI: 10.1714/3343.33130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania - Presidente Fondazione per il Tuo cuore, Firenze - Heart Care Foundation Onlus
| | | | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma
| | - Giuseppina Maura Francese
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | - Adriano Murrone
- U.O.C. Cardiologia-UTIC, Ospedali di Città di Castello e Gubbio - Gualdo Tadino Azienda USL Umbria 1, Perugia
| | | | - Andrea Di Lenarda
- S.C. Cardiovascolare e Medicina dello Sport, A.S.U. Integrata di Trieste
| | - Serafina Valente
- U.O.C. Cardiologia Clinico-Chirurgica-UTIC, A.O.U. Senese Ospedale Santa Maria alle Scotte, Siena
| | - Loris Roncon
- U.O.C. Cardiologia, Ospedale Santa Maria della Misericordia, Rovigo
| | - Enzo Amodeo
- U.O.C. Cardiologia-UTIC, Ospedale Santa Maria degli Ungheresi, Polistena (RC)
| | - Nadia Aspromonte
- U.O.S. Scompenso Cardiaco, Dipartimento Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma
| | - Manlio Gianni Cipriani
- Cardiologia 2-Insufficienza Cardiaca e Trapianti, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | | | - Massimo Imazio
- Cardiologia, Presidio Molinette, A.O.U. Città della Salute e della Scienza di Torino, Torino
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43
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Lucà F, Cipolletta L, Di Fusco SA, Rao CM, Ingianni N, Iorio A, Francese GM, Gelsomino S, Zecchin M, Gabrielli D, Gulizia MM. A practical guide to pacemaker follow-up. Minerva Cardioangiol 2020; 67:433-438. [PMID: 31637899 DOI: 10.23736/s0026-4725.19.04843-6] [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: 11/08/2022]
Affiliation(s)
- Fabiana Lucà
- Unit of Intensive Therapy, Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy - .,Unit of Interventional Cardiology, Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy -
| | - Laura Cipolletta
- Department of Cardiovascular Sciences, Clinic of Cardiology, Ospedali Riuniti di Ancona University Hospital, Ancona, Italy
| | - Stefania A Di Fusco
- Unit of Cardiology, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy.,Unit of Intensive Therapy, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Carmelo M Rao
- Unit of Intensive Therapy, Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy.,Unit of Interventional Cardiology, Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy
| | - Nadia Ingianni
- Unit of Cardiology, Paolo Borsellino Hospital, ASP Trapani, Marsala, Italy.,Unit of Intensive Therapy, Paolo Borsellino Hospital, ASP Trapani, Marsala, Italy
| | - Annamaria Iorio
- Unit of Cardiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giuseppina M Francese
- Unit of Cardiology, Garibaldi-Nesima Hospital, Azienda di Rilevo Nazionale e Alta Specialità, Catania, Italy
| | - Sandro Gelsomino
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, the Netherlands
| | - Massimo Zecchin
- Unit of Cardiology, Ospedali Riuniti University Hospital, Trieste, Italy
| | | | - Michele M Gulizia
- Unit of Cardiology, Garibaldi-Nesima Hospital, Azienda di Rilevo Nazionale e Alta Specialità, Catania, Italy.,Fondazione per il Tuo Cuore, Florence, Italy
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44
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Zecchin M, Solimene F, D'Onofrio A, Zanotto G, Iacopino S, Pignalberi C, Calvi V, Maglia G, Della Bella P, Quartieri F, Curnis A, Biffi M, Capucci A, Caravati F, Senatore G, Santamaria M, Lissoni F, Manzo M, Marini M, Giammaria M, Rapacciuolo A, Sinagra G, Giacopelli D, Gargaro A, Pisanò EC. Atrial signal amplitude predicts atrial high-rate episodes in implantable cardioverter defibrillator patients: Insights from a large database of remote monitoring transmissions. J Arrhythm 2020; 36:353-362. [PMID: 32256887 PMCID: PMC7132187 DOI: 10.1002/joa3.12319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/07/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Parameters measured during implantable cardioverter defibrillator (ICD) implant also depend on bioelectrical properties of the myocardium. We aimed to explore their potential association with clinical outcomes in patients with single/dual-chamber ICD and cardiac resynchronization therapy defibrillator (CRT-D). METHODS In the framework of the Home Monitoring Expert Alliance, baseline electrical parameters for all implanted leads were compared by the occurrence of all-cause mortality, adjudicated ventricular arrhythmia (VA), and atrial high-rate episode lasting ≥24 hours (24 h AHRE). RESULTS In a cohort of 2976 patients (58.1% ICD) with a median follow-up of 25 months, event rates were 3.1/100 patient-years for all-cause mortality, 18.1/100 patient-years for VA, and 9.3/100 patient-years for 24 h AHRE. At univariate analysis, baseline shock impedance was consistently lower in groups with events than without, with a 40 Ω cutoff that better identified high-risk patients. However, at multivariable analysis, the adjusted-hazard ratios (HRs) lost statistical significance for any endpoint. Baseline atrial sensing amplitude during sinus rhythm was lower in patients with 24 h AHRE than in those without (2.45 [IQR: 1.65-3.85] vs 3.51 [IQR: 2.37-4.67] mV, P < .01). The adjusted HR for 24 h AHRE in patients with atrial sensing >1.5 mV vs those with values ≤1.5 mV was 0.52 (95% CI: 0.33-0.83), P = .006. CONCLUSIONS Although lower baseline shock impedance was observed in patients with events, the association lost statistical significance at multivariable analysis. Conversely, low sinus rhythm atrial sensing (≤1.5 mV) measured with standard transvenous leads could identify subjects at high risk of atrial arrhythmia.
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Affiliation(s)
| | | | | | | | | | | | - Valeria Calvi
- Policlinico G. Rodolico, Az. O.U. Policlinico ‐ V. EmanueleCataniaItaly
| | | | | | | | | | - Mauro Biffi
- Policlinico Sant'Orsola‐MalpighiBolognaItaly
| | | | | | | | | | | | - Michele Manzo
- Azienda Ospedaliera Universitaria S.Giovanni di Dio e Ruggi D'AragonaSalernoItaly
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45
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Proclemer A, Zecchin M, D'Onofrio A, Boriani G, Ricci RP, Rebellato L, Ghidina M, Bianco G, Bernardelli E, Miconi A, Zorzin AF, Gregori D. [The Pacemaker and Implantable Cardioverter-Defibrillator Registry of the Italian Association of Arrhythmology and Cardiac Pacing - Annual report 2018]. G Ital Cardiol (Rome) 2020; 21:157-169. [PMID: 32051640 DOI: 10.1714/3300.32710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The pacemaker (PM) and implantable cardioverter-defibrillator (ICD) Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) monitors the main epidemiological data in real-world practice. The survey for the 2018 activity collects information about demographics, clinical characteristics, main indications for PM/ICD therapy and device types from the Italian collaborating centers. METHODS The Registry collects prospectively national PM and ICD implantation activity on the basis of European cards. RESULTS PM Registry: data about 23 912 PM implantations were collected (20 084 first implants and 3828 replacements). The number of collaborating centers was 180. Median age of treated patients was 81 years (75 quartile I; 86 quartile III). ECG indications included atrioventricular conduction disorders in 34.5% of first PM implants, sick sinus syndrome in 18.3%, atrial fibrillation plus bradycardia in 13.0%, other in 34.2%. Among atrioventricular conduction defects, third-degree atrioventricular block was the most common type (19.2% of first implants). Use of single-chamber PMs was reported in 24.9% of first implants, of dual-chamber PMs in 67.6%, of PMs with cardiac resynchronization therapy (CRT) in 1.6%, and of single lead atrial-synchronized ventricular stimulation (VDD/R PMs) in 5.9%. ICD Registry: data about 18 353 ICD implantations were collected (13 944 first implants and 4359 replacements). The number of collaborating centers was 433. Median age of treated patients was 71 years (63 quartile I; 78 quartile III). Primary prevention indication was reported in 84.3% of first implants, secondary prevention in 15.7% (cardiac arrest in 5.3%). A single-chamber ICD was used in 27.9% of first implants, dual-chamber ICD in 31.9% and biventricular ICD in 40.2%. CONCLUSIONS The PM and ICD Registry appears fundamental for monitoring PM and ICD utilization on a large national scale with rigorous examination of demographics and clinical indications. The PM Registry showed stable electrocardiographic and symptom indications, with an important prevalence of dual-chamber pacing. The use of CRT-PM regards a very limited number of patients. The ICD Registry documented a large use of prophylactic and biventricular ICD, reflecting a favorable adherence to trials and guidelines in clinical practice. In order to increase and optimize the cooperation of Italian implanting centers, online data entry (http://www.aiac.it/riprid) should be adopted at large scale.
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Affiliation(s)
- Alessandro Proclemer
- S.O.C. Cardiologia e Fondazione IRCAB, Azienda Sanitaria Universitaria Integrata S. Maria della Misericordia, Udine
| | - Massimo Zecchin
- S.O.C. Cardiologia, Azienda Sanitaria Universitaria Integrata, Trieste
| | - Antonio D'Onofrio
- U.O.S.D. Aritmologia, A.O.R.N. dei Colli, Ospedale V. Monaldi, Napoli
| | | | | | - Luca Rebellato
- S.O.C. Cardiologia e Fondazione IRCAB, Azienda Sanitaria Universitaria Integrata S. Maria della Misericordia, Udine
| | - Marco Ghidina
- S.O.C. Cardiologia e Fondazione IRCAB, Azienda Sanitaria Universitaria Integrata S. Maria della Misericordia, Udine
| | - Giulia Bianco
- S.O.C. Cardiologia e Fondazione IRCAB, Azienda Sanitaria Universitaria Integrata S. Maria della Misericordia, Udine
| | - Emanuela Bernardelli
- S.O.C. Cardiologia e Fondazione IRCAB, Azienda Sanitaria Universitaria Integrata S. Maria della Misericordia, Udine
| | - Antonella Miconi
- S.O.C. Cardiologia e Fondazione IRCAB, Azienda Sanitaria Universitaria Integrata S. Maria della Misericordia, Udine
| | | | - Dario Gregori
- Dipartimento di Medicina Ambientale e Salute Pubblica, Università degli Studi, Padova
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46
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Lodolo E, Galassi G, Spada G, Zecchin M, Civile D, Bressoux M. Post-LGM coastline evolution of the NW Sicilian Channel: Comparing high-resolution geophysical data with Glacial Isostatic Adjustment modeling. PLoS One 2020; 15:e0228087. [PMID: 32012178 PMCID: PMC6996818 DOI: 10.1371/journal.pone.0228087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 01/07/2020] [Indexed: 11/28/2022] Open
Abstract
Since about 20,000 years ago, the geography of the Earth has been profoundly modified by the gradual sea-level rise caused by the melting of continental ice sheets. Flat areas and regions characterized by very low gradients experienced, more than others, rapid flooding, with the progressive disappearance of vast coastal territories. Here we present a reconstruction of the late Quaternary coastline evolution of the north-western sector of the Sicilian Channel, constrained by high-resolution seismic profiles where the marker of the post-Last Glacial Maximum (LGM) marine transgression has been clearly identified and mapped. The locations of the post-LGM seismic horizon have been compared with predictions of a Glacial Isostatic Adjustment (GIA) model, which accounts for the migration of the shorelines in response to sea-level rise and for Earth’s rotational and deformational effects associated with deglaciation. We have verified that most of the points mapped through seismic data interpretation fall along the palaeo-coastline that the GIA model predicts for the 21 kyrs B.P. time frame. However, the model shows a misfit in the marine sector between Mazara del Vallo and Sciacca, where the available data indicate a Quaternary tectonic uplift. The analysis of the seismic profiles provides useful constraints to current GIA models. These add on existing histories of relative sea level in the Mediterranean Sea, allowing to gain new insight into the evolution of the palaeo-geography of the region of study and of the whole Sicilian Channel since the LGM, even in areas where direct geophysical observations are not available yet. In this respect, one of the most attractive implications of the ancient coastline evolution is linked with the underwater archaeology. The sea-level rise heavily impacted the distribution of human settlements, possibly forcing site abandonment and migrations, and this is particularly relevant in the Mediterranean basin, the cradle of the western civilization. The underwater traces left by these ancient populations represent the fundamental proofs to reconstruct the early history of our precursors.
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Affiliation(s)
- Emanuele Lodolo
- Istituto Nazionale di Oceanografia e di Geofisica Sperimentale—OGS, Trieste, Italy
- * E-mail:
| | - Gaia Galassi
- Dipartimento di Scienze Pure e Applicate, Urbino University ''Carlo Bo'', Urbino, Italy
| | - Giorgio Spada
- Dipartimento di Scienze Pure e Applicate, Urbino University ''Carlo Bo'', Urbino, Italy
| | - Massimo Zecchin
- Istituto Nazionale di Oceanografia e di Geofisica Sperimentale—OGS, Trieste, Italy
| | - Dario Civile
- Istituto Nazionale di Oceanografia e di Geofisica Sperimentale—OGS, Trieste, Italy
| | - Mathilde Bressoux
- Ecole Nationale Supérieure de Géologie, Université de Lorraine, Nancy, France
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47
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Zecchin M, Bianco E. [2019 ESC Guidelines on supraventricular tachycardias: what's new?]. G Ital Cardiol (Rome) 2020; 21:96-99. [PMID: 32051631 DOI: 10.1714/3300.32701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Massimo Zecchin
- S.C. Cardiologia, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste
| | - Elisabetta Bianco
- S.C. Cardiologia, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste
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48
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Artico J, Zecchin M, Zorzin Fantasia A, Skerl G, Ortis B, Franco S, Albani S, Barbati G, Cristallini J, Cannata' A, Sinagra G. Long-term patient satisfaction with implanted device remote monitoring: a comparison among different systems. J Cardiovasc Med (Hagerstown) 2020; 20:542-550. [PMID: 31107287 DOI: 10.2459/jcm.0000000000000818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Remote monitoring is an effective strategy to improve patients' outcomes and reduce hospitalization in patients with cardiac implantable electronic devices. However, data on patients' satisfaction are scarce. The aim of the current study was to assess patients' satisfaction, ease of use and impact on daily activities of the remote monitoring and to investigate whether there are differences among different devices and different manufacturers. METHODS A modified Home Monitoring Acceptance and Satisfaction Questionnaire telephone survey on the perceived quality of the different systems was performed with all patients followed with remote monitoring for at least 3 months. RESULTS Among 604 patients with remote monitoring screened by telephone, 466 patients (77%) answered the questionnaire [142 patients (30.5%) had a pacemaker, 317 patients (68%) had an implantable cardioverter defibrillator, and seven patients (1.5%) had an implantable loop recorder]. Ninety-seven percent of patients were satisfied by the remote monitoring system during the entire follow-up and found it easy to use. Similarly, 85% of patients did not experience any restriction in daily activities, and for 99% of patients it did not affect their privacy. Importantly, for the vast majority of patients, remote monitoring gave a great (56.7%) or moderate (33.4%) sense of security. CONCLUSION Daily impact of cardiac implantable electronic devices still remains a challenging issue for caregivers. The introduction of remote monitoring allowed closer follow-up and improved outcomes. Our results highlighted patients' satisfaction, who also felt safer, with the remote monitoring, its ease of use, and the absence of any disturbances in patients' everyday activities or in their privacy.
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Affiliation(s)
- Jessica Artico
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
| | - Massimo Zecchin
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
| | - Anna Zorzin Fantasia
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
| | - Giulia Skerl
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
| | - Benedetta Ortis
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
| | - Stefania Franco
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
| | - Stefano Albani
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
| | - Giulia Barbati
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Jacopo Cristallini
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
| | - Antonio Cannata'
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste
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Cannatà A, De Angelis G, Boscutti A, Normand C, Artico J, Gentile P, Zecchin M, Heymans S, Merlo M, Sinagra G. Arrhythmic risk stratification in non-ischaemic dilated cardiomyopathy beyond ejection fraction. Heart 2020; 106:656-664. [PMID: 31964657 DOI: 10.1136/heartjnl-2019-315942] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 09/08/2019] [Revised: 12/29/2019] [Accepted: 01/07/2020] [Indexed: 12/22/2022] Open
Abstract
Sudden cardiac death and arrhythmia-related events in patients with non-ischaemic dilated cardiomyopathy (NICM) have been significantly reduced over the last couple of decades as a result of evidence-based pharmacological and non-pharmacological therapeutic strategies. Nevertheless, the arrhythmic stratification in patients with NICM remains extremely challenging, and the simple indication based on left ventricular ejection fraction appears to be insufficient. Therefore, clinicians need to go beyond the current criteria for implantable cardioverter-defibrillator implantation in the direction of a multiparametric evaluation of arrhythmic risk. Several parameters for arrhythmic risk stratification, ranging from electrocardiographic, echocardiographic, imaging-derived and genetic markers, are crucial for proper arrhythmic risk stratification and a multiparametric evaluation of risk in patients with NICM. In particular, integration of cardiac magnetic resonance parameters (mostly late gadolinium enhancement) and specific genetic information (ie, presence of LMNA, PLN, FLNC mutations) appears fundamental for proper implementation of the current arrhythmic risk stratification. Finally, a novel approach focused on both arrhythmic risk and prediction of left ventricular reverse remodelling during follow-up might be useful for effective multiparametric and dynamic arrhythmic risk stratification in NICM. In the future, a complete and integrated evaluation might be mandatory to implement arrhythmic risk prediction in patients with NICM and to discriminate the competing risk between heart failure-related events and life-threatening arrhythmias.
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Affiliation(s)
- Antonio Cannatà
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.,Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Giulia De Angelis
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Andrea Boscutti
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Camilla Normand
- Cardiology Division, Stavanger University Hospital, Stavanger, Norway.,Institute of Internal Medicine, University of Bergen, Bergen, Norway
| | - Jessica Artico
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Piero Gentile
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Massimo Zecchin
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Stephane Heymans
- Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology, KU Leuven, Belgium.,Department of Cardiology, CARIM School for Cardiovascular Diseases Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,The Netherlands Heart Institute, Utrecht, The Netherlands
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
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Merlo M, Zaffalon D, Stolfo D, Altinier A, Barbati G, Zecchin M, Bardari S, Sinagra G. ECG in dilated cardiomyopathy: specific findings and long-term prognostic significance. J Cardiovasc Med (Hagerstown) 2019; 20:450-458. [PMID: 30985353 DOI: 10.2459/jcm.0000000000000804] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective was to provide an exhaustive characterization of ECG features in a large cohort of dilated cardiomyopathies (DCMs) and then investigate their possible prognostic role in the long term. BACKGROUND ECG is an accessible, reproducible, low-cost diagnostic and prognostic tool. However, an extensive description of ECG features and their long-term prognostic role in a large cohort of DCM is lacking. METHODS All available baseline ECGs of DCM patients enrolled from 1992 to 2013 were systematically analysed. Patients underwent to a complete clinical-laboratory evaluation. The study outcome measures were death or heart transplant (D/HT) and sudden death or malignant ventricular arrhythmias (SD/MVA). RESULTS Four hundred and fourteen DCM patients were enrolled. During a median follow-up of 125 months, 55 and 57 patients experienced D/HT and SD/MVA, respectively. At multivariate analysis, left ventricular hypertrophy (P = 0.017), heart rate (HR, P = 0.005) and anterolateral T-wave inversion (P = 0.041) predicted D/HT. Regarding SD/MVA, S wave amplitude in V2 (P = 0.008), R wave amplitude in DIII (P = 0.007), anterolateral T-wave inversion (P = 0.017) emerged as predictors. At receiver-operating curve analyses, the addition of ECG models to the clinical-laboratory evaluation significantly increased the area under the curve both for D/HT (from 0.68 to 0.74, P = 0.042) and SD/MVA (from 0.70 to 0.77, P = 0.048). CONCLUSION The exhaustive systematic evaluation of ECG has an incremental impact in the prognostication of a large cohort of DCM patients, also regarding the arrhythmic stratification.
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Affiliation(s)
- Marco Merlo
- Cardiovascular Department, 'Ospedali Riuniti' and University of Trieste
| | - Denise Zaffalon
- Cardiovascular Department, 'Ospedali Riuniti' and University of Trieste
| | - Davide Stolfo
- Cardiovascular Department, 'Ospedali Riuniti' and University of Trieste
| | | | - Giulia Barbati
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Massimo Zecchin
- Cardiovascular Department, 'Ospedali Riuniti' and University of Trieste
| | - Stefano Bardari
- Cardiovascular Department, 'Ospedali Riuniti' and University of Trieste
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