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Santinelli V, Ciconte G, Manguso F, Anastasia L, Micaglio E, Calovic Z, Vicedomini G, Mazza B, Vecchi M, Mecarocci V, Locati ET, Boccellino A, Negro G, Napolano A, Giannelli L, Pappone C. High-risk Brugada syndrome: factors associated with arrhythmia recurrence and benefits of epicardial ablation in addition to implantable cardioverter defibrillator implantation. Europace 2023; 26:euae019. [PMID: 38252933 PMCID: PMC10824473 DOI: 10.1093/europace/euae019] [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] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 11/30/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
AIMS This study aims to evaluate the prognostic impact of the arrhythmogenic substrate size in symptomatic Brugada syndrome (BrS) as well as to validate the long-term safety and effectiveness of epicardial radiofrequency ablation (RFA) compared with no-RFA group. METHODS AND RESULTS In this prospective investigational long-term registry study, 257 selected symptomatic BrS patients with implantable cardioverter defibrillator (ICD) implantation were included. Among them, 206 patients underwent epicardial RFA and were monitored for over 5 years post-ablation (RFA group), while 51 patients received only ICD implantation declining RFA. Primary endpoints included risk factors for ventricular fibrillation (VF) events pre-ablation and freedom from VF events post-ablation. In the RFA group, BrS substrates were identified in the epicardial surface of the right ventricle. During the pre-RFA follow-up period (median 27 months), VF episodes and VF storms were experienced by 53 patients. Independent risk factors included substrate size [hazard ratio (HR), 1.13; 95% confidence interval (CI), 1.08-1.18; P < 0.001], aborted cardiac arrest (HR, 2.98; 95% CI, 1.68-5.28; P < 0.001), and SCN5A variants (HR, 2.22; 95% CI, 1.15-4.27; P = 0.017). In the post-RFA follow-up (median 40 months), the RFA group demonstrated superior outcomes compared with no-RFA (P < 0.001) without major procedure-related complications. CONCLUSION Our study underscores the role of BrS substrate extent as a crucial prognostic factor for recurrent VF and validates the safety and efficacy of RFA when compared with a no-RFA group. Our findings highlight the importance of ajmaline in guiding epicardial mapping/ablation in symptomatic BrS patients, laying the groundwork for further exploration of non-invasive methods to guide informed clinical decision-making.
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Affiliation(s)
- Vincenzo Santinelli
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Giuseppe Ciconte
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Francesco Manguso
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Luigi Anastasia
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Emanuele Micaglio
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Zarko Calovic
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Gabriele Vicedomini
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Beniamino Mazza
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Mattia Vecchi
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Valerio Mecarocci
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Emanuela T Locati
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Antonio Boccellino
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Gabriele Negro
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Antonio Napolano
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Luigi Giannelli
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
- University Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milan, Italy
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Pappone C, Ciconte G, Vicedomini G, Anastasia L, Santinelli V. Epicardial arrhythmogenic substrate in long QT syndrome. Heart Rhythm 2023; 20:1782-1784. [PMID: 38040481 DOI: 10.1016/j.hrthm.2023.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Carlo Pappone
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Institute of Molecular and Translational Cardiology (IMTC), San Donato Milanese, Milan, Italy.
| | - Giuseppe Ciconte
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Institute of Molecular and Translational Cardiology (IMTC), San Donato Milanese, Milan, Italy
| | - Gabriele Vicedomini
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luigi Anastasia
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Institute of Molecular and Translational Cardiology (IMTC), San Donato Milanese, Milan, Italy
| | - Vincenzo Santinelli
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Locati ET, Van Dam PM, Ciconte G, Heilbron F, Boonstra M, Vicedomini G, Micaglio E, Ćalović Ž, Anastasia L, Santinelli V, Pappone C. Electrocardiographic temporo-spatial assessment of depolarization and repolarization changes after epicardial arrhythmogenic substrate ablation in Brugada syndrome. Eur Heart J Digit Health 2023; 4:473-487. [PMID: 38045442 PMCID: PMC10689926 DOI: 10.1093/ehjdh/ztad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 12/05/2023]
Abstract
Aims In Brugada syndrome (BrS), with spontaneous or ajmaline-induced coved ST elevation, epicardial electro-anatomic potential duration maps (epi-PDMs) were detected on a right ventricle (RV) outflow tract (RVOT), an arrhythmogenic substrate area (AS area), abolished by epicardial-radiofrequency ablation (EPI-AS-RFA). Novel CineECG, projecting 12-lead electrocardiogram (ECG) waveforms on a 3D heart model, previously localized depolarization forces in RV/RVOT in BrS patients. We evaluate 12-lead ECG and CineECG depolarization/repolarization changes in spontaneous type-1 BrS patients before/after EPI-AS-RFA, compared with normal controls. Methods and results In 30 high-risk BrS patients (93% males, age 37 + 9 years), 12-lead ECGs and epi-PDMs were obtained at baseline, early after EPI-AS-RFA, and late follow-up (FU) (2.7-16.1 months). CineECG estimates temporo-spatial localization during depolarization (Early-QRS and Terminal-QRS) and repolarization (ST-Tpeak, Tpeak-Tend). Differences within BrS patients (baseline vs. early after EPI-AS-RFA vs. late FU) were analysed by Wilcoxon signed-rank test, while differences between BrS patients and 60 age-sex-matched normal controls were analysed by the Mann-Whitney test. In BrS patients, baseline QRS and QTc durations were longer and normalized after EPI-AS-ATC (151 ± 15 vs. 102 ± 13 ms, P < 0.001; 454 ± 40 vs. 421 ± 27 ms, P < 0.000). Baseline QRS amplitude was lower and increased at late FU (0.63 ± 0.26 vs. 0.84 ± 13 ms, P < 0.000), while Terminal-QRS amplitude decreased (0.24 ± 0.07 vs. 0.08 ± 0.03 ms, P < 0.000). At baseline, CineECG depolarization/repolarization wavefront prevalently localized in RV/RVOT (Terminal-QRS, 57%; ST-Tpeak, 100%; and Tpeak-Tend, 61%), congruent with the AS area on epi-PDM. Early after EPI-AS-RFA, RV/RVOT localization during depolarization disappeared, as Terminal-QRS prevalently localized in the left ventricle (LV, 76%), while repolarization still localized on RV/RVOT [ST-Tpeak (44%) and Tpeak-Tend (98%)]. At late FU, depolarization/repolarization forces prevalently localized in the LV (Terminal-QRS, 94%; ST-Tpeak, 63%; Tpeak-Tend, 86%), like normal controls. Conclusion CineECG and 12-lead ECG showed a complex temporo-spatial perturbation of both depolarization and repolarization in BrS patients, prevalently localized in RV/RVOT, progressively normalizing after epicardial ablation.
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Affiliation(s)
- Emanuela T Locati
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Peter M Van Dam
- Cardiology Department, Utrecht University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
- Center for Digital Medicine and Robotics, Jagiellonian University Medical College, Kopernika 7e, 31-034 Kraków, Poland
| | - Giuseppe Ciconte
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Francesca Heilbron
- Milano Bicocca University, Istituto Auxologico, Via Thomas Mann 8, 20162 Milan, Italy
| | - Machteld Boonstra
- Cardiology Department, Utrecht University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
| | - Gabriele Vicedomini
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Emanuele Micaglio
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Žarko Ćalović
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Luigi Anastasia
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Vincenzo Santinelli
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Carlo Pappone
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
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Tarantino A, Ciconte G, Ghiroldi A, Mastrocinque F, Micaglio E, Boccellino A, Negro G, Piccoli M, Cirillo F, Vicedomini G, Santinelli V, Anastasia L, Pappone C. Challenges in Brugada Syndrome Stratification: Investigating SCN5A Mutation Localization and Clinical Phenotypes. Int J Mol Sci 2023; 24:16658. [PMID: 38068978 PMCID: PMC10706434 DOI: 10.3390/ijms242316658] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/15/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
Brugada Syndrome (BrS) is a genetic heart condition linked to sudden cardiac death. Though the SCN5A gene is primarily associated with BrS, there is a lack of comprehensive studies exploring the connection between SCN5A mutation locations and the clinical presentations of the syndrome. This study aimed to address this gap and gain further understanding of the syndrome. The investigation classified 36 high-risk BrS patients based on SCN5A mutations within the transmembrane/structured (TD) and intra-domain loops (IDLs) lacking a 3D structure. We characterized the intrinsically disordered regions (IDRs) abundant in IDLs, using bioinformatics tools to predict IDRs and post-translational modifications (PTMs) in NaV1.5. Interestingly, it was found that current predictive tools often underestimate the impacts of mutations in IDLs and disordered regions. Moreover, patients with SCN5A mutations confined to IDL regions-previously deemed 'benign'-displayed clinical symptoms similar to those carrying 'damaging' variants. Our research illuminates the difficulty in stratifying patients based on SCN5A mutation locations, emphasizing the vital role of IDLs in the NaV1.5 channel's functioning and protein interactions. We advocate for caution when using predictive tools for mutation evaluation in these regions and call for the development of improved strategies in accurately assessing BrS risk.
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Affiliation(s)
- Adriana Tarantino
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy; (A.T.); (M.P.); (F.C.)
- School of Medicine, University Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milan, Italy;
| | - Giuseppe Ciconte
- School of Medicine, University Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milan, Italy;
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy; (F.M.); (E.M.); (A.B.); (G.N.); (G.V.); (V.S.)
| | - Andrea Ghiroldi
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy; (A.T.); (M.P.); (F.C.)
| | - Flavio Mastrocinque
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy; (F.M.); (E.M.); (A.B.); (G.N.); (G.V.); (V.S.)
| | - Emanuele Micaglio
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy; (F.M.); (E.M.); (A.B.); (G.N.); (G.V.); (V.S.)
| | - Antonio Boccellino
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy; (F.M.); (E.M.); (A.B.); (G.N.); (G.V.); (V.S.)
| | - Gabriele Negro
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy; (F.M.); (E.M.); (A.B.); (G.N.); (G.V.); (V.S.)
| | - Marco Piccoli
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy; (A.T.); (M.P.); (F.C.)
| | - Federica Cirillo
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy; (A.T.); (M.P.); (F.C.)
| | - Gabriele Vicedomini
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy; (F.M.); (E.M.); (A.B.); (G.N.); (G.V.); (V.S.)
| | - Vincenzo Santinelli
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy; (F.M.); (E.M.); (A.B.); (G.N.); (G.V.); (V.S.)
| | - Luigi Anastasia
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy; (A.T.); (M.P.); (F.C.)
- School of Medicine, University Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milan, Italy;
| | - Carlo Pappone
- School of Medicine, University Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milan, Italy;
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy; (F.M.); (E.M.); (A.B.); (G.N.); (G.V.); (V.S.)
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Pappone C, Ciconte G, Anastasia L, Gaita F, Grant E, Micaglio E, Locati ET, Calovic Z, Vicedomini G, Santinelli V. Right ventricular epicardial arrhythmogenic substrate in long-QT syndrome patients at risk of sudden death. Europace 2023; 25:948-955. [PMID: 36610790 PMCID: PMC10062343 DOI: 10.1093/europace/euac264] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/16/2022] [Indexed: 01/09/2023] Open
Abstract
AIMS The long-QT syndrome (LQTS) represents a leading cause of sudden cardiac death (SCD). The aim of this study was to assess the presence of an underlying electroanatomical arrhythmogenic substrate in high-risk LQTS patients. METHODS AND RESULTS The present study enrolled 11 consecutive LQTS patients who had experienced frequent implantable cardioverter-defibrillator (ICD discharges triggered by ventricular fibrillation (VF). We acquired electroanatomical biventricular maps of both endo and epicardial regions for all patients and analyzed electrograms sampled from several myocardial regions. Abnormal electrical activities were targeted and eliminated by the means of radiofrequency catheter ablation. VF episodes caused a median of four ICD discharges in eleven patients (6 male, 54.5%; mean age 44.0 ± 7.8 years, range 22-53) prior to our mapping and ablation procedures. The average QTc interval was 500.0 ± 30.2 ms. Endo-epicardial biventricular maps displayed abnormally fragmented, low-voltage (0.9 ± 0.2 mV) and prolonged electrograms (89.9 ± 24.1 ms) exclusively localized in the right ventricular epicardium. We found electrical abnormalities extending over a mean epicardial area of 15.7 ± 3.1 cm2. Catheter ablation of the abnormal epicardial area completely suppressed malignant arrhythmias over a mean 12 months of follow-up (median VF episodes before vs. after ablation, 4 vs. 0; P = 0.003). After the procedure, the QTc interval measured in a 12-lead ECG analysis shortened to a mean of 461.8 ± 23.6 ms (P = 0.004). CONCLUSION This study reveals that, among high-risk LQTS patients, regions localized in the epicardium of the right ventricle harbour structural electrophysiological abnormalities. Elimination of these abnormal electrical activities successfully prevented malignant ventricular arrhythmia recurrences.
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Affiliation(s)
- Carlo Pappone
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milano, Italy
- Vita-Salute San Raffaele University, via Olgettina 58, 20132 Milano, Italy
- Institute of Molecular and Translational Cardiology (IMTC), piazza Malan 2, 20097, San Donato Milanese, Milan, Italy
| | - Giuseppe Ciconte
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milano, Italy
- Institute of Molecular and Translational Cardiology (IMTC), piazza Malan 2, 20097, San Donato Milanese, Milan, Italy
| | - Luigi Anastasia
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milano, Italy
- Vita-Salute San Raffaele University, via Olgettina 58, 20132 Milano, Italy
- Institute of Molecular and Translational Cardiology (IMTC), piazza Malan 2, 20097, San Donato Milanese, Milan, Italy
| | - Fiorenzo Gaita
- Department of Medical Sciences, Città della Salute e Della Scienza, University of Torino, Corso Bramante 88, 10126 Torino, Italy
| | - Edward Grant
- Institute of Molecular and Translational Cardiology (IMTC), piazza Malan 2, 20097, San Donato Milanese, Milan, Italy
- Department of Chemistry and Department of Physics & Astronomy, The University of British Columbia, 2036 Main Mall, Vancouver, BC V6T1Z1, Canada
| | - Emanuele Micaglio
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milano, Italy
- Institute of Molecular and Translational Cardiology (IMTC), piazza Malan 2, 20097, San Donato Milanese, Milan, Italy
| | - Emanuela T Locati
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milano, Italy
| | - Zarko Calovic
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milano, Italy
| | - Gabriele Vicedomini
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milano, Italy
- Institute of Molecular and Translational Cardiology (IMTC), piazza Malan 2, 20097, San Donato Milanese, Milan, Italy
| | - Vincenzo Santinelli
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milano, Italy
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Van Dam PM, Locati ET, Ciconte G, Borrelli V, Santinelli V, Vicedomini G, Monasky MM, Micaglio E, Giannelli L, Mecarocci V, Calovic Z, Pappone C. The electro-anatomical pathway for normal and bundle branch block ECGs. J Electrocardiol 2021. [DOI: 10.1016/j.jelectrocard.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pappone C, Santinelli V, Mecarocci V, Tondi L, Ciconte G, Manguso F, Sturla F, Vicedomini G, Micaglio E, Anastasia L, Pica S, Camporeale A, Lombardi M. Brugada Syndrome: New Insights From Cardiac Magnetic Resonance and Electroanatomical Imaging. Circ Arrhythm Electrophysiol 2021; 14:e010004. [PMID: 34693720 DOI: 10.1161/circep.121.010004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Indexed: 12/19/2022]
Abstract
BACKGROUND Brugada syndrome (BrS) is considered a purely electrical disease with variable electrical substrates. Variable rates of mechanical abnormalities have been also reported. Whether exists a link between electrical and mechanical abnormalities has never been previously explored. This investigational physiopathological study aimed to determine the relationship between the substrate size/location, as exposed by ajmaline provocation, and the severity of mechanical abnormalities, as assessed by cardiac magnetic resonance in patients with BrS. METHODS Twenty-four consecutive high-risk patients with BrS (mean age, 38±11 years, 17 males), presenting with malignant syncope and documented polymorphic ventricular tachycardia/ventricular fibrillation, and candidate to implantable cardioverter defibrillator implantation, underwent cardiac magnetic resonance and electroanatomic maps. During each examination, ajmaline test (1 mg/kg over 5 minutes) was performed. Cardiac magnetic resonance findings were compared with 24 age, sex, and body surface area-matched controls. In patients with BrS, the correlation between the electrical substrate extent and right ventricular regional mechanical abnormalities before/after ajmaline challenge was analyzed. RESULTS After ajmaline, patients with BrS showed a reduction of right ventricular (RV) ejection fraction (P<0.001), associated with decreased transversal displacement (U, P<0.001) and longitudinal strain (ε, P<0.001) localized at RV outflow tract. In patients with BrS significant preajmaline/postajmaline changes of transversal displacement (ΔU, P<0.001) and longitudinal strain (Δε, P<0.001) were found. In the control group, no mechanical changes were observed after ajmaline. The electrical substrate consistently increased after ajmaline from 1.7±2.8 cm2 to 14.2±7.3 cm2 (P<0.001), extending from the RV outflow tract to the neighboring segments of the RV anterior wall. Postajmaline RV ejection fraction inversely correlated with postajmaline substrate extent (r=-0.830, P<0.001). In patients with BrS and normal controls, cardiac magnetic resonance detected neither myocardial fibrosis nor RV outflow tract morphological abnormalities. CONCLUSIONS BrS is a dynamic RV electromechanical disease, where functional abnormalities correlate with the maximal extent of the substrate size. These findings open new lights on the physiopathology of the disease. Registration: URL: https://clinicaltrial.gov; Unique identifier: NCT03524079.
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Affiliation(s)
- Carlo Pappone
- Arrhythmology Department (C.P., V.S., V.M., G.C., F.M., G.V., E.M., L.A.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Vincenzo Santinelli
- Arrhythmology Department (C.P., V.S., V.M., G.C., F.M., G.V., E.M., L.A.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Valerio Mecarocci
- Arrhythmology Department (C.P., V.S., V.M., G.C., F.M., G.V., E.M., L.A.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Lara Tondi
- Multimodality Cardiac Imaging Section (L.T., S.P., A.C., M.L.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giuseppe Ciconte
- Arrhythmology Department (C.P., V.S., V.M., G.C., F.M., G.V., E.M., L.A.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Manguso
- Arrhythmology Department (C.P., V.S., V.M., G.C., F.M., G.V., E.M., L.A.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sturla
- Computer Simulation Laboratory (F.S.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Gabriele Vicedomini
- Arrhythmology Department (C.P., V.S., V.M., G.C., F.M., G.V., E.M., L.A.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Emanuele Micaglio
- Arrhythmology Department (C.P., V.S., V.M., G.C., F.M., G.V., E.M., L.A.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luigi Anastasia
- Arrhythmology Department (C.P., V.S., V.M., G.C., F.M., G.V., E.M., L.A.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Silvia Pica
- Multimodality Cardiac Imaging Section (L.T., S.P., A.C., M.L.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Antonia Camporeale
- Multimodality Cardiac Imaging Section (L.T., S.P., A.C., M.L.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section (L.T., S.P., A.C., M.L.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
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8
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Ciconte G, Monasky MM, Santinelli V, Micaglio E, Vicedomini G, Anastasia L, Negro G, Borrelli V, Giannelli L, Santini F, de Innocentiis C, Rondine R, Locati ET, Bernardini A, Mazza BC, Mecarocci V, Ćalović Ž, Ghiroldi A, D'Imperio S, Benedetti S, Di Resta C, Rivolta I, Casari G, Petretto E, Pappone C. Brugada syndrome genetics is associated with phenotype severity. Eur Heart J 2021; 42:1082-1090. [PMID: 33221895 PMCID: PMC7955973 DOI: 10.1093/eurheartj/ehaa942] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/02/2020] [Accepted: 11/02/2020] [Indexed: 12/14/2022] Open
Abstract
Aims Brugada syndrome (BrS) is associated with an increased risk of sudden cardiac death due to ventricular tachycardia/fibrillation (VT/VF) in young, otherwise healthy individuals. Despite SCN5A being the most commonly known mutated gene to date, the genotype–phenotype relationship is poorly understood and remains uncertain. This study aimed to elucidate the genotype–phenotype correlation in BrS. Methods and results Brugada syndrome probands deemed at high risk of future arrhythmic events underwent genetic testing and phenotype characterization by the means of epicardial arrhythmogenic substrate (AS) mapping, and were divided into two groups according to the presence or absence of SCN5A mutation. Two-hundred probands (160 males, 80%; mean age 42.6 ± 12.2 years) were included in this study. Patients harbouring SCN5A mutations exhibited a spontaneous type 1 pattern and experienced aborted cardiac arrest or spontaneous VT/VF more frequently than the other subjects. SCN5A-positive patients exhibited a larger epicardial AS area, more prolonged electrograms and more frequently observed non-invasive late potentials. The presence of an SCN5A mutation explained >26% of the variation in the epicardial AS area and was the strongest predictor of a large epicardial area. Conclusion In BrS, the genetic background is the main determinant for the extent of the electrophysiological abnormalities. SCN5A mutation carriers exhibit more pronounced epicardial electrical abnormalities and a more aggressive clinical presentation. These results contribute to the understanding of the genetic determinants of the BrS phenotypic expression and provide possible explanations for the varying degrees of disease expression. ![]()
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Affiliation(s)
- Giuseppe Ciconte
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Michelle M Monasky
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Vincenzo Santinelli
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Emanuele Micaglio
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Gabriele Vicedomini
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Luigi Anastasia
- Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Gabriele Negro
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Valeria Borrelli
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Luigi Giannelli
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Francesca Santini
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Carlo de Innocentiis
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Roberto Rondine
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Emanuela T Locati
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Andrea Bernardini
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Beniamino C Mazza
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Valerio Mecarocci
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Žarko Ćalović
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Andrea Ghiroldi
- Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Sara D'Imperio
- Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Sara Benedetti
- Clinical Genomics - SMEL, IRCCS San Raffaele Hospital, Milan, Italy
| | - Chiara Di Resta
- Vita-Salute San Raffaele University, Milan, Italy.,Clinical Genomics - SMEL, IRCCS San Raffaele Hospital, Milan, Italy
| | - Ilaria Rivolta
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giorgio Casari
- Vita-Salute San Raffaele University, Milan, Italy.,Clinical Genomics - SMEL, IRCCS San Raffaele Hospital, Milan, Italy
| | - Enrico Petretto
- Programme in Cardiovascular and Metabolic Disorders and Centre for Computational Biology, Duke-NUS Medical School Singapore, Republic of Singapore
| | - Carlo Pappone
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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9
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Ciconte G, Santinelli V, Vicedomini G, Borrelli V, Monasky MM, Micaglio E, Giannelli L, Negro G, Giordano F, Mecarocci V, Mazza BC, Locati E, Anastasia L, Calovic Z, Pappone C. Non-invasive assessment of the arrhythmogenic substrate in Brugada syndrome using signal-averaged electrocardiogram: clinical implications from a prospective clinical trial. Europace 2020; 21:1900-1910. [PMID: 31647530 DOI: 10.1093/europace/euz295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/21/2019] [Indexed: 12/12/2022] Open
Abstract
AIMS Brugada syndrome (BrS) represents a major cause of sudden cardiac death in young individuals. The risk stratification to forecast future life-threatening events is still controversial. Non-invasive assessment of late potentials (LPs) has been proposed as a risk stratification tool. However, their nature in BrS is still undetermined. The purpose of this study is to assess the electrophysiological determinants of non-invasive LPs. METHODS AND RESULTS Two hundred and fifty consecutive patients with (Group 1, n = 96) and without (Group 2, n = 154) BrS-related symptoms were prospectively enrolled in the registry. Signal-averaged electrocardiogram (SAECG) was performed in all subjects before undergoing epicardial mapping. Group 1 patients exhibited larger arrhythmogenic substrates (AS; 5.8 ± 2.8 vs. 2.6 ± 2.1 cm2, P < 0.001) with more delayed potentials (220.4 ± 46.0 vs. 186.7 ± 42.3 ms, P < 0.001). Late potentials were present in 82/96 (85.4%) Group 1 and in 31/154 (20.1%) Group 2 individuals (P < 0.001). Patients exhibiting LPs had more frequently a spontaneous Type 1 pattern (30.1% vs. 10.9%, P < 0.001), SCN5A mutation (34.5% vs. 21.2%, P = 0.02), and exhibited a larger AS with longer potentials (5.8 ± 2.7 vs. 2.2 ± 1.7 cm2; 231.2 ± 37.3 vs. 213.8 ± 39.0 ms; P < 0.001, respectively). Arrhythmogenic substrate dimension was the strongest predictor of the presence of LPs (odds ratio 1.9; P < 0.001). An AS area of at least 3.5 cm2 identified patients with LPs (area under the curve 0.88, 95% confidence interval 0.843-0.931; P < 0.001) with a sensitivity of 86%, specificity 88%, positive predictive value 85%, and negative predictive value 89%. CONCLUSION The results of this study support the role of the epicardial AS as an electrophysiological determinant of non-invasive LPs, which may serve as a tool in the non-invasive assessment of the BrS substrate, as SAECG-LPs could be considered an expression of the abnormal epicardial electrical activity. ClinicalTrials.gov number (NCT02641431; NCT03106701).
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Affiliation(s)
- Giuseppe Ciconte
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Vincenzo Santinelli
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Gabriele Vicedomini
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Valeria Borrelli
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Michelle M Monasky
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Emanuele Micaglio
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Luigi Giannelli
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Gabriele Negro
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Federica Giordano
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Valerio Mecarocci
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Beniamino C Mazza
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Emanuela Locati
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Luigi Anastasia
- Department of Stem Cells Tissue, Stem Cells for Tissue Engineering Lab, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Zarko Calovic
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Carlo Pappone
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
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10
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Ciconte G, Vicedomini G, Li W, Mangual JO, McSpadden L, Ryu K, Saviano M, Vitale R, Conti M, Ćalović Ž, Santinelli V, Pappone C. Non-paroxysmal atrial fibrillation mapping: characterization of the electrophysiological substrate using a novel integrated mapping technique. Europace 2020; 21:1193-1202. [PMID: 31056645 DOI: 10.1093/europace/euz123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/11/2018] [Accepted: 04/12/2019] [Indexed: 01/05/2023] Open
Abstract
AIMS Clinical outcomes after radiofrequency catheter ablation (RFCA) remain suboptimal in the treatment of non-paroxysmal atrial fibrillation (AF). Electrophysiological mapping may improve understanding of the underlying mechanisms. To describe the arrhythmia substrate in patients with persistent (Pers) and long-standing persistent (LSPers) AF, undergoing RFCA, using an integrated mechanism mapping technique. METHODS AND RESULTS Patients underwent high-density electroanatomical mapping before and after catheter ablation. Integrated maps characterized electrogram (EGM) cycle length (CL) in regions with repetitive-regular (RR) activations, stable wavefront propagation, fragmentation, and peak-to-peak bipolar voltage. Among 83 patients (72% male, 60 ± 11 years old), RR activations were identified in 376 regions (mean CL 180 ± 31 ms). PersAF patients (n = 43) showed more RR sites per patient (5.3 ± 2.4 vs. 3.7 ± 2.1, P = 0.002) with faster CL (166 ± 29 vs. 190 ± 29 ms; P < 0.001) and smaller surface area of fragmented EGMs (15 ± 14% vs. 27 ± 17%, P < 0.001) compared with LSPersAF. The post-ablation map in 50 patients remaining in AF, documented reduction of the RR activities per patient (1.5 ± 0.7 vs. 3.7 ± 1.4, P < 0.001) and area of fragmentation (22 ± 17% vs. 8 ± 9%, P < 0.001). Atrial fibrillation termination during ablation occurred at RR sites (0.48 ± 0.24 mV; 170.5 ± 20.2 ms CL) in 31/33 patients (94%). At the latest follow-up, arrhythmia freedom was higher among patients receiving ablation >75% of RR sites (Q4 82.6%, Q3 63.1%, Q2 35.1%, and Q1 0%; P < 0.001). CONCLUSION The integrated mapping technique allowed characterization of multiple arrhythmic substrates in non-paroxysmal AF patients. This technique might serve as tool for a substrate-targeted ablation approach.
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Affiliation(s)
- Giuseppe Ciconte
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Gabriele Vicedomini
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Wenwen Li
- Applied Research, Abbott, Sylmar, CA, USA
| | | | | | | | - Massimo Saviano
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Raffaele Vitale
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Manuel Conti
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Žarko Ćalović
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Vincenzo Santinelli
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Carlo Pappone
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
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11
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Tondi L, Mecarocci V, Sturla F, Pica S, Giannelli L, Ciconte G, Camporeale A, Santinelli V, Lombardi M, Pappone C. Right ventricular functional changes detected by CMR during ajmaline challenge in patients with Brugada syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0236] [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
3D echocardiography has recently revealed alterations of right ventricular (RV) function in Brugada syndrome (BrS) during ajmaline challenge (AC). Cardiac magnetic resonance (CMR) is the gold standard for functional and anatomical RV assessment. CMR feature-tracking (FT) analysis is able to detect subtle functional changes in the underlying myocardial substrate.
Purpose
To investigate RV functional changes during AC in BrS patients using CMR-FT analysis.
Methods
24 consecutive BrS and 28 matched controls underwent CMR. CMR protocol included paraxial and parasagittal cine bSSFP sequences, acquired before and 2÷5 minutes after ajmaline infusion (1 mg/kg in 5 minutes), to obtain a comprehensive evaluation of the RV free wall. All patients were closely monitored with ECG. Semi-automatic threshold-based quantification of ventricular volumes, function and mass was performed in QMass. CMR-FT analysis of RV function was performed in QStrain. Values of longitudinal strain (LS) and transverse displacement (TD) of the RV wall before and after AC were compared in BrS patients and in the control group.
Results
AC induced Type 1 ECG pattern in all BrS patients and no ECG changes in controls. In BrS patients TD of the RV free wall was significantly reduced (P≤0.003) at peak ajmaline effect; controls reported sub-millimetric TD changes. LS of the RV wall was significantly impaired in BrS patients (P<0.0001) on both b SSFP sequences; LS remained comparable (P=0.62) in controls on the parasagittal sequence; minor but not negligible (P=0.01) LS changes were noticed on the paraxial stack. (Table 1)
Conclusions
In patients with BrS CMR-FT analysis during AC unveils dysfunctional RV wall mechanics in areas generally associated with abnormal electrical activity.
TD and LS in a Brs patient post AC
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Tondi
- IRCCS Polyclinic San Donato, Milan, Italy
| | | | - F Sturla
- IRCCS Polyclinic San Donato, Milan, Italy
| | - S Pica
- IRCCS Polyclinic San Donato, Milan, Italy
| | | | - G Ciconte
- IRCCS Polyclinic San Donato, Milan, Italy
| | | | | | - M Lombardi
- IRCCS Polyclinic San Donato, Milan, Italy
| | - C Pappone
- IRCCS Polyclinic San Donato, Milan, Italy
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12
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Monasky MM, Micaglio E, Vicedomini G, Locati ET, Ciconte G, Giannelli L, Giordano F, Crisà S, Vecchi M, Borrelli V, Ghiroldi A, D'Imperio S, Di Resta C, Benedetti S, Ferrari M, Santinelli V, Anastasia L, Pappone C. Comparable clinical characteristics in Brugada syndrome patients harboring SCN5A or novel SCN10A variants. Europace 2020; 21:1550-1558. [PMID: 31292628 DOI: 10.1093/europace/euz186] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 03/25/2019] [Accepted: 06/10/2019] [Indexed: 12/19/2022] Open
Abstract
AIMS The Brugada syndrome (BrS) is an inherited disease associated with an increased risk of sudden cardiac death. Often, the genetic cause remains undetected. Perhaps due at least in part because the NaV1.8 protein is expressed more in both the central and peripheral nervous systems than in the heart, the SCN10A gene is not included in diagnostic arrhythmia/sudden death panels in the vast majority of cardiogenetics centres. METHODS AND RESULTS Clinical characteristics were assessed in patients harboring either SCN5A or novel SCN10A variants. Genetic testing was performed using Next Generation Sequencing on genomic DNA. Clinical characteristics, including the arrhythmogenic substrate, in BrS patients harboring novel SCN10A variants and SCN5A variants are comparable. Clinical characteristics, including gender, age, personal history of cardiac arrest/syncope, spontaneous BrS electrocardiogram pattern, family history of sudden death, and arrhythmic substrate are not significantly different between probands harboring SCN10A or SCN5A variants. CONCLUSION Future studies are warranted to further characterize the role of these specific SCN10A variants.
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Affiliation(s)
- Michelle M Monasky
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Emanuele Micaglio
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Gabriele Vicedomini
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Emanuela T Locati
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Giuseppe Ciconte
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Luigi Giannelli
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Federica Giordano
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Simonetta Crisà
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Mattia Vecchi
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Valeria Borrelli
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Andrea Ghiroldi
- Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, Milan, Italy
| | - Sara D'Imperio
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy.,Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, Milan, Italy
| | - Chiara Di Resta
- Genomic Unit for the Diagnosis of Human Pathologies, Division of Genetics and Cellular Biology, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Sara Benedetti
- Laboratory of Clinical Molecular Biology and Cytogenetics, IRCCS San Raffaele Hospital, Milan, Italy
| | - Maurizio Ferrari
- Genomic Unit for the Diagnosis of Human Pathologies, Division of Genetics and Cellular Biology, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Laboratory of Clinical Molecular Biology and Cytogenetics, IRCCS San Raffaele Hospital, Milan, Italy
| | - Vincenzo Santinelli
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Luigi Anastasia
- Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
| | - Carlo Pappone
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
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13
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van Dam PM, Locati ET, Ciconte G, Borrelli V, Heilbron F, Santinelli V, Vicedomini G, Monasky MM, Micaglio E, Giannelli L, Mecarocci V, Ćalović Ž, Anastasia L, Pappone C. Novel CineECG Derived From Standard 12-Lead ECG Enables Right Ventricle Outflow Tract Localization of Electrical Substrate in Patients With Brugada Syndrome. Circ Arrhythm Electrophysiol 2020; 13:e008524. [DOI: 10.1161/circep.120.008524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/16/2022]
Abstract
Background:
In Brugada syndrome (BrS), diagnosed in presence of a spontaneous or ajmaline-induced type-1 pattern, ventricular arrhythmias originate from the right ventricle outflow tract (RVOT). We developed a novel CineECG method, obtained by inverse electrocardiogram (ECG) from standard 12-lead ECG, to localize the electrical activity pathway in patients with BrS.
Methods:
The CineECG enabled the temporospatial localization of the ECG waveforms, deriving the mean temporospatial isochrone from standard 12-lead ECG. The study sample included (1) 15 patients with spontaneous type-1 Brugada pattern, and (2) 18 patients with ajmaline-induced BrS (at baseline and after ajmaline), in whom epicardial potential duration maps were available; (3) 17 type-3 BrS pattern patients not showing type-1 BrS pattern after ajmaline (ajmaline-negative); (4) 47 normal subjects; (5) 18 patients with right bundle branch block (RBBB). According to CineECG algorithm, each ECG was classified as Normal, Brugada, RBBB, or Undetermined.
Results:
In patients with spontaneous or ajmaline-induced BrS, CineECG localized the terminal mean temporospatial isochrone forces in the RVOT, congruent with the arrhythmogenic substrate location detected by epicardial potential duration maps. The RVOT location was never observed in normal, RBBB, or ajmaline-negative patients. In most patients with ajmaline-induced BrS (78%), the RVOT location was already evident at baseline. The CineECG classified all normal subjects and ajmaline-negative patients at baseline as Normal or Undetermined, all patients with RBBB as RBBB, whereas all patients with spontaneous and ajmaline-induced BrS as Brugada. Compared with standard 12-lead ECG, CineECG at baseline had a 100% positive predictive value and 81% negative predictive value in predicting ajmaline test results.
Conclusions:
In patients with spontaneous and ajmaline-induced BrS, the CineECG localized the late QRS activity in the RVOT, a phenomenon never observed in normal, RBBB, or ajmaline-negative patients. The possibility to identify the RVOT as the location of the arrhythmogenic substrate by the noninvasive CineECG, based on the standard 12-lead ECG, opens new prospective for diagnosing patients with BrS.
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Affiliation(s)
- Peter M. van Dam
- Department of Cardiology, University Medical Center Utrecht, the Netherlands (P.M.v.D.)
- ECG Excellence BV, Nieuwerbrug aan den Rijn, the Netherlands (P.M.v.D.)
| | - Emanuela T. Locati
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Giuseppe Ciconte
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Valeria Borrelli
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Francesca Heilbron
- Milano Bicocca University, Istituto Auxologico Italiano San Luca, Milan, Italy (F.H.)
| | - Vincenzo Santinelli
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Gabriele Vicedomini
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Michelle M. Monasky
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Emanuele Micaglio
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Luigi Giannelli
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Valerio Mecarocci
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Žarko Ćalović
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Luigi Anastasia
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
- Vita-Salute San Raffaele University (L.A., C.P.)
| | - Carlo Pappone
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
- Vita-Salute San Raffaele University (L.A., C.P.)
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14
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Pappone C, Mecarocci V, Manguso F, Ciconte G, Vicedomini G, Sturla F, Votta E, Mazza B, Pozzi P, Borrelli V, Anastasia L, Micaglio E, Locati E, Monasky MM, Lombardi M, Calovic Z, Santinelli V. New electromechanical substrate abnormalities in high-risk patients with Brugada syndrome. Heart Rhythm 2019; 17:637-645. [PMID: 31756528 DOI: 10.1016/j.hrthm.2019.11.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 10/01/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The relationship between the typical electrocardiographic pattern and electromechanical abnormalities has never been systematically explored in Brugada syndrome (BrS). OBJECTIVES The aims of this study were to characterize the electromechanical substrate in patients with BrS and to evaluate the relationship between electrical and mechanical abnormalities. METHODS We enrolled 50 consecutive high-risk patients with BrS (mean age 42 ± 7.2 years), with implantable cardioverter-defibrillator implantation for primary or secondary prevention of ventricular tachyarrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF]), undergoing substrate mapping and ablation. Patients underwent 3-dimensional (3D) echocardiography with 3D wall motion/deformation quantification and electroanatomic mapping before and after ajmaline administration (1 mg/kg in 5 minutes); 3D mechanical changes were compared with 50 age- and sex-matched controls. The effect of substrate ablation on electromechanical abnormalities was also assessed. RESULTS In all patients, ajmaline administration induced Brugada type 1 pattern, with a significant increase in the electrical substrate (P < .001), particularly in patients with previous spontaneous VT/VF (P = .007). Induction of Brugada pattern was associated with lowering of right ventricular (RV) ejection fraction (P < .001) and worsening of 3D RV mechanical function (P < .001), particularly in the anterior free wall of the RV outflow tract, without changes in controls. RV electrical and mechanical abnormalities were highly correlated (r = 0.728, P < .001). By multivariate analysis, only the area of RV dysfunction was an independent predictor of spontaneous VT/VF (odds ratio 1.480; 95% confidence interval 1.159-1.889; P = .002). Substrate ablation abolished both BrS-electrocardiographic pattern and mechanical abnormalities, despite ajmaline rechallenge. CONCLUSION BrS is an electromechanical disease affecting the RV. The typical BrS pattern reflects an extensive RV arrhythmic substrate, driving consistent RV mechanical abnormalities. Substrate ablation abolished both Brugada pattern and mechanical abnormalities.
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Affiliation(s)
- Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Valerio Mecarocci
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Manguso
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giuseppe Ciconte
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Gabriele Vicedomini
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sturla
- Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Emiliano Votta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Beniamino Mazza
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Paolo Pozzi
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Valeria Borrelli
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luigi Anastasia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Emanuele Micaglio
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Emanuela Locati
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Michelle M Monasky
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Massimo Lombardi
- Department of Cardiovascular Imaging, Policlinico San Donato, San Donato Milanese, Italy
| | - Zarko Calovic
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Vincenzo Santinelli
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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15
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Ciconte G, Vicedomini G, Giacopelli D, Calovic Z, Conti M, Spinelli B, Saviano M, Santinelli V, Pappone C. Feasibility of Remote Monitoring Using a Novel Long-Dipole Insertable Cardiac Monitor. JACC Clin Electrophysiol 2019; 4:559-561. [PMID: 30067500 DOI: 10.1016/j.jacep.2017.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/21/2017] [Indexed: 11/19/2022]
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16
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Pappone C, Ciconte G, Manguso F, Vicedomini G, Mecarocci V, Conti M, Giannelli L, Pozzi P, Borrelli V, Menicanti L, Calovic Z, Della Ratta G, Brugada J, Santinelli V. Assessing the Malignant Ventricular Arrhythmic Substrate in Patients With Brugada Syndrome. J Am Coll Cardiol 2019; 71:1631-1646. [PMID: 29650119 DOI: 10.1016/j.jacc.2018.02.022] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Guidelines recommend the use of implanted cardioverter-defibrillators in patients with Brugada syndrome and induced ventricular tachyarrhythmias, but there is no evidence supporting it. OBJECTIVES This prospective registry study was designed to explore clinical and electrophysiological predictors of malignant ventricular tachyarrhythmia inducibility in Brugada syndrome. METHODS A total of 191 consecutive selected patients with (group 1; n = 88) and without (group 2; n = 103) Brugada syndrome-related symptoms were prospectively enrolled in the registry. Patients underwent electrophysiological study and substrate mapping or ablation before and after ajmaline testing (1 mg/kg/5 min). RESULTS Overall, before ajmaline testing, 53.4% of patients had ventricular tachyarrhythmia inducibility, which was more frequent in group 1 (65.9%) than in group 2 (42.7%; p < 0.001). Regardless of clinical presentation, larger substrates with more fragmented long-duration ventricular potentials were found in patients with inducible arrhythmias than in patients without inducible arrhythmias (p < 0.001). One extrastimulus was used in more extensive substrates (median 13 cm2; p < 0.001), and ventricular fibrillation was the more frequently induced rhythm (p < 0.001). After ajmaline, patients without arrhythmia inducibility had arrhythmia inducibility without a difference in substrate characteristics between the 2 groups. The substrate size was the only independent predictor of inducibility (odds ratio: 4.51; 95% confidence interval: 2.51 to 8.09; p < 0.001). A substrate size of 4 cm2 best identified patients with inducible arrhythmias (area under the curve: 0.98; p < 0.001). Substrate ablation prevented ventricular tachyarrhythmia reinducibility. CONCLUSIONS In Brugada syndrome dynamic substrate variability represents the pathophysiological basis of lethal ventricular tachyarrhythmias. Substrate size is independently associated with arrhythmia inducibility, and its determination after ajmaline identifies high-risk patients missed by clinical criteria. Substrate ablation is associated with electrocardiogram normalization and not arrhythmia reinducibility. (Epicardial Ablation in Brugada Syndrome [BRUGADA_I]; NCT02641431; Epicardial Ablation in Brugada Syndrome: An Extension Study of 200 BrS Patients; NCT03106701).
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Affiliation(s)
- Carlo Pappone
- Arrhythmology Department, Scientific Institute for Research, Hospitalization, and Health Care (IRCCS) Policlinico San Donato University Hospital, San Donato Milanese, Italy.
| | - Giuseppe Ciconte
- Arrhythmology Department, Scientific Institute for Research, Hospitalization, and Health Care (IRCCS) Policlinico San Donato University Hospital, San Donato Milanese, Italy
| | - Francesco Manguso
- Arrhythmology Department, Scientific Institute for Research, Hospitalization, and Health Care (IRCCS) Policlinico San Donato University Hospital, San Donato Milanese, Italy
| | - Gabriele Vicedomini
- Arrhythmology Department, Scientific Institute for Research, Hospitalization, and Health Care (IRCCS) Policlinico San Donato University Hospital, San Donato Milanese, Italy
| | - Valerio Mecarocci
- Arrhythmology Department, Scientific Institute for Research, Hospitalization, and Health Care (IRCCS) Policlinico San Donato University Hospital, San Donato Milanese, Italy
| | - Manuel Conti
- Arrhythmology Department, Scientific Institute for Research, Hospitalization, and Health Care (IRCCS) Policlinico San Donato University Hospital, San Donato Milanese, Italy
| | - Luigi Giannelli
- Arrhythmology Department, Scientific Institute for Research, Hospitalization, and Health Care (IRCCS) Policlinico San Donato University Hospital, San Donato Milanese, Italy
| | - Paolo Pozzi
- Arrhythmology Department, Scientific Institute for Research, Hospitalization, and Health Care (IRCCS) Policlinico San Donato University Hospital, San Donato Milanese, Italy
| | - Valeria Borrelli
- Arrhythmology Department, Scientific Institute for Research, Hospitalization, and Health Care (IRCCS) Policlinico San Donato University Hospital, San Donato Milanese, Italy
| | - Lorenzo Menicanti
- Cardiac Surgery Department, IRCCS Policlinico San Donato University Hospital, San Donato Milanese, Italy
| | - Zarko Calovic
- Arrhythmology Department, Scientific Institute for Research, Hospitalization, and Health Care (IRCCS) Policlinico San Donato University Hospital, San Donato Milanese, Italy
| | - Giuseppe Della Ratta
- Arrhythmology Department, Scientific Institute for Research, Hospitalization, and Health Care (IRCCS) Policlinico San Donato University Hospital, San Donato Milanese, Italy
| | - Josep Brugada
- Cardiology Department, Cardiovascular Institute, Hospital Clinic and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Vincenzo Santinelli
- Arrhythmology Department, Scientific Institute for Research, Hospitalization, and Health Care (IRCCS) Policlinico San Donato University Hospital, San Donato Milanese, Italy
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17
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Pappone C, Ciconte G, Vicedomini G, Mangual JO, Li W, Conti M, Giannelli L, Lipartiti F, McSpadden L, Ryu K, Guazzi M, Menicanti L, Santinelli V. Clinical Outcome of Electrophysiologically Guided Ablation for Nonparoxysmal Atrial Fibrillation Using a Novel Real-Time 3-Dimensional Mapping Technique: Results From a Prospective Randomized Trial. Circ Arrhythm Electrophysiol 2019. [PMID: 29535136 DOI: 10.1161/circep.117.005904] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical outcomes after ablation of persistent atrial fibrillation remain suboptimal. Identification of AF drivers using a novel integrated mapping technique may be crucial to ameliorate the clinical outcome. METHODS AND RESULTS Persistent AF patients were prospectively enrolled to undergo high-density electrophysiological mapping to identify repetitive-regular activities (RRas) before modified circumferential pulmonary vein (PV) ablation. They have been randomly assigned (1:1 ratio) to ablation of RRa followed by modified circumferential PV ablation (mapping group; n=41) or modified circumferential PV ablation alone (control group; n=40). The primary end point was freedom from arrhythmic recurrences at 1 year. In total, 81 persistent AF patients (74% male; mean age, 61.7±10.6 years) underwent mapping/ablation procedure. The regions exhibiting RRa were 479 in 81 patients (5.9±2.4 RRa per patient): 232 regions in the mapping group (n=41) and 247 in the control group (n=40). Overall, 185 of 479 (39%) RRas were identified within the PVs, whereas 294 of 479 (61%) in non-PV regions. Mapping-guided ablation resulted in higher arrhythmia termination rate when compared with conventional strategy (25/41, 61% versus 12/40, 30%; P<0.007). Total radiofrequency duration (P=0.38), mapping (P=0.46), and fluoroscopy times (P=0.69) were not significantly different between the groups. No major procedure-related adverse events occurred. After 1 year, 73.2% of mapping group patients were free from recurrences versus 50% of control group (P=0.03). CONCLUSIONS Targeted ablation of regions showing RRa provided an adjunctive benefit in terms of arrhythmia freedom at 1-year follow-up in the treatment of persistent AF. These findings might support a patient-tailored strategy in subjects with nonparoxysmal AF and should be confirmed by additional larger, randomized, multicenter studies. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier NCT02571218.
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Affiliation(s)
- Carlo Pappone
- From the Department of Arrhythmology and Electrophysiology (C.P., G.C., G.V., M.C., L.G., F.L., V.S.), Department of Cardiac Surgery (L.M.), and Heart Failure Unit (M.G.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; and Abbott, Sylmar, Los Angeles, CA (J.O.M., W.L., L.M., K.R.).
| | - Giuseppe Ciconte
- From the Department of Arrhythmology and Electrophysiology (C.P., G.C., G.V., M.C., L.G., F.L., V.S.), Department of Cardiac Surgery (L.M.), and Heart Failure Unit (M.G.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; and Abbott, Sylmar, Los Angeles, CA (J.O.M., W.L., L.M., K.R.)
| | - Gabriele Vicedomini
- From the Department of Arrhythmology and Electrophysiology (C.P., G.C., G.V., M.C., L.G., F.L., V.S.), Department of Cardiac Surgery (L.M.), and Heart Failure Unit (M.G.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; and Abbott, Sylmar, Los Angeles, CA (J.O.M., W.L., L.M., K.R.)
| | - Jan O Mangual
- From the Department of Arrhythmology and Electrophysiology (C.P., G.C., G.V., M.C., L.G., F.L., V.S.), Department of Cardiac Surgery (L.M.), and Heart Failure Unit (M.G.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; and Abbott, Sylmar, Los Angeles, CA (J.O.M., W.L., L.M., K.R.)
| | - Wenwen Li
- From the Department of Arrhythmology and Electrophysiology (C.P., G.C., G.V., M.C., L.G., F.L., V.S.), Department of Cardiac Surgery (L.M.), and Heart Failure Unit (M.G.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; and Abbott, Sylmar, Los Angeles, CA (J.O.M., W.L., L.M., K.R.)
| | - Manuel Conti
- From the Department of Arrhythmology and Electrophysiology (C.P., G.C., G.V., M.C., L.G., F.L., V.S.), Department of Cardiac Surgery (L.M.), and Heart Failure Unit (M.G.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; and Abbott, Sylmar, Los Angeles, CA (J.O.M., W.L., L.M., K.R.)
| | - Luigi Giannelli
- From the Department of Arrhythmology and Electrophysiology (C.P., G.C., G.V., M.C., L.G., F.L., V.S.), Department of Cardiac Surgery (L.M.), and Heart Failure Unit (M.G.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; and Abbott, Sylmar, Los Angeles, CA (J.O.M., W.L., L.M., K.R.)
| | - Felicia Lipartiti
- From the Department of Arrhythmology and Electrophysiology (C.P., G.C., G.V., M.C., L.G., F.L., V.S.), Department of Cardiac Surgery (L.M.), and Heart Failure Unit (M.G.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; and Abbott, Sylmar, Los Angeles, CA (J.O.M., W.L., L.M., K.R.)
| | - Luke McSpadden
- From the Department of Arrhythmology and Electrophysiology (C.P., G.C., G.V., M.C., L.G., F.L., V.S.), Department of Cardiac Surgery (L.M.), and Heart Failure Unit (M.G.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; and Abbott, Sylmar, Los Angeles, CA (J.O.M., W.L., L.M., K.R.)
| | - Kyungmoo Ryu
- From the Department of Arrhythmology and Electrophysiology (C.P., G.C., G.V., M.C., L.G., F.L., V.S.), Department of Cardiac Surgery (L.M.), and Heart Failure Unit (M.G.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; and Abbott, Sylmar, Los Angeles, CA (J.O.M., W.L., L.M., K.R.)
| | - Marco Guazzi
- From the Department of Arrhythmology and Electrophysiology (C.P., G.C., G.V., M.C., L.G., F.L., V.S.), Department of Cardiac Surgery (L.M.), and Heart Failure Unit (M.G.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; and Abbott, Sylmar, Los Angeles, CA (J.O.M., W.L., L.M., K.R.)
| | - Lorenzo Menicanti
- From the Department of Arrhythmology and Electrophysiology (C.P., G.C., G.V., M.C., L.G., F.L., V.S.), Department of Cardiac Surgery (L.M.), and Heart Failure Unit (M.G.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; and Abbott, Sylmar, Los Angeles, CA (J.O.M., W.L., L.M., K.R.)
| | - Vincenzo Santinelli
- From the Department of Arrhythmology and Electrophysiology (C.P., G.C., G.V., M.C., L.G., F.L., V.S.), Department of Cardiac Surgery (L.M.), and Heart Failure Unit (M.G.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; and Abbott, Sylmar, Los Angeles, CA (J.O.M., W.L., L.M., K.R.)
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18
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Micaglio E, Monasky MM, Ciconte G, Vicedomini G, Conti M, Mecarocci V, Giannelli L, Giordano F, Pollina A, Saviano M, Pozzi PR, Di Resta C, Benedetti S, Ferrari M, Santinelli V, Pappone C. Novel SCN5A Frameshift Mutation in Brugada Syndrome Associated With Complex Arrhythmic Phenotype. Front Genet 2019; 10:547. [PMID: 31231430 PMCID: PMC6565861 DOI: 10.3389/fgene.2019.00547] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 07/30/2018] [Accepted: 05/23/2019] [Indexed: 11/16/2022] Open
Abstract
In this case report, we characterize a novel inherited frameshift mutation c.4700_4701del (p.Phe1567Cysfs*221) in a single copy of the SCN5A gene and its association with Brugada syndrome (BrS). The proband experienced a life-threatening ventricular arrhythmia successfully treated with DC-shock and he also suffered from supraventricular tachycardia. Ajmaline test confirmed the BrS diagnosis. No other mutation nor low frequency variants in the other 23 analyzed genes were detected. The same mutation was found in the father and sister, who were both diagnosed with BrS. We hypothesize that this mutation could be responsible for BrS and potentially linked to supraventricular tachycardias. Further studies are needed to confirm this observation and to assess the clinical relevance of this mutation, in terms of risk-stratification.
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Affiliation(s)
- Emanuele Micaglio
- Arrhythmology Department, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Giuseppe Ciconte
- Arrhythmology Department, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Manuel Conti
- Arrhythmology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Valerio Mecarocci
- Arrhythmology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Luigi Giannelli
- Arrhythmology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Federica Giordano
- Arrhythmology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Alberto Pollina
- Arrhythmology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Massimo Saviano
- Arrhythmology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Paolo R Pozzi
- Arrhythmology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Chiara Di Resta
- Genomic Unit for the Diagnosis of Human Pathologies, Division of Genetics and Cellular Biology, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Sara Benedetti
- Laboratory of Clinical Molecular Biology and Cytogenetics, IRCCS San Raffaele Hospital, Milan, Italy
| | - Maurizio Ferrari
- Genomic Unit for the Diagnosis of Human Pathologies, Division of Genetics and Cellular Biology, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Laboratory of Clinical Molecular Biology and Cytogenetics, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, Milan, Italy
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19
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Monasky MM, Micaglio E, Ciconte G, Benedetti S, Di Resta C, Vicedomini G, Borrelli V, Ghiroldi A, Piccoli M, Anastasia L, Santinelli V, Ferrari M, Pappone C. Genotype/Phenotype Relationship in a Consanguineal Family With Brugada Syndrome Harboring the R1632C Missense Variant in the SCN5A Gene. Front Physiol 2019; 10:666. [PMID: 31191357 PMCID: PMC6546918 DOI: 10.3389/fphys.2019.00666] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 02/12/2019] [Accepted: 05/09/2019] [Indexed: 12/19/2022] Open
Abstract
Brugada syndrome (BrS) is a known cause of sudden cardiac death. The genetic basis of BrS is not well understood, and no one single gene is linked to even a majority of BrS cases. However, mutations in the gene SCN5A are the most common, although the high amount of phenotypic variability prevents a clear correlation between genotype and phenotype. Research techniques are limited, as most BrS cases still remain without a genetic diagnosis, thus impairing the implementation of experimental models representative of a general pathogenetic mechanism. In the present study, we report the largest family to-date with the segregation of the heterozygous variant NM_198056:c.4894C>T (p.Arg1632Cys) in the SCN5A gene. The genotype-phenotype relationship observed suggests a likely pathogenic effect of this variant. Functional studies to better understand the molecular effects of this variant are warranted.
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Affiliation(s)
- Michelle M Monasky
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Emanuele Micaglio
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giuseppe Ciconte
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Sara Benedetti
- Laboratory of Clinical Molecular Biology and Cytogenetics, IRCCS San Raffaele Hospital, Milan, Italy
| | - Chiara Di Resta
- Genomic Unit for the Diagnosis of Human Pathologies, Division of Genetics and Cellular Biology, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Gabriele Vicedomini
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Valeria Borrelli
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Andrea Ghiroldi
- Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marco Piccoli
- Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luigi Anastasia
- Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Vincenzo Santinelli
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Maurizio Ferrari
- Laboratory of Clinical Molecular Biology and Cytogenetics, IRCCS San Raffaele Hospital, Milan, Italy.,Genomic Unit for the Diagnosis of Human Pathologies, Division of Genetics and Cellular Biology, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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20
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Abstract
Brugada syndrome (BrS) represents an inherited disorder associated with risk of sudden cardiac death due to VF in patients without structural heart disease. Currently, BrS is diagnosed by typical cove-shaped ST-segment elevation >2 mm in >1 RV precordial lead V1, V2 occurring spontaneously or after a sodium-channel blocker provocation test without any further evidence of malignant arrhythmias. An ICD should always be implanted in symptomatic BrS patients to prevent sudden death, despite high rates of complications with these devices. In asymptomatic people, an electrophysiological study should be performed to evaluate the need for an ICD. The recent discovery of a functional substrate has revolutionised our approach to the pathophysiology and management of BrS. Promising new therapeutic options have emerged in the last 3 years. Ajmaline is able to determine the extension of the substrate by prolonging the duration and fragmentation of abnormal epicardial electrograms. Substrate ablation results in the disappearance of both coved-type ECG and ventricular tachycardia/VF inducibility. These findings are clinically relevant, suggesting that epicardial ablation guided by ajmaline infusion may be an effective therapeutic option in BrS, potentially removing the need for ICD implantation.
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Affiliation(s)
- Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese Milan, Italy
| | - Vincenzo Santinelli
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese Milan, Italy
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21
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Micaglio E, Monasky MM, Ciconte G, Vicedomini G, Conti M, Mecarocci V, Giannelli L, Giordano F, Pollina A, Saviano M, Crisà S, Borrelli V, Ghiroldi A, D'Imperio S, Di Resta C, Benedetti S, Ferrari M, Santinelli V, Anastasia L, Pappone C. SCN5A Nonsense Mutation and NF1 Frameshift Mutation in a Family With Brugada Syndrome and Neurofibromatosis. Front Genet 2019; 10:50. [PMID: 30828344 PMCID: PMC6384234 DOI: 10.3389/fgene.2019.00050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/21/2019] [Indexed: 02/05/2023] Open
Abstract
In this case series, we report for the first time a family in which the inherited nonsense mutation [c. 3946C > T (p.Arg1316*)] in the SCN5A gene segregates in association with Brugada syndrome (BrS). Moreover, we also report, for the first time, the frameshift mutation [c.7686delG (p.Ile2563fsX40)] in the NF1 gene, as well as its association with type 1 neurofibromatosis (NF1), characterized by pigmentary lesions (café au lait spots, Lisch nodules, freckling) and cutaneous neurofibromas. Both of these mutations and associated phenotypes were discovered in the same family. This genetic association may identify a subset of patients at higher risk of sudden cardiac death who require the appropriate electrophysiological evaluation. This case series highlights the importance of genetic testing not only to molecularly confirm the pathology but also to identify asymptomatic family members who need clinical examinations and preventive interventions, as well as to advise about the possibility of avoiding recurrence risk with medically assisted reproduction.
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Affiliation(s)
- Emanuele Micaglio
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Michelle M Monasky
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giuseppe Ciconte
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Gabriele Vicedomini
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Manuel Conti
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Valerio Mecarocci
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luigi Giannelli
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Federica Giordano
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alberto Pollina
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Massimo Saviano
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Simonetta Crisà
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Valeria Borrelli
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Andrea Ghiroldi
- Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Sara D'Imperio
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Chiara Di Resta
- Genomic Unit for the Diagnosis of Human Pathologies, Division of Genetics and Cellular Biology, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Sara Benedetti
- Laboratory of Clinical Molecular Biology and Cytogenetics, IRCCS San Raffaele Hospital, Milan, Italy
| | - Maurizio Ferrari
- Genomic Unit for the Diagnosis of Human Pathologies, Division of Genetics and Cellular Biology, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Laboratory of Clinical Molecular Biology and Cytogenetics, IRCCS San Raffaele Hospital, Milan, Italy
| | - Vincenzo Santinelli
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luigi Anastasia
- Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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22
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Ciconte G, Ćalović Ž, McSpadden LC, Ryu K, Mangual J, Caporaso I, Baldi M, Saviano M, Cuko A, Vitale R, Conti M, Giannelli L, Vicedomini G, Santinelli V, Pappone C. Multipoint left ventricular pacing improves response to cardiac resynchronization therapy with and without pressure-volume loop optimization: comparison of the long-term efficacy of two different programming strategies. J Interv Card Electrophysiol 2018; 54:141-149. [DOI: 10.1007/s10840-018-0480-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/30/2018] [Indexed: 11/30/2022]
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23
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Pappone C, Santinelli V. Ablation for persistent atrial fibrillation in patients with heart failure: is it underutilized? J Cardiovasc Med (Hagerstown) 2018. [PMID: 29538154 DOI: 10.2459/jcm.0000000000000645] [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: 11/05/2022]
Affiliation(s)
- Carlo Pappone
- Department of Arrhythmology, Electrophysiology and Cardiac Pacing, IRCCS Policlinico San Donato, San Donato Milanese, University of Milan, Milan, Italy
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24
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Ciconte G, Santinelli V, Brugada J, Vicedomini G, Conti M, Monasky MM, Borrelli V, Castracane W, Aloisio T, Giannelli L, Di Dedda U, Pozzi P, Ranucci M, Pappone C. General Anesthesia Attenuates Brugada Syndrome Phenotype Expression: Clinical Implications From a Prospective Clinical Trial. JACC Clin Electrophysiol 2018; 4:518-530. [PMID: 30067493 DOI: 10.1016/j.jacep.2017.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/17/2017] [Accepted: 11/23/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study investigates the electrocardiographic-electrophysiological effects of administration of anesthetic drugs for general anesthesia (GA) in patients with BrS at high risk of sudden cardiac death (SCD). BACKGROUND The safety of anesthetic agents in Brugada syndrome (BrS) is under debate. METHODS All consecutive patients with spontaneous type 1 BrS electrocardiographic (ECG) patterns undergoing epicardial ablation of the arrhythmogenic substrate (AS) under GA were enrolled. Anesthesia was induced with single bolus of propofol and maintained with sevofluorane. ECG measurements were collected before, immediately after, and 20 min after induction of GA. Three-dimensional maps during GA and after ajmaline indicated the epicardial AS before ablation. RESULTS Thirty-six patients with BrS (32 male, 88.9%; mean age 38.8 ± 12.0 years) with a spontaneous type 1 ECG pattern underwent GA. Induction was performed using propofol at mean dose of 1.6 to 2.6 mg/kg (2.1 ± 0.3 mg/kg). Twenty-eight (28 of 36, 77.8%) patients showed a reversion to a nondiagnostic pattern. ST-segment elevation (0.32 ± 0.01 mV vs. 0.19 ± 0.02 mV; p < 0.001) and J-wave amplitude (0.47 ± 0.02 mV vs. 0.31 ± 0.03 mV; p < 0.001) decreased after propofol. The AS area during GA, in the absence of BrS pattern, significantly enlarged after administration of ajmaline (3.6 ± 0.5 cm2 vs. 20.3 ± 0.8 cm2). No patient developed malignant arrhythmias during GA induction and maintenance. CONCLUSIONS This study shows that GA using single-bolus propofol and volatile anesthetics is safe in high-risk patients with BrS, and it may exert a modulating effect by reducing the manifestation of type 1 BrS pattern and AS in the form of epicardial abnormal ECGs. (Epicardial Ablation in Brugada Syndrome: An Extension Study of 200 BrS Patients; NCT03106701).
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Affiliation(s)
- Giuseppe Ciconte
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Vincenzo Santinelli
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Gabriele Vicedomini
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Manuel Conti
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Michelle M Monasky
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Valeria Borrelli
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Walter Castracane
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Tommaso Aloisio
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luigi Giannelli
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Umberto Di Dedda
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paolo Pozzi
- Johnson & Johnson, Biosense Webster, Pomezia, Rome, Italy
| | - Marco Ranucci
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
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25
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Ciconte G, Ćalović Ž, Vicedomini G, Cuko A, McSpadden LC, Jiang C, Ryu K, Caporaso I, Stutz R, Winter D, Saviano M, Vitale R, Conti M, Santinelli V, Pappone C. Multipoint pacing improves peripheral hemodynamic response: Noninvasive assessment using radial artery tonometry. Pacing Clin Electrophysiol 2017; 41:106-113. [PMID: 29222865 DOI: 10.1111/pace.13254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 11/14/2017] [Accepted: 11/28/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multipoint left ventricular (LV) pacing (MultiPoint™ Pacing [MPP], Abbott, Sylmar, CA, USA) improves the response rate to cardiac resynchronization therapy (CRT). We evaluated the feasibility of noninvasive radial artery tonometry (RAT) to characterize arterial pressure morphology changes (pre-ejection period [PEP] and ejection duration [ED]) between conventional CRT and MPP pacing interventions. METHODS Patients with a MPP-enabled CRT device (Quadra Assura MP™, Abbott) underwent noninvasive RAT assessment (SphygmoCor CVMS, AtCor Medical Inc., Itasca, IL, USA) at 3-6 months after implantation. A pacing protocol was performed in a randomized order including one optimized conventional biventricular CRT (CONV) configuration using the distal electrode and five MPP configurations. The PEP, ED, and PEP/ED ratio were determined for each intervention from the RAT pressure waveform and electrocardiogram. RESULTS Pressure waveforms were successfully recorded in 19 patients (89% male, QRS 147 ± 16 ms, 63% ischemic). In 17/19 (89%) patients, at least one MPP intervention resulted in improved PEP, ED, and PEP/ED compared to CONV. The MPP intervention with greatest separation of LV cathodes and minimum intra-LV delay significantly improved PEP (mean PEP -15 ± 33% vs -8 ± 32% [CONV], P = 0.04) and ED (mean ED +8 ± 8% [MPP] vs +4 ± 7% [CONV], P = 0.02), and PEP/ED (-0.07 ± 0.14 [MPP] vs -0.04 ± 0.13 [CONV], P = 0.02) compared with CONV. CONCLUSIONS Noninvasive RAT efficiently characterizes changes in PEP and ED between CONV and MPP interventions. MPP configurations using the widest separation among LV cathodes and minimum intra-LV delay may significantly improve RAT-derived parameters as compared to conventional CRT.
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Affiliation(s)
- Giuseppe Ciconte
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Žarko Ćalović
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Gabriele Vicedomini
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Amarild Cuko
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | | | | | | | | | | | | | - Massimo Saviano
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Raffaele Vitale
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Manuel Conti
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Vincenzo Santinelli
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Carlo Pappone
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
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26
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Ciconte G, Conti M, Vicedomini G, Santinelli V, Brugada J, Pappone C. Intermittent alternance of Brugada ECG patterns: Insights from a unique electrophysiological phenomenon. J Cardiovasc Electrophysiol 2017; 28:1482-1484. [PMID: 28833819 DOI: 10.1111/jce.13317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Giuseppe Ciconte
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Manuel Conti
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Gabriele Vicedomini
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Vincenzo Santinelli
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Josep Brugada
- Cardiovascula Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Carlo Pappone
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
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27
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Ciconte G, Saviano M, Giannelli L, Calovic Z, Baldi M, Ciaccio C, Cuko A, Vitale R, Giacopelli D, Conti M, Lipartiti F, Giordano F, Maresca F, Moscatiello M, Vicedomini G, Santinelli V, Pappone C. Atrial fibrillation detection using a novel three-vector cardiac implantable monitor: the atrial fibrillation detect study. Europace 2017; 19:1101-1108. [DOI: 10.1093/europace/euw181] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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28
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Pappone C, Brugada J, Vicedomini G, Ciconte G, Manguso F, Saviano M, Vitale R, Cuko A, Giannelli L, Calovic Z, Conti M, Pozzi P, Natalizia A, Crisà S, Borrelli V, Brugada R, Sarquella-Brugada G, Guazzi M, Frigiola A, Menicanti L, Santinelli V. Electrical Substrate Elimination in 135 Consecutive Patients With Brugada Syndrome. Circ Arrhythm Electrophysiol 2017; 10:e005053. [DOI: 10.1161/circep.117.005053] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 04/13/2017] [Indexed: 11/16/2022]
Abstract
Background—
There is emerging evidence that localization and elimination of abnormal electric activity in the epicardial right ventricular outflow tract may be beneficial in patients with Brugada syndrome.
Methods and Results—
A total of 135 symptomatic Brugada syndrome patients having implantable cardiac defibrillator were enrolled: 63 (group 1) having documented ventricular tachycardia (VT)/ventricular fibrillation (VF) and Brugada syndrome–related symptoms, and 72 (group 2) having inducible VT/VF without ECG documentation at the time of symptoms. About 27 patients of group 1 experienced multiple implantable cardiac defibrillator shocks for recurrent VT/VF episodes. Three-dimensional maps before and after ajmaline determined the arrhythmogenic electrophysiological substrate (AES) as characterized by prolonged fragmented ventricular potentials. Primary end point was identification and elimination of AES leading to ECG pattern normalization and VT/VF noninducibility. Extensive areas of AES were found in the right ventricle epicardium, which were wider in group 1 (
P
=0.007). AES increased after ajmaline in both groups (
P
<0.001) and was larger in men (
P
=0.008). The increase of type-1 ST-segment elevation correlated with AES expansion (
r
=0.682,
P
<0.001). Radiofrequency ablation eliminated AES leading to ECG normalization and VT/VF noninducibility in all patients. During a median follow-up of 10 months, the ECG remained normal even after ajmaline in all except 2 patients who underwent a repeated effective procedure for recurrent VF.
Conclusions—
In Brugada syndrome, AES is commonly located in the right ventricle epicardium and ajmaline exposes its extent and distribution, which is correlated with the degree of coved ST-elevation. AES elimination by radiofrequency ablation results in ECG normalization and VT/VF noninducibility. Substrate-based ablation is effective in potentially eliminating the arrhythmic consequences of this genetic disease.
Clinical Trial Registration—
URL:
https://clinicaltrials.gov
. Unique identifier: NCT02641431.
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Affiliation(s)
- Carlo Pappone
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Josep Brugada
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Gabriele Vicedomini
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Giuseppe Ciconte
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Francesco Manguso
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Massimo Saviano
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Raffaele Vitale
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Amarild Cuko
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Luigi Giannelli
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Zarko Calovic
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Manuel Conti
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Paolo Pozzi
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Andrea Natalizia
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Simonetta Crisà
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Valeria Borrelli
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Ramon Brugada
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Georgia Sarquella-Brugada
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Marco Guazzi
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Alessandro Frigiola
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Lorenzo Menicanti
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Vincenzo Santinelli
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
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Pappone C, Santinelli V. Implantable cardioverter defibrillator and catheter ablation in Brugada syndrome. J Cardiovasc Med (Hagerstown) 2017; 18 Suppl 1:e35-e39. [DOI: 10.2459/jcm.0000000000000449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Pappone C, Brugada J, Vicedomini G, Ciconte G, Giannelli L, Saviano M, Santinelli V. 22-01: Epicardial ablation in Brugada syndrome. Insights from a prospective Registry study of 50 consecutive patients. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i25b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pappone C, Ciconte G, Saviano M, Li W, Afonso V, Mangual J, Romano E, Cuko A, Giannelli L, Conti M, Vitale R, Baldi M, Vicedomini G, Santinelli V. 209-04: Characteristics and Anatomical Distribution of Electrophysiological Drivers in Patients with Paroxysmal and Persistent Atrial Fibrillation. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i140c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pappone C, Ciconte G, Saviano M, Li W, Afonso V, Mangual J, Romanelli E, Crisa S, Cuko A, Giannelli L, Vitale R, Conti M, Baldi M, Vicedomini G, Santinelli V. 136-22: Fast and Regular Activities outside the Pulmonary Veins following Circumferential Pulmonary Vein Ablation in AF Patients. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i95b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pappone C, Calovic Z, Cuko A, Vicedomini G, Mcspadden L, Ryu K, Caporaso I, Baldi M, Saviano M, Giannelli L, Moscatiello M, Vitale R, Santinelli V. 139-02: Comparison of the long-term efficacy of two different programming strategies for multipoint left ventricular pacing. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Anselmino M, Matta M, D'ascenzo F, Pappone C, Santinelli V, Bunch TJ, Neumann T, Schilling RJ, Hunter RJ, Noelker G, Fiala M, Frontera A, Thomas G, Katritsis D, Jais P, Weerasooriya R, Kalman JM, Gaita F. Catheter ablation of atrial fibrillation in patients with diabetes mellitus: a systematic review and meta-analysis. Europace 2015; 17:1518-25. [DOI: 10.1093/europace/euv214] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pappone C, Santinelli V. Electrophysiology testing and catheter ablation are helpful when evaluating asymptomatic patients with Wolff-Parkinson-White pattern: the pro perspective. Card Electrophysiol Clin 2015; 7:371-6. [PMID: 26304515 DOI: 10.1016/j.ccep.2015.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Important advances in the natural history and diagnosis of, and therapy for, asymptomatic Wolff-Parkinson-White (WPW) syndrome have been made in the last decade by our group. These data have necessitated revisiting current practice guidelines to decide on the optimal management of the asymptomatic WPW population. There has also been an emphasis on identifying initially asymptomatic individuals who are at risk by nationwide screening programs using the electrocardiogram for prophylactic catheter ablation to prevent the lifetime risk of sudden cardiac death, particularly in young asymptomatic people, because only a subgroup of them is at high risk, requiring early catheter ablation.
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Affiliation(s)
- Carlo Pappone
- Department of Arrhythmology, Policlinico San Donato, University of Milan, Piazza Edmondo Malan, Milan 20097, Italy.
| | - Vincenzo Santinelli
- Department of Arrhythmology, Policlinico San Donato, University of Milan, Piazza Edmondo Malan, Milan 20097, Italy
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Brugada J, Pappone C, Berruezo A, Vicedomini G, Manguso F, Ciconte G, Giannelli L, Santinelli V. Brugada Syndrome Phenotype Elimination by Epicardial Substrate Ablation. Circ Arrhythm Electrophysiol 2015; 8:1373-81. [PMID: 26291334 DOI: 10.1161/circep.115.003220] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [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: 05/09/2015] [Accepted: 07/30/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Whether Brugada syndrome (BrS) depends on functional epicardial substrates, which may be definitively eliminated by radiofrequency ablation, remains unknown. METHODS AND RESULTS Patients with BrS underwent epicardial mapping to identify areas of abnormal electrograms as target for radiofrequency ablation. Substrate identification consisted in mapping right ventricle epicardial surface before and after flecainide (2 mg/kg per 10 minutes). After radiofrequency ablation, flecainide and remap confirmed elimination of abnormal substrate, BrS ECG pattern, and ventricular tachycardia/ventricular fibrillation inducibility. Flecainide testing was performed at each follow-up visits ≤6 months. Fourteen patients with BrS, median age 39 years (30.3-42.3) with implantable cardioverter-defibrillator were enrolled. Low-voltage areas (<1.5 mV) were commonly identified on the anterior right free wall and right ventricular outflow tract, which increased after flecainide from 17.6 cm(2) (12.1-24.2) to 28.5 cm(2) (21.6-30.2; P=0.001). Similarly, areas with abnormal electrograms increased after flecainide from 19.0 (17.5-23.6) to 27.3 cm(2) (24.0-31.2; P=0.001). After 23.8 minutes (18.1-28.5) of radiofrequency ablation, abnormal electrograms disappeared, whereas low-voltage areas were replaced by scar areas (<0.5 mV) of 25.9 cm(2) (19.6-31.0). Substrate elimination resulted in BrS ECG pattern disappearance and no ventricular tachycardia/ventricular fibrillation inducibility without complications. After a median follow-up of 5 months (3.8-5.3), ECG remained normal despite flecainide. CONCLUSIONS In patients with BrS, there is a relationship between abnormal ECG pattern, the extent of abnormal epicardial substrate, and ventricular tachycardia/ventricular fibrillation inducibility. Ablation of the substrate identified in the presence of flecainide can eliminate the BrS phenotype and warrants further study.
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Affiliation(s)
- Josep Brugada
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain (J.B., A.B.); and Arrhythmology Department, Maria Cecilia Hospital, Cotignola and Policlinico San Donato, University of Milan, Milan, Italy (C.P., G.V., F.M., G.C., L.G., V.S.)
| | - Carlo Pappone
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain (J.B., A.B.); and Arrhythmology Department, Maria Cecilia Hospital, Cotignola and Policlinico San Donato, University of Milan, Milan, Italy (C.P., G.V., F.M., G.C., L.G., V.S.).
| | - Antonio Berruezo
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain (J.B., A.B.); and Arrhythmology Department, Maria Cecilia Hospital, Cotignola and Policlinico San Donato, University of Milan, Milan, Italy (C.P., G.V., F.M., G.C., L.G., V.S.)
| | - Gabriele Vicedomini
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain (J.B., A.B.); and Arrhythmology Department, Maria Cecilia Hospital, Cotignola and Policlinico San Donato, University of Milan, Milan, Italy (C.P., G.V., F.M., G.C., L.G., V.S.)
| | - Francesco Manguso
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain (J.B., A.B.); and Arrhythmology Department, Maria Cecilia Hospital, Cotignola and Policlinico San Donato, University of Milan, Milan, Italy (C.P., G.V., F.M., G.C., L.G., V.S.)
| | - Giuseppe Ciconte
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain (J.B., A.B.); and Arrhythmology Department, Maria Cecilia Hospital, Cotignola and Policlinico San Donato, University of Milan, Milan, Italy (C.P., G.V., F.M., G.C., L.G., V.S.)
| | - Luigi Giannelli
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain (J.B., A.B.); and Arrhythmology Department, Maria Cecilia Hospital, Cotignola and Policlinico San Donato, University of Milan, Milan, Italy (C.P., G.V., F.M., G.C., L.G., V.S.)
| | - Vincenzo Santinelli
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain (J.B., A.B.); and Arrhythmology Department, Maria Cecilia Hospital, Cotignola and Policlinico San Donato, University of Milan, Milan, Italy (C.P., G.V., F.M., G.C., L.G., V.S.)
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Pappone C, Vicedomini G, Petretta A, Giannelli L, Cuko A, Santinelli V. Ventricular fibrillation in lone atrial fibrillation as clinical manifestation of latent Brugada syndrome: Usefulness of flecainide testing. HeartRhythm Case Rep 2015; 1:285-289. [PMID: 28491569 PMCID: PMC5419534 DOI: 10.1016/j.hrcr.2015.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Carlo Pappone
- Arrhythmology Department, University of Milan, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gabriele Vicedomini
- Arrhythmology Department, University of Milan, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Andrea Petretta
- Arrhythmology Department, University of Milan, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luigi Giannelli
- Arrhythmology Department, University of Milan, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Amarild Cuko
- Arrhythmology Department, University of Milan, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Vincenzo Santinelli
- Arrhythmology Department, University of Milan, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Pappone C, Vicedomini G, Manguso F, Saviano M, Baldi M, Pappone A, Ciaccio C, Giannelli L, Ionescu B, Petretta A, Vitale R, Cuko A, Calovic Z, Fundaliotis A, Moscatiello M, Tavazzi L, Santinelli V. Response to letter regarding article, "Wolff-Parkinson-White syndrome in the era of catheter ablation: insights from a registry study of 2169 patients". Circulation 2015; 131:e499. [PMID: 25986452 DOI: 10.1161/circulationaha.114.014534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carlo Pappone
- Department of Arrhythmology, Policlinico San Donato, University of Milan, Milan, Italy
| | - Gabriele Vicedomini
- Department of Arrhythmology, Policlinico San Donato, University of Milan, Milan, Italy
| | - Francesco Manguso
- Department of Arrhythmology, Policlinico San Donato, University of Milan, Milan, Italy
| | - Massimo Saviano
- Department of Arrhythmology, Policlinico San Donato, University of Milan, Milan, Italy
| | - Mario Baldi
- Department of Arrhythmology, Policlinico San Donato, University of Milan, Milan, Italy
| | - Alessia Pappone
- Department of Arrhythmology, Policlinico San Donato, University of Milan, Milan, Italy
| | - Cristiano Ciaccio
- Department of Arrhythmology, Policlinico San Donato, University of Milan, Milan, Italy
| | - Luigi Giannelli
- Department of Arrhythmology, Policlinico San Donato, University of Milan, Milan, Italy
| | - Bogdan Ionescu
- Department of Arrhythmology, Policlinico San Donato, University of Milan, Milan, Italy
| | - Andrea Petretta
- Department of Arrhythmology, Policlinico San Donato, University of Milan, Milan, Italy
| | - Raffaele Vitale
- Department of Arrhythmology, Policlinico San Donato, University of Milan, Milan, Italy
| | - Amarild Cuko
- Department of Arrhythmology, Policlinico San Donato, University of Milan, Milan, Italy
| | - Zarko Calovic
- Department of Arrhythmology, Policlinico San Donato, University of Milan, Milan, Italy
| | - Angelica Fundaliotis
- Department of Arrhythmology, Policlinico San Donato, University of Milan, Milan, Italy
| | - Mario Moscatiello
- Department of Arrhythmology, Policlinico San Donato, University of Milan, Milan, Italy
| | - Luigi Tavazzi
- Department of Arrhythmology, Policlinico San Donato, University of Milan, Milan, Italy
| | - Vincenzo Santinelli
- Department of Arrhythmology, Policlinico San Donato, University of Milan, Milan, Italy
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Pappone C, Vicedomini G, Manguso F, Baldi M, Petretta A, Giannelli L, Saviano M, Pappone A, Ionescu B, Ciaccio C, Vitale R, Cuko A, Calovic Z, Fundaliotis A, Moscatiello M, Catalano C, Santinelli V. The natural history of WPW syndrome. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Pappone C, alovi A, Cuko A, McSpadden LC, Ryu K, Jordan CD, Saviano M, Baldi M, Pappone A, Dozza L, Giannelli L, Fragakis N, Vicedomini G, Santinelli V. Multipoint left ventricular pacing provides additional echocardiographic benefit to responders and non-responders to conventional cardiac resynchronization therapy. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Pappone C, Vicedomini G, Manguso F, Saviano M, Baldi M, Pappone A, Ciaccio C, Giannelli L, Ionescu B, Petretta A, Vitale R, Cuko A, Calovic Z, Fundaliotis A, Moscatiello M, Tavazzi L, Santinelli V. Wolff-Parkinson-White syndrome in the era of catheter ablation: insights from a registry study of 2169 patients. Circulation 2014; 130:811-9. [PMID: 25052405 DOI: 10.1161/circulationaha.114.011154] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND The management of Wolff-Parkinson-White is based on the distinction between asymptomatic and symptomatic presentations, but evidence is limited in the asymptomatic population. METHODS AND RESULTS The Wolff-Parkinson-White registry was an 8-year prospective study of either symptomatic or asymptomatic Wolff-Parkinson-White patients referred to our Arrhythmology Department for evaluation or ablation. Inclusion criteria were a baseline electrophysiological testing with or without radiofrequency catheter ablation (RFA). Primary end points were the percentage of patients who experienced ventricular fibrillation (VF) or potentially malignant arrhythmias and risk factors. Among 2169 enrolled patients, 1001 (550 asymptomatic) did not undergo RFA (no-RFA group) and 1168 (206 asymptomatic) underwent ablation (RFA group). There were no differences in clinical and electrophysiological characteristics between the 2 groups except for symptoms. In the no-RFA group, VF occurred in 1.5% of patients, virtually exclusively (13 of 15) in children (median age, 11 years), and was associated with a short accessory pathway antegrade refractory period (P<0.001) and atrioventricular reentrant tachycardia initiating atrial fibrillation (P<0.001) but not symptoms. In the RFA group, ablation was successful in 98.5%, and after RFA, no patients developed malignant arrhythmias or VF over the 8-year follow-up. Untreated patients were more likely to experience malignant arrhythmias and VF (log-rank P<0.001). Time-dependent receiver-operating characteristic curves for predicting VF identified an optimal anterograde effective refractory period of the accessory pathway cutoff of 240 milliseconds. CONCLUSIONS The prognosis of the Wolff-Parkinson-White syndrome essentially depends on intrinsic electrophysiological properties of AP rather than on symptoms. RFA performed during the same procedure after electrophysiological testing is of benefit in improving the long-term outcomes.
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Affiliation(s)
- Carlo Pappone
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.).
| | - Gabriele Vicedomini
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Francesco Manguso
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Massimo Saviano
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Mario Baldi
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Alessia Pappone
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Cristiano Ciaccio
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Luigi Giannelli
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Bogdan Ionescu
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Andrea Petretta
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Raffaele Vitale
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Amarild Cuko
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Zarko Calovic
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Angelica Fundaliotis
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Mario Moscatiello
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Luigi Tavazzi
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Vincenzo Santinelli
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
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Pappone C, Berto MB, Santinelli V. The Unique MediGuide Technology For CRT Lead Placement And Catheter Ablation. J Atr Fibrillation 2014; 7:1072. [PMID: 27957083 DOI: 10.4022/jafib.1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/10/2014] [Accepted: 06/09/2014] [Indexed: 11/10/2022]
Abstract
Electrophysiologic procedures such as catheter ablation and/or cardiac resynchronization therapy (CRT) are usually performed under fluoroscopic guidance alone. Currently, we are witnessing the birth of a new era in which many patients can be safely and effectively treated without the use of fluoroscopy. Using MediGuide technology continuous fluoroscopy is no longer required to ascertain the position of the device/catheter, which minimizes the radiation exposure for both the physician and patient, with a further benefit by minimal need for contrast agent. This novel system provides real time tracking of devices projected into live fluoroscopy or pre-recorded cine-angiography. MediGuide technology is an important step forward facilitating complex ablation procedures such as AF ablation and CRT implantation.
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Affiliation(s)
- Carlo Pappone
- Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola; Italy
| | - Martina Boscolo Berto
- Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola; Italy
| | - Vincenzo Santinelli
- Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola; Italy
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Pappone C, Calovic Z, Cuko A, Mcspadden LC, Ryu K, Romano E, Baldi M, Pappone A, Vicedomini G, Santinelli V. PT077 Multipoint left ventricular pacing gives greater benefit in patients with lower baseline ejection fraction. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.1870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Pappone C, Calovic Z, Cuko A, Mcspadden LC, Ryu K, Romano E, Saviano M, Vitale R, Vicedomini G, Santinelli V. O157 Multipoint left ventricular pacing provides similar acute hemodynamic improvement regardless of QRS duration or lead location in cardiac resynchronization therapy patients. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.1364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Pappone C, Ćalović Ž, Vicedomini G, Cuko A, McSpadden LC, Ryu K, Romano E, Saviano M, Baldi M, Pappone A, Ciaccio C, Giannelli L, Ionescu B, Petretta A, Vitale R, Fundaliotis A, Tavazzi L, Santinelli V. Multipoint left ventricular pacing improves acute hemodynamic response assessed with pressure-volume loops in cardiac resynchronization therapy patients. Heart Rhythm 2014; 11:394-401. [DOI: 10.1016/j.hrthm.2013.11.023] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Indexed: 11/29/2022]
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Pappone C, Augello G, Gugliotta F, Santinelli V. Robotic and magnetic navigation for atrial fibrillation ablation. How and why? Expert Rev Med Devices 2014; 4:885-94. [DOI: 10.1586/17434440.4.6.885] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Pappone C, Vicedomini G, Santinelli V. Atrio-Esophageal Fistula After AF Ablation: Pathophysiology, Prevention &Treatment. J Atr Fibrillation 2013; 6:860. [PMID: 28496888 DOI: 10.4022/jafib.860] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 07/23/2013] [Accepted: 07/23/2013] [Indexed: 11/10/2022]
Abstract
Atrioesophageal fistula is an extremely rare but often fatal late complication of atrial fibrillation ablation procedures resulting from massive thermal injury to the esophagus and surrounding structures. Causes of death include cerebral air embolism, massive gastrointestinal bleeding, and septic shock. Because of its exceptionally low rate of occurrence, no predictors of lesion development have been found and there has not been an uniform approach to either early diagnosis or corrective therapy. Currently, preventive strategies include empirically reducing power titration during PVI and/or while ablating the posterior left atrial wall, limiting energy delivery time and number, avoiding overlapping ablation lines as well as monitoring intraluminal esophageal temperature. In addition, it has been suggested to use conscious sedation rather than general anesthesia for better pain perception, monitoring intraprocedural esophageal position in relation to the posterior left atrium and extensive patient education regarding signs and symptoms of esophageal injury. Early diagnosis is essential to enable an aggressive treatment including stenting and/or surgical intervention to minimize the excessive morbidity and mortality associated with this condition. Unfortunately, despite application of such preventive measures, cases of complete atrial-esophageal fistula have still been reported.
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Affiliation(s)
- Carlo Pappone
- GVM Research and Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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Pappone C, Calovic Z, Cuko A, McSpadden LC, Ryu K, Baldi M, Pappone A, Saviano M, Giannelli L, Ciaccio C, Petretta A, Moscatiello M, Fundaliotis A, Vitale R, Ionescu B, Vicedomini G, Santinelli V. Multisite Left Ventricular Pacing in a Single Coronary Sinus Branch Improves 3-Month Echocardiographic and Clinical Response to Cardiac Resynchronization Therapy. J Card Fail 2013. [DOI: 10.1016/j.cardfail.2013.06.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Wolff-Parkinson-White syndrome (WPW) is associated with a small but lifetime risk of cardiac arrest and/or sudden cardiac death (SCD). However, the exact risk is not well defined, particularly in asymptomatic persons. Over recent years the authors have collected and reported new follow-up data among a large number of asymptomatic WPW patients, particularly children, intensively followed. These data have significantly contributed to the knowledge and definition of the natural history of WPW from childhood to adulthood. The risk of SCD is higher in asymptomatic children than in adults, and early ablation can be offered only to selected subjects after electrophysiologic testing.
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Affiliation(s)
- Carlo Pappone
- Arrhythmology Department, Maria Cecilia Hospital, Via Corriera 1, 48010 Cotignola, Italy
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Pappone C, Santinelli V. Post Ablation Left Atrial Tachycardia: Understanding Mechanism, Prevention and Treatment. J Atr Fibrillation 2012; 5:525. [PMID: 28496760 PMCID: PMC5153123 DOI: 10.4022/jafib.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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 03/14/2012] [Accepted: 03/16/2012] [Indexed: 06/07/2023]
Abstract
Currently, post-ablation Atrial Tachycardias (ATs) represent a growing clinical problem particularly in patients with persistent AF undergoing a more extensive substrate ablation. Understanding mechanisms and location of potentially widely located arrhythmogenic substrates in the left atrium is crucial for successful ablation. Mapping and ablation are challenging since complex and multiple ATs may frequently develop during the index procedure and before conversion to sinus rhythm. Use of irrigated ablation guided by detailed 3-D electroanatomic activation maps combined with entrainment pacing is effective with excellent acute and long-term success rates, rarely requiring multiple procedures.
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Affiliation(s)
- Carlo Pappone
- Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy
| | - Vincenzo Santinelli
- Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy
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