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3. Ablation of Paroxysmal Atrial Fibrillation: between Present and Future

Author

Robles, Antonio Gianluca, primary, Palamà, Zefferino, primary, Scarà, Antonio, primary, Borrelli, Alessio, primary, Gianfrancesco, Domenico, primary, Bartolomucci, Francesco, primary, Nesti, Martina, primary, Cavarretta, Elena, primary, De Masi De Luca, Gabriele, primary, Romano, Silvio, primary, and Sciarra, Luigi, primary

Published
2024
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4. Contact-force monitoring increases accuracy of right ventricular voltage mapping avoiding “false scar” detection in patients with no evidence of structural heart disease

Author

Sciarra, Luigi, Palamà, Zefferino, Nesti, Martina, Lanzillo, Chiara, Di Roma, Mauro, De Ruvo, Ermenegildo, Robles, Antonio Gianluca, Cavarretta, Elena, Scarà, Antonio, De Luca, Lucia, Grieco, Domenico, Rillo, Mariano, Romano, Silvio, Petroni, Renata, Penco, Maria, and Calò, Leonardo

Published
2020
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7. Long-Term Follow-Up In Paroxysmal Atrial Fibrillation Patients With Documented Isolated Trigger

Author

Palamà, Zefferino, primary, Robles, Antonio Gianluca, additional, Paoletti, Matteo, additional, Nesti, Martina, additional, De Ruvo, Ermenegildo, additional, Scarà, Antonio, additional, Borrelli, Alessio, additional, De Masi De Luca, Gabriele, additional, Rillo, Mariano, additional, Calò, Leonardo, additional, Cavarretta, Elena, additional, Romano, Silvio, additional, and Sciarra, Luigi, additional

Published
2023
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10. Low fluoroscopy permanent His bundle pacing using a new electroanatomic mapping system ( KODEX EPD ). A multicenter experience

Author

Scarà, Antonio, primary, Golia, Paolo, additional, Grieco, Domenico, additional, Borrelli, Alessio, additional, De Ruvo, Ermenegildo, additional, Bressi, Edoardo, additional, Politano, Alessandro, additional, De Luca, Lucia, additional, Bruni, Giuseppe, additional, Fagagnini, Alessandro, additional, Panuccio, Marco, additional, Rebecchi, Marco, additional, Zecchi, Paolo, additional, Solimene, Francesco, additional, Calò, Leonardo, additional, and Sciarra, Luigi, additional

Published
2022
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12. Tailoring the Ablative Strategy for Atrial Fibrillation: A State-of-the-Art Review

Author

Palamà, Zefferino, Nesti, Martina, Robles, Antonio Gianluca, Scarà, Antonio, Romano, Silvio, Cavarretta, Elena, Penco, Maria, Delise, Pietro, Rillo, Mariano, Calò, Leonardo, and Sciarra, Luigi

Subjects
Article Subject
Abstract

In spite of technological progress and the improving skills of operators, atrial fibrillation (AF) ablation results appear to date to be at a plateau. In any case, the superiority of ablation over pharmacological therapy in terms of effectiveness, reduction of hospitalizations, and improvement has been well demonstrated in recent randomized trials. Triggers, substrate, and modulating factors (elements of Coumel’s triangle) play different roles in paroxysmal and persistent AF, so induction and perpetuation mechanisms of arrhythmia may be different in each patient. Although effective ablative strategies are available for the treatment of paroxysmal AF triggers and persistent AF substrates, an adequate clinical evaluation of the patient is crucial in order to increase the chances of success. Recognizing triggers allows not only performing an effective ablation but also to avoid unnecessary lesions and at the same time reducing the risk of complications. AF beginning and triggers could be recorded by 12-lead ECG, continuous Holter monitoring, or implantable devices. In case of an unsuccessful noninvasive evaluation, nonpulmonary vein triggers should be investigated with an electrophysiological study. Persistent AF needs more effort to perform an accurate substrate characterization. Among the many methods proposed, recently the use of high-density mapping and multipolar catheters seems of particular benefit in order to clarify the arrhythmia mechanisms. Surgical and hybrid techniques allow to treat regions such as the posterior wall or Bachmann’s bundle, which is fundamental for an ablative strategy that goes beyond just pulmonary vein isolation. Too often, patients are referred to electrophysiology laboratories without adequate preprocedural screening and planning in order to submit them to a standard “ready-made” procedure. The accurate search for triggers in paroxysmal AF and the correct recognition of the link between a possible underlying heart disease and the substrate in persistent AF could allow us to tailor the interventional approach in order to overcome the current plateau, increasing ablative procedure success and minimizing complications.

Published
2022
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13. 629 CPVT and complete atrio-ventricular block: two faces of the same coin?

Author

Petrungaro, Mattia, primary, Nesti, Martina, additional, Cavaretta, Elena, additional, Palamà, Zefferino, additional, Scarà, Antonio, additional, Martino, Annamaria, additional, Robles, Antonio Gianluca, additional, De Maio, Melissa, additional, Romano, Silvio, additional, Penco, Maria, additional, Calò, Leonardo, additional, and Sciarra, Luigi, additional

Published
2021
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14. Low fluoroscopy permanent His bundle pacing using a new electroanatomic mapping system (KODEX EPD). A multicenter experience.

Author

Scarà, Antonio, Golia, Paolo, Grieco, Domenico, Borrelli, Alessio, De Ruvo, Ermenegildo, Bressi, Edoardo, Politano, Alessandro, De Luca, Lucia, Bruni, Giuseppe, Fagagnini, Alessandro, Panuccio, Marco, Rebecchi, Marco, Zecchi, Paolo, Solimene, Francesco, Calò, Leonardo, and Sciarra, Luigi

Subjects
RESEARCH, SICK sinus syndrome, SCIENTIFIC observation, CASE-control method, FLUOROSCOPY, ELECTROPHYSIOLOGY, HEART block, CARDIAC pacing, DESCRIPTIVE statistics, HIS bundle, LONGITUDINAL method
Abstract

Background: His bundle pacing (HBP) may be a challenging procedure, often involving a long fluoroscopic time (FT) and a long procedural time (PT). We sought to evaluate whether the use of a new nonfluroscopic mapping (NFM) system, the KODEX‐EPD, is able to reduce FT and PT when mapping is performed by the pacing catheter rather than an electrophysiological mapping catheter. Methods and Results: We included 46 consecutive patients (77 ± 8 years; 63% male) who underwent HBP; in 22 a NFM‐guided procedure with the KODEX‐EPD system was performed (group 1), whereas in 24 a conventional fluoroscopy‐guided approach was used (group 2). Pacing indications were sick sinus syndrome in 13, atrioventricular block in 21, and cardiac resynchronization therapy in 12 cases. Both a lumen‐less fixed helix lead and a stylet‐driven extendable helix lead were used, respectively, in 24% and 76% of patients. HBP was successful in 22 patients (100%) in group 1 and 23 patients (96%) in group 2. The FT was significantly reduced in group 1 (183 ± 117 s vs 464.1 ± 352 s in group 2, p =.012). There were no significant differences between groups in PT and other procedural outcomes. Conclusions: The KODEX‐EPD system may be safely used in HBP procedures. It is effective in reducing ionizing radiation exposure, as evidenced by the significant drop in FT, without increasing PT. [ABSTRACT FROM AUTHOR]

Published
2023
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18. Atrial fibrillation and autonomic nervous system: A translational approach to guide therapeutic goals

Author

Rebecchi, Marco, primary, Panattoni, Germana, additional, Edoardo, Bressi, additional, Ruvo, Ermenegildo, additional, Sciarra, Luigi, additional, Politano, Alessandro, additional, Sgueglia, Marianna, additional, Ricagni, Chiara, additional, Verbena, Sara, additional, Crescenzi, Cinzia, additional, Sangiorgi, Catia, additional, Borrelli, Alessio, additional, De Luca, Lucia, additional, Scarà, Antonio, additional, Grieco, Domenico, additional, Jacomelli, Ilaria, additional, Martino, Annamaria, additional, and Calò, Leonardo, additional

Published
2021
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22. Diabetes mellitus and atrial remodelling in patients with paroxysmal atrial fibrillation: Role of electroanatomical mapping and catheter ablation

Author

Grieco, Domenico, primary, Palamà, Zefferino, additional, Borrelli, Alessio, additional, De Ruvo, Ermenegildo, additional, Sciarra, Luigi, additional, Scarà, Antonio, additional, Goanta, Emilia, additional, Calabrese, Vito, additional, Pozzilli, Paolo, additional, Di Sciascio, Germano, additional, and Calò, Leonardo, additional

Published
2018
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23. The Extent of Microvascular Damage During Myocardial Contrast Echocardiography Is Superior to Other Know Indexes of Post-Infarct Reperfusion in Predicting Left Ventricular Remodeling

Author

Galiuto, Leonarda, Garramone, Barbara, Scarà, Antonio, Rebuzzi, Antonio Giuseppe, Crea, Filippo, La Torre, Giuseppe, Funaro, Stefania, Madonna, M, Fedele, Francesco, Agati, Luciano, Galiuto, Leonarda (ORCID:0000-0002-6831-479X), Scarà , Antonio, Rebuzzi, Antonio Giuseppe (ORCID:0000-0002-9873-957X), Crea, Filippo (ORCID:0000-0001-9404-8846), Galiuto, Leonarda, Garramone, Barbara, Scarà, Antonio, Rebuzzi, Antonio Giuseppe, Crea, Filippo, La Torre, Giuseppe, Funaro, Stefania, Madonna, M, Fedele, Francesco, Agati, Luciano, Galiuto, Leonarda (ORCID:0000-0002-6831-479X), Scarà , Antonio, Rebuzzi, Antonio Giuseppe (ORCID:0000-0002-9873-957X), and Crea, Filippo (ORCID:0000-0001-9404-8846)

Abstract

Objectives: We sought the value of the extent of microvasculkar damage as assessed with myocardial contrast echocardiography (MCE) in the prediction of left ventricular (LV) remodeling after ST-elevation myocardial infarction (STEMI) as compared with established clinical and angiographic parameters of reperfusion. Background: Early identification of post-percutaneous coronary intervention microvascular dyysfunction may help in tailoring appropriate pharmacologoical interventions in high-risk patients. The ideal method to establish effective microvascular reperfusion after percutaneous coronary intervention remains to be determined. Methods: A total of 110 patients with first successfully reperfused STEMI were enrolled in the AMICI (Acute Myocardial Infarction Contrast Imaging) multicenter study. Afetr reperfusion, peak creatine kinase, ST-segment reduction, and Thrombolysis in Myocardial Infarction (TIMI) and myocardial blush grade were calculated. We evaluate reperfusion defects with MCE by using continous infusion of SONOVUE (Bracco, Milan, Italy) in real-time imaging. The endocardial lenght of contrast defect (CD) on day 1 after reperfusion was calculated. Wall motion score index, the extent of wall motion abnormalities, LV end-diastolic volume, and ejection fraction after reperfusion and at follow-up also were calculated. Results: Of 110 patients, 25% evolved in LV remodeling and 75% did not. Although peak cretine kinase, ST-segment reduction > 70%, and myocardial blush grade were not different between groups, in patients exhibiting LV remodeling, TIMI grade 3 flow was less frequent (p<0.001), wall motion score index was greater (p<0.001), and CD was greater (p<0.001). At multivariate analysis, only TIMI flow grade < 3 and CD with a cutoff of >25% were independently assocoated with LV remodeling. Among patients with grade 3 TIMI flow, CD was the only independent variable associated with LV remodeling. Conclusions: Among opatients with grade 3 TIMI flow, the exte

Published
2008

24. 136-19: Prudent power setting and limited duration of RF applications may reduce procedural complication using a novel irrigated circular radiofrequency ablation catheter

Author

De Ruvo, Ermenegildo, primary, Grieco, Domenico, additional, Sciarra, Luigi, additional, Goanta, Emilia, additional, Borrelli, Alessio, additional, Scarà, Antonio, additional, Rebecchi, Marco, additional, Golia, Paolo, additional, De Luca, Lucia, additional, and Calo', Leonardo, additional

Published
2016
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25. 176-82: Effectiveness of Remote Monitoring in Patients Implanted with a new miniaturized Injectable Cadiac Monitor

Author

De Ruvo, Ermenegildo, primary, Panuccio, Marco, additional, Sette, Antonella, additional, Martino, Annamaria, additional, Fagagnini, Alessandro, additional, Grieco, Domenico, additional, Goanta, Emilia, additional, Sciarra, Luigi, additional, Scarà, Antonio, additional, Borrelli, Alessio, additional, Golia, Paolo, additional, De Luca, Lucia, additional, Tota, Claudia, additional, and Calo', Leonardo, additional

Published
2016
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26. 16-16: First evaluation of contact force during atrial fibrillation ablation using a novel robotic system (AMIGO®) combined to a force-sensing catheter. A single centre experience

Author

Scarà, Antonio, primary, Sciarra, Luigi, additional, De Ruvo, Ermenegildo, additional, Mercurio, Marina, additional, Borrelli, Alessio, additional, Rebecchi, Marco, additional, Grieco, Domenico, additional, De Luca, Lucia, additional, and Calo', Leonardo, additional

Published
2016
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27. 176-12: Long term follow-up of long lasting persistent AF ablation with the intraprocedural use of ibutilide to identify active CFAEs: a single center registry

Author

Luigi Sciarra, Ermenegildo De Ruvo, Alessio Borrelli, Emilia Goanta, Ludovica Scialla, Leonardo Calò, Paolo Golia, Scarà Antonio, Lucia De Luca, Domenico Grieco, Annamaria Martino, and Marco Rebecchi

Subjects
Long lasting, medicine.medical_specialty, Long term follow up, business.industry, Ibutilide, Single Center, Physiology (medical), Internal medicine, medicine, Cardiology, Cardiology and Cardiovascular Medicine, Af ablation, business, medicine.drug
Published
2016

28. Abnormal venous return: Still a challenge for electrophysiology procedures? A case report.

Author

Robles AG, Borrelli A, de Ruvo E, Sciarra L, Scarà A, De Luca L, Grieco D, and Calò L

Abstract

Catheter ablation of cardiac arrhythmias is usually performed through the femoral venous approach. Systemic venous return anomalies such as interruption of the inferior vena cava may represent a challenge during electrophysiological procedures. A 55-year-old patient with previous surgical correction of abnormal pulmonary venous return was admitted for poorly tolerated atrial flutter recurrences. He also had an interrupted inferior vena cava continuing as azygos vein and left superior vena cava draining via coronary sinus into the right atrium. Cavotricuspid isthmus radiofrequency ablation was successfully performed through the persistent left superior vena cava using a three-dimensional (3D) electroanatomical mapping system. Despite systemic venous abnormalities may potentially have important implications during electrophysiological procedures, arrhythmias can be successfully ablated with the aid of 3D electroanatomical mapping systems. < Learning objective: Congenital venous return anomalies can represent significant difficulties in accessing catheters to the cardiac chambers during electrophysiological procedures, which may be facilitated by three-dimensional mapping systems. Radiofrequency ablation of the cavotricuspid isthmus can be successfully performed using the femoral approach and introducing catheters into the right atrium sequentially through the femoral-iliac venous axis, the azygos vein, the persistent left superior vena cava, and the coronary sinus.>., (© 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Published
2020
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