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Giordano M, Marzullo R, Gaio G, Bigazzi MC, Palladino MT, Della Cioppa N, Gaudieri G, Fabiani D, Sarubbi B, Russo MG. Assessing the feasibility of using the antecubital vein to perform right heart catheterization in children and adults with congenital heart disease: a retrospective, observational single-center study. J Invasive Cardiol 2023; 35. [PMID: 37984324 DOI: 10.25270/jic/23.00219] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND Right heart catheterization (RHC) usually is performed via the femoral vein or the internal jugular vein. However, the antecubital fossa vein is a valid venous access, and it has become increasingly popular to perform right heart catheterization utilizing this access. METHODS A retrospective, observational study was conducted to describe use of the antecubital fossa vein for right heart catheterization in adults and children with congenital heart disease (CHD). Patients who had undergone RHC via antecubital fossa vein at the authors' hospital between September 2019 and December 2022 were included. The outcomes studied were procedural failure and procedure-related adverse events. RESULTS Fifty-two patients with CHD underwent right cardiac catheterization via an upper arm vein. The upper arm vein was unable to perform the RHC in only 2 patients (3.8%). Only 1 patient developed a minor adverse event. No irreversible and/or life-threating adverse events were detected. CONCLUSIONS The upper arm veins are safe and effective to perform a RHC in children and adults with CHD. This approach demonstrates a high percentage of technical success, and few mild complications.
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Affiliation(s)
- Mario Giordano
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy.
| | - Raffaella Marzullo
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Gianpiero Gaio
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Maurizio Cappelli Bigazzi
- Invasive Cardiology Unit, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Maria Teresa Palladino
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Nadia Della Cioppa
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Gabriella Gaudieri
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Dario Fabiani
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Maria Giovanna Russo
- Pediatric Cardiology Division, University of Campania Luigi Vanvitelli, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
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Ciriello GD, Colonna D, Papaccioli G, Correra A, Romeo E, Palladino MT, Cioppa ND, Russo MG, Sarubbi B. Triple Antiarrhythmic Therapy in Newborns with Refractory Atrioventricular Reentrant Tachycardia. Pediatr Cardiol 2023; 44:1040-1049. [PMID: 37093256 DOI: 10.1007/s00246-023-03162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/10/2023] [Indexed: 04/25/2023]
Abstract
Atrioventricular reentrant tachycardia (AVRT) is the most common form of supraventricular tachycardia in newborns. AVRT is sometimes refractory to conventional antiarrhythmic therapy. We describe our experience about the use of the triple combination of flecainide + propranolol + amiodarone as third-line regimen for refractory and recurrent AVRT in newborns. We considered a series of 14 patients who had failed both first-line and second-line therapy and were treated using the combination of flecainide + propranolol + amiodarone. Transoesophageal electrophysiologic study (TES) was performed to test the effectiveness of medical therapy during hospitalization and to try to reduce the amount of therapy, after amiodarone wash-out, before 1 year of age. TES was repeated at 1 year of age to test the spontaneous resolution of the arrhythmia after treatment discontinuation. Rhythm control was achieved in all 14 patients. At a mean age of 9.3 ± 2 months, AVRT was not inducible by TES in 11/12 amiodarone-free patients. At a mean age of 14.1 ± 3 months, AVRT was still inducible in 7/12 patients after interrupting the entire antiarrhythmic therapy (58.3%). Triple combination was effective as third-line option to suppress AVRT refractory to single and double antiarrhythmic therapy, with no significant adverse events. Our experience suggests that triple therapy could be maintained for a short-term treatment, discontinuing amiodarone before 1 year of age to avoid long-term side effects. Newborns who needed triple therapy appear to have a lower chance of accessory pathway disappearance at 1 year of age. TES could be useful for risk stratification of recurrences at the time of drug discontinuation in infants considered to be at higher risk of recurrent AVRT.
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Affiliation(s)
- Giovanni Domenico Ciriello
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy.
- Pediatric Cardiology Unit, Monaldi Hospital, "L.Vanvitelli" University, Naples, Italy.
| | - Diego Colonna
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
- Pediatric Cardiology Unit, Monaldi Hospital, "L.Vanvitelli" University, Naples, Italy
| | - Giovanni Papaccioli
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
| | - Anna Correra
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
| | - Emanuele Romeo
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
| | | | - Nadia Della Cioppa
- Pediatric Cardiology Unit, Monaldi Hospital, "L.Vanvitelli" University, Naples, Italy
| | - Maria Giovanna Russo
- Pediatric Cardiology Unit, Monaldi Hospital, "L.Vanvitelli" University, Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
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Ziacchi M, Bisignani G, Palmisano P, Scalone A, Martignani C, Elvira Mocavero P, Caravati F, Della Cioppa N, Mazzuero A, Pecora D, Vicentini A, Landolina ME, Debonis S, Scimia P, Lovecchio M, Valsecchi S, Diemberger I, Droghetti A. Serratus anterior plane block in subcutaneous implantable cardioverter defibrillator implantation: A case‐control analysis. J Cardiovasc Electrophysiol 2019; 31:144-149. [DOI: 10.1111/jce.14293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/15/2019] [Accepted: 11/25/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Matteo Ziacchi
- Institute of CardiologyUniversity of Bologna, Policlinico S.Orsola‐MalpighiBologna Italy
| | | | | | | | - Cristian Martignani
- Institute of CardiologyUniversity of Bologna, Policlinico S.Orsola‐MalpighiBologna Italy
| | - Paola Elvira Mocavero
- “Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie”, Monaldi HospitalNaples Italy
| | - Fabrizio Caravati
- Division of Cardiology“Circolo e Fondazione Macchi” HospitalVarese Italy
| | - Nadia Della Cioppa
- Division of CardiologySecond University of Naples, Monaldi HospitalNaples Italy
| | | | | | | | | | | | - Paolo Scimia
- Department of Anesthesia and Intensive Care UnitASST CremonaCremona Italy
| | | | | | - Igor Diemberger
- Institute of CardiologyUniversity of Bologna, Policlinico S.Orsola‐MalpighiBologna Italy
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Russo V, Nigro G, Papa AA, Rago A, Della Cioppa N, Cristiano A, Russo MG. Adenosine-induced sinus tachycardia in a patient with Myotonic Dystrophy type 1. Acta Myol 2014; 33:104-6. [PMID: 25709381 PMCID: PMC4299166] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report the case of a 32-year-old man with Myotonic Dystrophy type 1 showing adenosine-induced sinus tachycardia during transesophageal electrophysiological evaluation.
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Affiliation(s)
- Vincenzo Russo
- Department of Cardio-Thoracic and Respiratory Sciences, Chair of Cardiology, Second University of Naples, Monaldi Hospital, Italy;,Address for correspondence: Gerardo Nigro, Department of Cardio-Thoracic and Respiratory Sciences, Chair of Cardiology, Second Univeristy of Naples, Monaldi Hospital, p.le Ettore Ruggeri, 80100 Naples, Italy. E-mail:
| | - Gerardo Nigro
- Department of Cardio-Thoracic and Respiratory Sciences, Chair of Cardiology, Second University of Naples, Monaldi Hospital, Italy
| | - Andrea Antonio Papa
- Department of Cardio-Thoracic and Respiratory Sciences, Chair of Cardiology, Second University of Naples, Monaldi Hospital, Italy
| | - Anna Rago
- Department of Cardio-Thoracic and Respiratory Sciences, Chair of Cardiology, Second University of Naples, Monaldi Hospital, Italy
| | | | - Anna Cristiano
- Department of Cardio-Thoracic and Respiratory Sciences, Chair of Cardiology, Second University of Naples, Monaldi Hospital, Italy
| | - Maria Giovanna Russo
- Department of Cardio-Thoracic and Respiratory Sciences, Chair of Cardiology, Second University of Naples, Monaldi Hospital, Italy
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Nigro G, Russo V, Rago A, Papa AA, Cioppa ND, Scarpati C, Palladino T, Corcione A, Sarubbi B, Caianiello G, Russo MG. The effect of aortic coarctation surgical repair on QTc and JTc dispersion in severe aortic coarctation newborns: a short-term follow-up study. Physiol Res 2013; 63:27-33. [PMID: 24182342 DOI: 10.33549/physiolres.932491] [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: 11/25/2022] Open
Abstract
Sudden death is a possible occurrence for newborns younger than 1 year with severe aortic coarctation (CoA) before surgical correction. In our previous study, we showed a significant increase of QTc-D and JTc-D in newborns with isolated severe aortic coarctation, electrocardiographic parameters that clinical and experimental studies have suggested could reflect the physiological variability of regional and ventricular repolarization and could provide a substrate for life-threatening ventricular arrhythmias. The aim of the current study was to evaluate the effect of surgical repair of CoA on QTc-d, JTc-d in severe aortic coarctation newborns with no associated congenital cardiac malformations. The study included 30 newborns (18M; 70+/-12 h old) affected by severe congenital aortic coarctation, without associated cardiac malformations. All newborns underwent to classic extended end-to-end repair. Echocardiographic and electrocardiographic measurements were performed in each patient 24 h before and 24 h after the interventional procedure and at the end of the follow-up period, 1 month after the surgical correction. All patients at baseline, 24 h and one month after CoA surgical repair did not significantly differ in terms of heart rate, weight, height, and echocardiographic parameters. There were no statistically significant differences in QTc-D (111.7+/-47.4 vs 111.9+/-63.8 ms vs 108.5+/-55.4 ms; P=0.4) and JTc-D (98.1+/-41.3 vs 111.4+/-47.5 vs 105.1+/-33.4 ms; P=0.3) before, 24 h and 1 month after CoA surgical correction. In conclusions, our study did not show a statistically significant decrease in QTc-D and JTc-D, suggesting the hypothesis that the acute left ventricular afterload reduction, related to successful CoA surgical correction, may not reduce the ventricular electrical instability in the short-term follow-up.
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Affiliation(s)
- G Nigro
- Chair of Cardiology, Second University of Naples, Naples,
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Russo V, Rago A, Palladino A, Papa AA, Di Meo F, Della Cioppa N, Golino P, Russo MG, Calabrò R, Politano L, Nigro G. P-wave duration and dispersion in patients with Emery-Dreifuss muscular dystrophy. J Investig Med 2012; 59:1151-4. [PMID: 22011621 DOI: 10.2310/jim.0b013e31822cf97a] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Paroxysmal episodes of atrial fibrillation frequently occur in Emery-Dreifuss muscular dystrophy (EDMD). Although previous studies have documented a variety of electrocardiographic abnormalities in EDMD, little is still known about P-wave dispersion (PD), an independent risk factor for the development of atrial fibrillation. The aim of our study was to evaluate the P-wave duration and PD in patients with EDMD with conserved systolic and diastolic cardiac function. METHODS The study involved 36 patients with EDMD (age, 20 [SD, 12] years; 26 men) and 36 healthy subjects used as controls, matched for age and sex. P-wave dispersion was carefully measured using 12-lead electrocardiogram. Compared with the healthy control group, patients with EDMD presented increased maximum P-wave duration (108.2 [SD, 22.2] vs 97.8 [SD, 11] milliseconds, P = 0.04) and PD (51.4 [SD, 12.8] vs 39.3 [SD, 9.7] milliseconds, P = 0.004) values. No statistically significant differences in left atrium diameter (37.1 [SD, 2.9] vs 34.1 [SD, 4.2] mm, P = 0.3) and maximum left atrium volume (15.2 [SD, 3.8] vs 14.1 [SD, 4.2] mL/m2, P = 0.4) were found between the 2 groups. We divided our study population into 2 subgroups, according to the different genetic diagnosis, patients with laminopathy EDMD (n = 17) or with emerinopathy EDMD (n = 19). No statistically significant differences were found in PD between the 2 subgroups (54.6 [SD, 15.6] vs 50.2 [SD, 11.5] milliseconds, P = 0.4). CONCLUSIONS Our study showed a significant increase of maximum P-wave duration and PD in patients with EDMD with conserved systolic and diastolic cardiac function.
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Affiliation(s)
- Vincenzo Russo
- Department of Cardiology, Second University of Naples-Monaldi Hospital, Naples, Italy.
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Nigro G, Russo V, de Chiara A, Rago A, Cioppa ND, Chianese R, Manfredi D, Calabrò R. Autonomic nervous system modulation before the onset of sustained atrioventricular nodal reentry tachycardia. Ann Noninvasive Electrocardiol 2010; 15:49-55. [PMID: 20146782 DOI: 10.1111/j.1542-474x.2009.00339.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Our study was designed to analyze dynamic changes in autonomic tone before the onset of typical sustained atrioventricular nodal reentry tachycardia (AVNRT) in a large group of patients without structural heart disease. MATERIALS AND METHODS Twenty-four-hour Holter tapes from 42 consecutive patients (27 men and 15 women; aged 30 + or - 21 years) with several episodes of sustained typical AVNRT were analyzed. The diagnosis was validated by transesophageal electrophysiological study. The time-domain calculated parameters were SDNN, SDANN, rMSSD, pNN50; the frequency-domain parameters were low-frequency power (LF, 0.04-0.15 Hz), high-frequency power (HF, 0.15-0.40 Hz), very low-frequency power (VLF, 0.008 to 0.04 Hz) and LF/HF. The mean values in the hour before the onset of sustained AVNRT were compared with the mean values of 2 hours before and 1 hour after the onset of sustained AVNRT. RESULTS The mean SDNN, rMSSD, pNN50, HF were significantly decreased during the hour preceding the onset of AVNRT, when compared to the mean values observed during the time periods selected. Instead, the LF values and LF/HF were increased before the onset of sustained AVNRT. No significant change in the VLF and atrial ectopic beats were observed. CONCLUSION This study suggests that sustained typical AVNRT episodes are preceded by increase in adrenergic drive.
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Affiliation(s)
- Gerardo Nigro
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy
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Nigro G, Russo V, Rago A, de Chiara A, Chianese R, Della Cioppa N, Calabrò R. Which parameters describe the electrophysiological properties of successful slow pathway RF ablation in patients with common atrioventricular nodal reentrant tachycardia? Anadolu Kardiyol Derg 2010; 10:126-129. [PMID: 20382610 DOI: 10.5152/akd.2010.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
OBJECTIVE Atrioventricular nodal reentrant tachycardia (AVNRT) accounts for about 60% of the patients presenting with paroxysmal supraventricular tachycardia. The radiofrequency (RF) catheter ablation of the slow atrioventricular (AV) node pathway is the preferred therapeutic approach in patients with AV node reentrant tachycardia. The aim of our study was describe the electrophysiological properties of successful slow pathway RF ablation in patients with common atrioventricular nodal reentrant tachycardia. METHODS The study design was a retrospective analysis involving fifty consecutive patients (18 males; mean age of 39+/-22 years) who underwent slow pathway ablation because of AVNRT. RESULTS Slow junctional beats with a cycle length longer than 550 ms were observed in 39 patients (79%); the presence of rapid junctional beats with a cycle length less than 550 ms was showed in 5 patients (10%). Moreover, in 32 of 50 patients (65%) duration of atrial electrogram more than 40 ms was noticed. Analyzing data reported, we found the statistically significant presence of slow junctional beats (p=0.001) and atrial electrogram >40 ms (p=0.05) in successful RF ablation procedures. CONCLUSION In patients with AVNRT undergoing slow pathway ablation, the duration of atrial electrogram >40 ms and slow junctional beats with cycle length >550 ms during the application of RF energy describe the electrophysiological properties of successful slow pathway RF ablation.
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Affiliation(s)
- Gerardo Nigro
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Italy
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Nigro G, Russo V, Ventriglia VM, Della Cioppa N, Palladino A, Nigro V, Calabrò R, Nigro G, Politano L. Early onset of cardiomyopathy and primary prevention of sudden death in X-linked Emery-Dreifuss muscular dystrophy. Neuromuscul Disord 2010; 20:174-7. [PMID: 20149661 DOI: 10.1016/j.nmd.2009.12.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 12/02/2009] [Accepted: 12/03/2009] [Indexed: 11/25/2022]
Abstract
We report the case of 14-year-old boy with X-linked Emery-Dreifuss muscular dystrophy who developed sick sinus syndrome and required placement of an implantable intracardiac cardioverter-defibrillator (ICD) to prevent sudden death. He demonstrated no significant risk factors for sudden death such as depressed left ventricular ejection fraction, or spontaneous or inducible ventricular tachycardia. One month after implantation, the patient experienced one appropriate ICD discharge.
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Affiliation(s)
- Gerardo Nigro
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Monaldi Hospital, Naples, Italy
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