140 results on '"Botto GL"'
Search Results
2. Cost/minimization analysisof a wearable cardioverter defibrillator in adult patients undergoing ICD explant procedures>Clinical and economic implications
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Boriani, G, Mantovani, Lg, Cortesi, Pa, De Ponti, R, Arena G, D Onofrio A., Curnis, A, Forleo, G, Guerra, F, Porcu, M, Sgarito, G, and Botto, Gl
- Published
- 2021
3. Grey zones on the use of new oral anticoagulants in atrial fibrillation. Expert opinion [Grey zones sull'uso dei nuovi anticoagulanti orali nella fibrillazione atriale. Opinioni degli esperti]
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Di Pasquale G, Iacovoni A, Filardi PP, Giustozzi M, De Ponti R, Falanga A, Botto GL, De Filippo P, Gavazzi A, Sciatti E, Senni M, Porcu M, Di Pasquale, G, Iacovoni, A, Filardi, P, Giustozzi, M, De Ponti, R, Falanga, A, Botto, G, De Filippo, P, Gavazzi, A, Sciatti, E, Senni, M, and Porcu, M
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New oral anticoagulant ,CHA2DS2-VASc score ,Atrial high-rate episode ,Guideline ,Triple therapy ,Atrial fibrillation - Abstract
Clinical guidelines, while representing an objective reference to perform appropriate treatment choices, contain grey zones, where recommendations are not supported by solid evidence. In a conference held in Bergamo in October 2018, an attempt was made to highlight some of the main grey zones in Cardiology and, through a comparison between experts, to draw shared conclusions that can illuminate our clinical practice. This manuscript contains the statements of the symposium concerning the controversies regarding new oral anticoagulants (NOACs) and atrial fibrillation (AF). The manuscript represents the organization of the meeting, with an initial review of current guidelines on this topic, followed by an expert presentation of pros (white) and cons (black) related to the identified "gaps of evidence". For every issue is then reported the response derived from the votes of the experts and the public, the discussion and, finally, the highlights, which are intended as practical "take home messages" to be used in everyday clinical practice. The first topic concerns the indication for anticoagulant therapy in patients with subclinical AF revealed by implanted devices. The second issue examines the opportunity to use NOACs in oncological patients with AF. The third gap evaluates the necessity of anticoagulating patients with AF and CHA2DS2-VASc 1 or CHA2DS2-VASc 2 if women. The last "gap in evidence" concerns the preference of triple or double therapy in patients with AF and acute coronary syndrome/coronary stenting. The work has also been implemented with evidences deriving from important randomized studies published after the date of the Conference.
- Published
- 2020
4. Grey zones on the use of new oral anticoagulants in atrial fibrillation. Expert opinion [Grey zones sull'uso dei nuovi anticoagulanti orali nella fibrillazione atriale. Opinioni degli esperti]
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Di Pasquale, G, Iacovoni, A, Filardi, P, Giustozzi, M, De Ponti, R, Falanga, A, Botto, G, De Filippo, P, Gavazzi, A, Sciatti, E, Senni, M, Porcu, M, Di Pasquale G, Iacovoni A, Filardi PP, Giustozzi M, De Ponti R, Falanga A, Botto GL, De Filippo P, Gavazzi A, Sciatti E, Senni M, Porcu M, Di Pasquale, G, Iacovoni, A, Filardi, P, Giustozzi, M, De Ponti, R, Falanga, A, Botto, G, De Filippo, P, Gavazzi, A, Sciatti, E, Senni, M, Porcu, M, Di Pasquale G, Iacovoni A, Filardi PP, Giustozzi M, De Ponti R, Falanga A, Botto GL, De Filippo P, Gavazzi A, Sciatti E, Senni M, and Porcu M
- Abstract
Clinical guidelines, while representing an objective reference to perform appropriate treatment choices, contain grey zones, where recommendations are not supported by solid evidence. In a conference held in Bergamo in October 2018, an attempt was made to highlight some of the main grey zones in Cardiology and, through a comparison between experts, to draw shared conclusions that can illuminate our clinical practice. This manuscript contains the statements of the symposium concerning the controversies regarding new oral anticoagulants (NOACs) and atrial fibrillation (AF). The manuscript represents the organization of the meeting, with an initial review of current guidelines on this topic, followed by an expert presentation of pros (white) and cons (black) related to the identified "gaps of evidence". For every issue is then reported the response derived from the votes of the experts and the public, the discussion and, finally, the highlights, which are intended as practical "take home messages" to be used in everyday clinical practice. The first topic concerns the indication for anticoagulant therapy in patients with subclinical AF revealed by implanted devices. The second issue examines the opportunity to use NOACs in oncological patients with AF. The third gap evaluates the necessity of anticoagulating patients with AF and CHA2DS2-VASc 1 or CHA2DS2-VASc 2 if women. The last "gap in evidence" concerns the preference of triple or double therapy in patients with AF and acute coronary syndrome/coronary stenting. The work has also been implemented with evidences deriving from important randomized studies published after the date of the Conference.
- Published
- 2020
5. P1561Left ventricular reverse remodeling by cardiac resynchronization is associated with lower risk of ventricular tachyarrhythmias
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Landolina, M., primary, Gasparini, M., additional, Lunati, M., additional, Proclemer, A., additional, Morani, G., additional, Biffi, M., additional, Ricci, R., additional, Rordorf, R., additional, Pisano, ECL, additional, Iacopino, S., additional, Botto, GL., additional, Padeletti, L., additional, and Boriani, G., additional
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- 2017
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6. P1446Can we predict new atrial fibrillation occurrence in single-chamber ICD patients ?
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Ziacchi, M., primary, Biffi, M., additional, Ricci, RP., additional, Facchin, D., additional, Morani, G., additional, Landolina, M., additional, Lunati, M., additional, Iacopino, S., additional, Capucci, A., additional, Bianchi, S., additional, Infusino, T., additional, Botto, GL., additional, Padeletti, L., additional, and Boriani, G., additional
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- 2017
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7. P1549The adherence to 2016 ESC guidelines for CRT is associated with an improved outcome, when compared with 2013 guidelines
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Mazza, A., primary, Caico, SI., additional, D'onofrio, A., additional, Pepi, P., additional, De Simone, A., additional, Botto, GL., additional, Pecora, D., additional, Pieragnoli, P., additional, Ferraro, A., additional, Giovannini, T., additional, Magnano, V., additional, Mazzuero, A., additional, Menichelli, M., additional, Malacrida, M., additional, and Stabile, G., additional
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- 2017
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8. 176Chronic apical and non-apical right ventricular pacing in patients with high-grade atrioventricular block: results of the right pace study
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Muto, C., primary, Calvi, V., additional, Botto, GL., additional, Pecora, D., additional, Porcelli, D., additional, Costa, A., additional, Ciaramitaro, G., additional, Airo' Farulla, R., additional, Rago, A., additional, Calvanese, R., additional, Baratto, MT., additional, Reggiani, A., additional, Giammaria, M., additional, Patane', S., additional, and Maglia, G., additional
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- 2017
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9. P1009Predictors of mortality in CRT patients: results from a large real-world population
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Botto, GL., primary, Palmisano, P., additional, Pepi, P., additional, D'onofrio, A., additional, Guarracini, F., additional, De Simone, A., additional, Caico, SI., additional, Pecora, D., additional, Santamaria, M., additional, Arena, G., additional, Pieragnoli, P., additional, Savarese, G., additional, Bertaglia, E., additional, Malacrida, M., additional, and Stabile, G., additional
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- 2017
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10. 184Adherence to ESC guidelines class I was associated to better prognosis, clinical response and LV reverse remodeling in a large real-world CRT population
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Ferraro, A., primary, Bertaglia, E., additional, Botto, GL., additional, Rapacciuolo, A., additional, Reggiani, A., additional, Marenna, B., additional, Marini, M., additional, Mazza, A., additional, Maglia, G., additional, Badolati, S., additional, Spotti, A., additional, Ricciardi, G., additional, Amadori, F., additional, Malacrida, M., additional, and Stabile, G., additional
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- 2017
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11. P404Acute effectiveness of subcutaneous implantable defibrillator in clinical practice
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D'onofrio, A., primary, Ziacchi, M., additional, Giofre', F., additional, Botto, GL., additional, Cipolletta, L., additional, Silvetti, MS., additional, Viani, S., additional, Pani, A., additional, Caravati, F., additional, Viscusi, M., additional, Rapacciuolo, A., additional, Mazzuero, A., additional, Vicentini, A., additional, Lovecchio, M., additional, and Russo, V., additional
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- 2017
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12. Improving stroke risk stratification using the CHADS2 and CHA2DS2-VASc risk scores in patients with paroxysmal atrial fibrillation by continuous arrhythmia burden monitoring
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BORIANI, GIUSEPPE, BIFFI, MAURO, Botto GL, Padeletti L, Santini M, Capucci A, Gulizia M, Ricci R, De Santo T, Corbucci G, Lip GY, Italian AT 500 Registry Investigators, Boriani G, Botto GL, Padeletti L, Santini M, Capucci A, Gulizia M, Ricci R, Biffi M, De Santo T, Corbucci G, Lip GY, and Italian AT-500 Registry Investigators.
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Male ,Pacemaker, Artificial ,ANTICOAGULATION ,ATRIAL FIBRILLATION ,STROKE ,Arrhythmias, Cardiac ,Middle Aged ,Risk Assessment ,Sensitivity and Specificity ,Risk Factors ,Humans ,Female ,Aged ,Retrospective Studies - Abstract
Background And Purpose- In patients with atrial fibrillation (AF), stroke risk stratification schema do not consider AF parameters. The aim of the study is to assess the impact of combining risk factors with continuous AF burden monitoring. Methods- In this retrospective study 568 patients implanted with a DDDR-P pacemaker (AT-500; Medtronic) and a history of AF were continuously monitored for 1 year. Results- During follow-up, 14 patients (2.5%) had a thromboembolic event. Patients were divided into 3 groups: AF burden ≤5 minutes per day (AF-free; n=223 [39%]), AF burden >5 minutes but
- Published
- 2011
13. Persistent atrial fibrillation worsen heart rate variabilità, activity and heart rate, as shown by a continuous minitoring by implantable biventricular pacemakers in heart failure patients. Poster Heart Rhythm 2007, 28th Annual Scientific Session of the Heart Rhythm Society
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Padeletti L, Pugliei A, Gasparini M, Lunati M, Sassara M, Lanolina M, Orazi S, Botto GL, Coltella A, Valsecchi S, Piro F., BORIANI, GIUSEPPE, Padeletti L, Pugliei A, Gasparini M, Lunati M, Sassara M, Lanolina M, Orazi S, Botto GL, Boriani G, Coltella A, Valsecchi S, and Piro F
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- 2007
14. Persistent atrial fibrillation worsen heart rate variabilità, activity and heart rate, as shown by a continuous minitoring by implantable biventricular pacemakers in heart failure patients
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Padeletti L, Puglisi A, Gasparini M, Lunati M, Sassara M, Lanolina M, Orazi S, Botto GL, Coltella A, Valsecchi S, Piro, BORIANI, GIUSEPPE, Padeletti L, Puglisi A, Gasparini M, Lunati M, Sassara M, Lanolina M, Orazi S, Botto GL, Boriani G, Coltella A, Valsecchi S, and Piro
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ATRIAL FIBRILLATION ,HEART FAILURE ,BIVENTRICULAR PACING ,MONITORING - Published
- 2007
15. Criteri di appropriatezza nel trattamento della fibrillazione atriale con dronedarone: aspetti pratici. L’opinione di un gruppo di esperti cardiologi italiani
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Botto, Gl, Capucci, A, Raviele, A, Boriani, G, Brignole, M, Calo', L, Calvi, V, DE PONTI, R, DE SIMONE, A, Delise, P, DI BIASE, M, Lombardi, F, Lunati, M, Santomauro, M, Senni, M, Stbile, G, Themistoclakis, S, Tritto, M, and Volpe, M.
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- 2013
16. Criteria of appropriateness in the treatment of atrial fibrillation with dronedarone: Practical aspects. The opinion of a group of Italian expert cardiologists
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Botto, Gl, Capucci, A, Raviele, A, Boriani, G, Brignole, M, Calò, L, Calvi, V, DE PONTI, Roberto, De Simone, A, Delise, P, Di Biase, M, Lombardi, F, Lunati, M, Santomauro, M, Senni, M, Stabile, G, Themistoclakis, S, Tritto, M, and Volpe, M.
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Appropriateness ,Atrial fibrillation ,Dronedarone - Published
- 2013
17. Persistent atrial fibrillation worsens heart rate variability, activity and heart rate, as shown by a continuous monitoring by implantable biventricular pacemakers in heart failure patients
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Puglisi, A, Gasparini, M, Lunati, M, Sassara, M, Padeletti, L, Landolina, M, Botto, Gl, Vincenti, A, Bianchi, S, Denaro, A, Grammatico, A, Boriani, G, and Curnis, Antonio
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- 2008
18. Impact of consistent atrial pacing algorithm on premature atrial complexe number and paroxysmal atrial fibrillation recurrences in brady-tachy syndrome: a randomized prospective cross over study
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Ricci, R, Santini, M, Puglisi, A, Azzolini, P, Capucci, A, Pignalberi, C, Boriani, Giuseppe, Botto, Gl, Spampinato, A, Bellocci, F, Proclemer, A, Grammatico, A, and de Seta, F.
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Male ,Sick Sinus Syndrome ,Cross-Over Studies ,Cardiac Pacing, Artificial ,Aged ,Atrial Fibrillation ,Electrocardiography ,Female ,Humans ,Prospective Studies ,Secondary Prevention ,Algorithms ,Artificial ,Cardiac Pacing - Abstract
The Consistent Atrial Pacing (CAP) algorithm has been designed to achieve a high percentage of atrial pacing to suppress paroxysmal atrial fibrillation. The aim of our study was to compare the impact of DDDR+CAP versus DDDR pacing on paroxysmal atrial fibrillation recurrences and triggers in patients with Brady-Tachy Syndrome.61 patients, 23 M and 38 F, mean age 75+/-9 y, affected by Brady-Tachy Syndrome, implanted with a DDDR pacemaker, were randomized to DDDR or DDDR+CAP pacing with cross over of pacing modality after 1 month.78 % of patients in DDDR pacing and 73 % in DDDR + CAP pacing (p=n.s.) were free from symptomatic paroxysmal atrial fibrillation recurrences. During DDDR+CAP pacing, the atrial pacing percentage increased from 77+/-29 % to 96+/-7 % (p0.0001). Automatic mode switch episodes/day were 0.73+/-1.09 in DDDR and 0.79+/-1.14 (p=n.s.) in DDDR+CAP. In patients with less than 50 % of atrial pacing during DDDR, automaticmode switch episodes/day decreased during DDDR+CAP from 1.13+/-1.59 to 0.23+/-0.32 (p0.05) and in patients with less than 90 % from 1.23+/-1.27 to 0.75+/-1.10 (p0.001). The number of premature atrial complexes per day decreased during DDDR + CAP from 2665+/-4468 to 556+/-704 (p0.02).CAP algorithm allowed continuous overdrive atrial pacing without major side effects. Triggers of paroxysmal atrial fibrillation induction, such as premature atrial complexes, were critically decreased. Paroxysmal atrial fibrillation episodes were reduced in patients with atrial pacing percentage lower than 90 % during DDDR pacing.
- Published
- 2001
19. Improving thromboprophylaxis using atrial fibrillation diagnostic capabilities in implantable cardioverter-defibrillators: the multicentre Italian ANGELS of AF Project.
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Boriani G, Santini M, Lunati M, Gasparini M, Proclemer A, Landolina M, Padeletti L, Botto GL, Capucci A, Bianchi S, Biffi M, Ricci RP, Vimercati M, Grammatico A, Lip GY, and Italian ClinicalService Project
- Published
- 2012
20. Efficacy of Low Interatrial Septum and Right Atrial Appendage Pacing for Prevention of Permanent Atrial Fibrillation in Patients With Sinus Node Disease: Results From the Electrophysiology-Guided Pacing Site Selection (EPASS) Study.
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Verlato R, Botto GL, Massa R, Amellone C, Perucca A, Bongiorni MG, Bertaglia E, Ziacchi V, Piacenti M, Del Rosso A, Russo G, Baccillieri MS, Turrini P, and Corbucci G
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- 2011
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21. Indications for the use of diagnostic implantable and external ECG loop recorders.
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Brignole M, Vardas P, Hoffman E, Huikuri H, Moya A, Ricci R, Sulke N, Wieling W, Auricchio A, Lip GY, Almendral J, Kirchhof P, Aliot E, Gasparini M, Braunschweig F, Botto GL, and Task Force members
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- 2009
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22. Outpatient treatment of recent-onset atrial fibrillation with the 'pill-in-the-pocket' approach.
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Alboni P, Botto GL, Baldi N, Luzi M, Russo V, Gianfranchi L, Marchi P, Calzolari M, Solano A, Baroffio R, and Gaggioli G
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- 2004
23. External cardioversion of atrial fibrillation: role of paddle position on technical efficacy and energy requirements.
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Botto GL, Politi A, Bonini W, Broffoni T, Bonatti R, Botto, G L, Politi, A, Bonini, W, Broffoni, T, and Bonatti, R
- Abstract
Aim: To define the effect of defibrillator paddle position on technical success and dc shock energy requirements of external cardioversion of atrial fibrillation.Methods: 301 patients (mean (SD) age 62 (11) years) with stable atrial fibrillation were randomly assigned to elective external cardioversion using anterolateral paddle position (ventricular apex-right infraclavicular area; group AL (151 patients)) or anteroposterior paddle position (sternal body-angle of the left scapula; group AP (150 patients)). A step up protocol was used, delivering a 3 J/kg body weight dc shock, then a 4 J/kg shock (maximum 360 J), and finally a second 4 J/kg shock using the alternative paddle location.Results: The two groups were comparable for the all clinical variables evaluated. The cumulative percentage of patients successfully converted to sinus rhythm was 58% in group AL and 67% in group AP with low energy dc shock (NS); this rose to 76% in group AL and to 87% in group AP with high energy dc shock (p = 0.013). Thirty seven patients in group AL and 19 in group AP experienced dc shock with the alternative paddle position; atrial fibrillation persisted in 10/37 in group AL and in 10/19 in group AP. Mean dc shock energy requirements were lower for group AP patients than for group AL patients, at 383 (235) v 451 (287) J, p = 0.025. Arrhythmia duration was the only factor that affected the technical success of external cardioversion (successful: 281 patients, 80 (109) days; unsuccessful: 20 patients, 193 (229) days; p < 0.0001). The success rate was lower if atrial fibrillation persisted for > 6 months: 29 of 37 (78%) v 252 of 264 (95%); p = 0.0001.Conclusions: An anteroposterior defibrillator paddle position is superior to an anterolateral location with regard to technical success in external cardioversion of stable atrial fibrillation, and permits lower dc shock energy requirements. Arrhythmia duration is the only clinical variable that can limit the restoration of sinus rhythm. [ABSTRACT FROM AUTHOR]- Published
- 1999
24. Improving stroke risk stratification using the CHADS2 and CHA2DS2-VASc risk scores in patients with paroxysmal atrial fibrillation by continuous arrhythmia burden monitoring.
- Author
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Boriani G, Botto GL, Padeletti L, Santini M, Capucci A, Gulizia M, Ricci R, Biffi M, De Santo T, Corbucci G, Lip GY, Italian AT-500 Registry Investigators, Boriani, Giuseppe, Botto, Giovanni Luca, Padeletti, Luigi, Santini, Massimo, Capucci, Alessandro, Gulizia, Michele, Ricci, Renato, and Biffi, Mauro
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- 2011
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25. Atrial tachyarrhythmias in primary and secondary prevention ICD recipients: clinical and prognostic data.
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Botto GL, Luzi M, Ruffa F, Russo G, and Ferrari G
- Abstract
Background: Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. The natural history of this disturbance and its effect on survival is still not known in patients with implantable cardioverter defibrillators (ICDs). Methods and Results: Several controlled trials for both secondary and primary prevention of sudden death using ICDs have been published in literature, and meta-analysis of them provided useful clinical information on the outcome during the follow-up of this population. AF occurs in about 25% of the patients with secondary prevention indication for ICD implantation. The prevalence of AF in patients with primary prevention indication for ICD implantation is much more difficult to define; it seems to be higher in patients with left ventricular dysfunction due to nonischemic etiology (ranging from 15% to 25%), and is lower in patients with ischemic etiology (about 5-10%). However, data from clinical registries, which are expected to better reflect clinical practice than randomized trials, seem to show a substantial difference as compared to the latter ones. A history of AF episodes in patients with an ICD indication for both primary and secondary prevention is probably associated with a higher risk of death. This is particularly evident in secondary prevention in ICD recipients, while it is still controversial in patients who received an ICD for primary prevention, particularly when patients with nonischemic etiology of their left ventricular dysfunction are considered. In a population of patients implanted with an ICD, there are several other clinical factors (ejection fraction, New York Heart Association functional class, age) that can interfere with the risk of death much more than AF itself. Conclusions: Further large-scale registries are needed to further characterize the population receiving ICD implantation, assessing the course of risk of death with regard to clinical variables and to evaluate the degree of acceptance of trials in clinical practice. [ABSTRACT FROM AUTHOR]
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- 2006
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26. Usefulness of echo-guided cardiac resynchronization pacing in patients undergoing "ablate and pace" therapy for permanent atrial fibrillation and effects of heart rate regularization and left ventricular resynchronization.
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Brignole M, Menozzi C, Botto GL, Mont L, Osca Asensi J, García Medina D, Oddone D, Navazio A, Luzi M, Iacopino S, De Fabrizio G, Proclemer A, Vardas P, Brignole, Michele, Menozzi, Carlo, Botto, Gian Luca, Mont, Lluís, Osca Asensi, Joaquín, García Medina, Dolores, and Oddone, Daniele
- Abstract
An acute comparative study of right ventricular (RV) pacing and echocardiographically guided cardiac resynchronization pacing (CRP) was performed in patients who underwent "ablate and pace" therapy for permanent atrial fibrillation. It was hypothesized that optimized CRP guided by tissue Doppler echocardiography would exert an additive beneficial hemodynamic effect to that of rate regularization achieved through atrioventricular junction ablation. An acute intrapatient comparison of echocardiographic parameters was performed between baseline preablation values and RV pacing and CRP (performed <24 hours after ablation) in 50 patients. Optimized CRP configuration was defined as the modality of pacing corresponding to that of the shortest intra-left ventricular (LV) delay among simultaneous biventricular pacing, sequential biventricular pacing, and single-chamber pacing. The intra-LV delay was defined as the difference between the longest and the shortest activation time in the six basal segments of the left ventricle. Compared with preablation measures, the ejection fraction increased by 10.8% during RV pacing (19% in patients with intra-LV delays <47.5 ms and 3% in those with intra-LV delays >47.5 ms). Compared with RV pacing, CRP caused a 9.2% increase in the ejection fraction, a 6.8% decrease in LV systolic diameter, and a 17.3% decrease in mitral regurgitation area; LV dyssynchrony was reduced from 52 +/- 27 to 21 +/- 12 ms. Similar results were observed in patients with and without depressed systolic function and in patients with and without left bundle branch block. In conclusion, rate regularization achieved through atrioventricular junction ablation and RV pacing provides a favorable hemodynamic effect that is inversely related to the level of LV dyssynchrony. Minimizing LV dyssynchrony by means of optimized CRP yields an additional important benefit. [ABSTRACT FROM AUTHOR]
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- 2008
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27. Device-Detected Atrial Tachyarrhythmias Predict Adverse Outcome in Real-World Patients With Implantable Biventricular Defibrillators
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Domenico Catanzariti, Maurizio Landolina, Giovanni Luca Botto, Laura La Rocca, Giuseppe Boriani, Andrea Grammatico, Maurizio Lunati, Alessandro Proclemer, Maurizio Gasparini, Luigi Padeletti, Massimo Santini, Giulio Molon, Santini M, Gasparini M, Landolina M, Lunati M, Proclemer A, Padeletti L, Catanzariti D, Molon G, Botto GL, La Rocca L, Grammatico A, and Boriani G
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Male ,Tachycardia, Ectopic Atrial ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Ventricular Function, Left ,defibrillator ,QRS complex ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Sinus rhythm ,Atrial tachycardia ,Aged ,Heart Failure ,Ejection fraction ,business.industry ,Stroke Volume ,Atrial fibrillation ,atrial tachyarrhythmias ,CARDIAC RESYNCHRONIZATION THERAPY ,CLINICAL OUTCOMES ,HEART FAILURE ,Stroke volume ,cardiac resynchronization ,Prognosis ,medicine.disease ,clinical outcomes ,Defibrillators, Implantable ,Heart failure ,Disease Progression ,Electrocardiography, Ambulatory ,Cardiology ,Female ,atrial tachyarrhythmia ,medicine.symptom ,business ,Cardiology and Cardiovascular Medicine ,Follow-Up Studies - Abstract
Objectives The purpose of this analysis was to evaluate the correlation between atrial tachycardia (AT) or atrial fibrillation (AF) and clinical outcomes in heart failure (HF) patients implanted with a cardiac resynchronization therapy defibrillator (CRT-D). Background In HF patients, AT and AF have high prevalence and are associated with compromised hemodynamic function. Methods Forty-four Italian cardiological centers followed up 1,193 patients who received a CRT-D according to current guidelines for advanced HF, New York Heart Association functional class ≥II, left ventricular ejection fraction ≤35%, and QRS complex ≥120 ms. All patients were in sinus rhythm at implant. Results During a median follow-up period of 13 months, AT/AF >10 min occurred in 361 of 1,193 (30%) patients. The composite end point (deaths or HF hospitalizations) occurred in 174 of 1,193 (14.6%). Multivariate time-dependent Cox regression analyses showed that composite end point risk was higher among patients with device-detected AT/AF (hazard ratio [HR]: 2.16, p = 0.032), New York Heart Association functional class III or IV compared with II (HR: 2.09, p = 0.002), and absence of beta-blockers (HR: 1.36, p = 0.036). Furthermore, the composite end point risk was inversely associated with left ventricular ejection fraction (HR: 1.04, p = 0.045), increasing by a factor of 4% for each 1% decrease in left ventricular ejection fraction. Conclusions In HF patients with CRT-D, device-detected AT/AF is associated with a worse prognosis. Continuous device diagnostics monitoring and Web-based alerts may inform the physician of AT/AF occurrences and identify patients at risk of cardiac deterioration or patients with suboptimal rate or rhythm control. (Italian ClinicalService Project; NCT01007474 )
- Published
- 2011
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28. Intravenous administration of flecainide or propafenone in patients with recent-onset atrial fibrillation does not predict adverse effects during 'pill-in-the-pocket' treatment
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Paolo Alboni, Alessandro Capucci, Federico Pacchioni, Giovanni Luca Botto, Marina Mancini, Giovanni Pasanisi, Giuseppe Boriani, Barbara Mariconti, Matteo Iori, Giovanni Russo, Alboni P, Botto GL, Boriani G, Russo G, Pacchioni F, Iori M, Pasanisi G, Mancini M, Mariconti B, and Capucci A.
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Adult ,medicine.medical_specialty ,Adolescent ,Heart disease ,Administration, Oral ,Self Administration ,Aged ,Ambulatory Care ,Anti-Arrhythmia Agents ,Atrial Fibrillation ,Drug Therapy, Combination ,Flecainide ,Hospitalization ,Humans ,Infusions, Intravenous ,Middle Aged ,Propafenone ,Tablets ,Young Adult ,Pharmacotherapy ,Oral administration ,Internal medicine ,medicine ,Adverse effect ,Presyncope ,business.industry ,Atrial fibrillation ,medicine.disease ,Anesthesia ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background Pill-in-the-pocket treatment should be prescribed only if the administration of a loading oral dose of flecainide or propafenone has been proved safe in hospital, since major adverse effects have been reported in 5% of patients during in-hospital treatment. However, in emergency rooms, the oral administration of these drugs for the conversion of atrial fibrillation (AF) is very rarely used because it is time consuming. Objective To investigate whether tolerance to intravenous administration of flecainide or propafenone might predict the safety of pill-in-the-pocket treatment—the out-of-hospital self-administration of these drugs after the onset of palpitations—in patients with AF of recent onset. Methods One hundred and twenty-two patients with AF of recent onset who were successfully treated (conversion of AF within 2 h without major adverse effects) in hospital with intravenous flecainide or propafenone were discharged on pill-in-the-pocket treatment. Results During a mean follow-up of 11±4 months, 79 patients self-treated 213 arrhythmic episodes; treatment was successful in 201 episodes (94%). Major adverse events occurred in five patients (6%) and in four (5%) of these during the first oral treatment (one syncope, two presyncope, one sinus arrest). No patient reported symptoms attributable to bradyarrhythmia or hypotension during the self-treatment of arrhythmic recurrences when the first oral treatment was not accompanied by any major adverse effects. The study was prematurely terminated because of the high incidence of major adverse effects during the first out-of-hospital treatment. Conclusion The patient9s tolerance of intravenous administration of flecainide or propafenone does not seem to predict adverse effects during out-of-hospital self-administration of these drugs.
- Published
- 2010
29. Presence and Duration of Atrial Fibrillation Detected by Continuous Monitoring: Crucial Implications for the Risk of Thromboembolic Events
- Author
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Giorgio Corbucci, Luigi Padeletti, Giovanni Russo, Marco Vimercati, Giuseppe Boriani, Michele Gulizia, Mauro Biffi, Stefano Favale, Alessandro Capucci, Giulio Molon, Massimo Santini, Giovanni L. Botto, Francesco Zolezzi, Renato Ricci, Botto GL, Padeletti L, Santini M, Capucci A, Gulizia M, Zolezzi F, Favale S, Molon G, Ricci R, Biffi M, Russo G, Vimercati M, Corbucci G, and Boriani G.
- Subjects
Male ,medicine.medical_specialty ,Comorbidity ,Risk Assessment ,Asymptomatic ,Electrocardiography ,Risk Factors ,Thromboembolism ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,Ambulatory ,medicine ,Humans ,Stroke ,Aged ,medicine.diagnostic_test ,business.industry ,Incidence ,Incidence (epidemiology) ,Atrial fibrillation ,Prognosis ,medicine.disease ,Italy ,Heart failure ,Electrocardiography, Ambulatory ,Female ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Risk assessment ,business - Abstract
AF and the Risk of Thromboembolic Events. Introduction: Asymptomatic atrial fibrillation (AF) can expose patients to the risk of stroke. The primary objective of this study was to assess the incidence of thromboembolic events in relationship with CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke, or transient ischemic attack) score and AF presence/duration. The secondary objective was to compare intermittent versus continuous monitoring strategies. Methods and Results: Data from patients with an implanted pacemaker and a history of AF were analyzed. Thromboembolic risk was quantified through CHADS2 score. Three AF groups were considered: patients with 5-minutes AF on 1 day but 24 hours (AF-24 hours). Monitoring strategies involving 24-hour Holter, 1-week Holter, and 30-day Holter were simulated. Data from 568 patients continuously monitored for 1 year were analyzed: 171 (30%) had CHADS2 score = 0; 269 (47%) had CHADS2 score = 1; 111 (20%) had CHADS2 score = 2; and 17 (3%) had CHADS2 score ≥ 3. During follow-up, 14 patients (2.5%) had an ischemic thromboembolic event. AF-24 hours patients numbered 223 (39.2%); AF-5 minutes, 179 (31.5%); and AF-free, 29.2%. By combining AF presence/duration with CHADS2 score, two subpopulations with markedly different risks of events (0.8% vs 5%, P = 0.035) were identified, the former corresponding to AF-free with CHADS2≤2, or AF-5 minutes with CHADS2≤1, or AF-24 hours with CHADS2= 0. The mean sensitivity in detecting an AF episode lasting >5 minutes was 44.4%, 50.4%, and 65.1% for 24-hour Holter, 1-week Holter, and 1-month Holter monitoring, respectively. Conclusion: In patients with recurrent AF episodes, risk stratification for thromboembolic events can be improved by combining CHADS2 score with AF presence/duration. (J Cardiovasc Electrophysiol, Vol. 20, pp. 241-248, March 2009)
- Published
- 2008
30. Temporal Variability of Atrial Fibrillation in Pacemaker Recipients for Bradycardia: Implications for Crossover Designed Trials, Study Sample Size, and Identification of Responder Patients by Means of Arrhythmia Burden
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Marco Vimercati, Serafino Orazi, Luigi Padeletti, Andrea Grammatico, Stefano Favale, Alessandro Proclemer, Massimo Santini, Giacomo Chiarandà, Mario Luzi, Tiziana DeSANTO, Francesco Solimene, Gianni Luzzi, Francesco Zolezzi, Giuseppe Boriani, Giovanni Luca Botto, Botto GL, Santini M, Padeletti L, Boriani G, Luzzi G, Zolezzi F, Orazi S, Proclemer A, Chiaranda G, Favale S, Solimene F, Luzi M, Vimercati M, Desanto T, and Grammatico A.
- Subjects
Male ,Research design ,Bradycardia ,medicine.medical_specialty ,Time Factors ,Cost of Illness ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,Humans ,Medicine ,Prospective Studies ,Prospective cohort study ,Aged ,Clinical Trials as Topic ,Cross-Over Studies ,business.industry ,Cardiac Pacing, Artificial ,Female ,Monte Carlo Method ,Research Design ,Sample Size ,Atrial fibrillation ,medicine.disease ,Crossover study ,Clinical trial ,Sample size determination ,Artificial ,Physical therapy ,Cardiac Pacing ,Observational study ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Most clinical trials that have tested pacing therapies to prevent and treat atrial tachyarrhythmias (AT) have chosen endpoints such as AT frequency or burden (defined as percentage of time a patient is in AT), but failed to show unequivocal evidence of a clinical impact. Aim: The aim of our multicenter prospective observational study was to measure the variability of AT burden and estimate its impact on study outcomes. Methods and Results: Two hundred and fifty patients indicated for permanent pacing and suffering from AT (age 71 ± 9 years; 47.2% male) received a dual-chamber pacemaker. AT burden was measured in two consecutive, 2-month observation periods; the Monte Carlo method was then applied to simulate findings of a crossover design study. We simulated several models of therapy impact, each model being characterized by the percentage of responder patients and the percentage reduction in AT burden. To show a significant impact of AT therapies in a sample of 250 patients in whom 100, 75, or 50% would be theoretical responders to therapies, AT burden reduction should be at least 27, 32, or 57%, respectively. Temporal fluctuations in AT burden were so high that about 60% of patients would falsely appear as responders or nonresponders in a crossover study, regardless of AT burden reduction. Conclusions: In patients paced for bradycardia and suffering from AT, high intrapatient variability in AT burden was measured. Various models of therapy impact showed that, in crossover trials of AT therapies, time-related fluctuations in AT burden negatively impact on sample sizes and impair the ability to identify patients as responders or nonresponders.
- Published
- 2007
31. Improving thromboprophylaxis using atrial fibrillation diagnostic capabilities in implantable cardioverter-defibrillators: the multicentre Italian ANGELS of AF Project
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Gregory Y.H. Lip, Marco Vimercati, Alessandro Capucci, Massimo Santini, Mauro Biffi, Giuseppe Boriani, Andrea Grammatico, Luigi Padeletti, Maurizio Gasparini, Stefano Bianchi, Maurizio Landolina, Renato Pietro Ricci, Giovanni Luca Botto, Maurizio Lunati, Alessandro Proclemer, Boriani G, Santini M, Lunati M, Gasparini M, Proclemer A, Landolina M, Padeletti L, Botto GL, Capucci A, Bianchi S, Biffi M, Ricci RP, Vimercati M, Grammatico A, and Lip GY
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,ANTICOAGULANTS ,Medication Adherence ,ATRIAL FIBRILLATION ,Thromboembolism ,Diabetes mellitus ,Antithrombotic ,medicine ,Humans ,Risk factor ,Intensive care medicine ,IMPLANTABLE CARDIOVERTER DEFIBRILLATOR ,Stroke ,Aged ,Fibrillation ,business.industry ,Atrial fibrillation ,Middle Aged ,Implantable cardioverter-defibrillator ,medicine.disease ,Defibrillators, Implantable ,Heart failure ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background— Atrial fibrillation (AF) is a well-established risk factor for stroke and thromboembolism and is a frequent comorbid arrhythmia in patients with implantable cardioverter-defibrillators (ICDs). The Anticoagulation Use Evaluation and Life Threatening Events Sentinels (ANGELS) of AF project was a medical care program aimed at supporting adherence to oral anticoagulation (OAC) guidelines for thromboprophylaxis through the use of ICD AF diagnostics. Methods and Results— Fifty Italian cardiology clinics followed 3438 patients with ICDs. In a subgroup of 15 centers (the ANGELS of AF centers), cardiologists attending to follow-up visits were supplied with specific reports describing stroke risk factors and risk scores (American College of Chest Physicians and CHADS 2 [congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or transient ischemic attack]), AF occurrence and duration, and current antithrombotic therapy for patients with AF, especially those with a CHADS 2 score >0 and not on OAC therapy. The remaining centers represented a control group of patients as a comparison of OAC use. In the ANGELS of AF centers, 709 (36%) patients had AF described either in their clinical history (n=426 [22%]) or as new-onset AF (n=257 [14%]). Among 683 (96%) patients with CHADS2 score >0, 209 (30.6%) were not taking an OAC. Appropriate OAC therapy was prescribed in 10% (22/209) of patients after evaluation of ANGELS of AF reports. The percentage of patients on OAC therapy, as indicated by guidelines, increased during follow-up from 46.1% at baseline, to 69.4% at the stroke risk evaluation phase, to up to 72.6% at the end of the observation period. In control centers, corresponding figures were 46.9% at baseline and 56.8% at the end of the observation period ( P Conclusions— The ANGELS of AF project demonstrates the possibility to improve OAC use in accordance with available guidelines for stroke risk reduction in AF by supplying attending physicians with reports about patients risk factors and AF information from continuous ICD monitoring. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01007474.
- Published
- 2012
32. Treatment of atrial fibrillation with a dual defibrillator in heart failure patients (TRADE HF): protocol for a randomized clinical trial
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Giuseppe Boriani, Giovanni Luca Botto, Giuseppe Grandinetti, Giovanni Raciti, Luigi Padeletti, Stefano Favale, Paolo De Filippo, Maurizio Landolina, Giulio Molon, Claudio Tondo, Mauro Biffi, Botto GL, Boriani G, Favale S, Landolina M, Molon G, Tondo C, Biffi M, Grandinetti G, De Filippo P, Raciti G, and Padeletti L.
- Subjects
medicine.medical_specialty ,Poor prognosis ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Medicine (miscellaneous) ,law.invention ,Cardiac Resynchronization Therapy ,Study Protocol ,Randomized controlled trial ,law ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,In patient ,Pharmacology (medical) ,cardiovascular diseases ,Cardiac Resynchronization Therapy Devices ,Prospective Studies ,Atrial tachycardia ,Fibrillation ,Heart Failure ,lcsh:R5-920 ,business.industry ,Atrial fibrillation ,Equipment Design ,CARDIAC RESYNCHRONIZATION THERAPY ,HEART FAILURE ,MULTICENTER STUDY ,HOSPITALIZATION ,medicine.disease ,Defibrillators, Implantable ,Hospitalization ,Treatment Outcome ,Italy ,Research Design ,Heart failure ,Cardiology ,cardiovascular system ,medicine.symptom ,lcsh:Medicine (General) ,business - Abstract
Background Heart failure(HF) and atrial fibrillation(AF) frequently coexist in the same patient and are associated with increased mortality and frequent hospitalizations. As the concomitance of AF and HF is often associated with a poor prognosis, the prompt treatment of AF in HF patients may significantly improve outcome. Methods/design Recent implantable cardiac resynchronization (CRT) devices allow electrical therapies to treat AF automatically. TRADE-HF (trial registration: NCT00345592; http://www.clinicaltrials.gov) is a prospective, randomized, double arm study aimed at demonstrating the efficacy of an automatic, device-based therapy for treatment of atrial tachycardia and fibrillation(AT/AF) in patients indicated for CRT. The study compares automatic electrical therapy to a traditional more usual treatment of AT/AF: the goal is to demonstrate a reduction in a combined endpoint of unplanned hospitalizations for cardiac reasons, death from cardiovascular causes or permanent AF when using automatic atrial therapy as compared to the traditional approach involving hospitalization for symptoms and in-hospital treatment of AT/AF. Discussion CRT pacemaker with the additional ability to convert AF as well as ventricular arrhythmias may play a simultaneous role in rhythm control and HF treatment. The value of the systematic implantation of CRT ICDs with the capacity to deliver atrial therapy in HF patients at risk of AF has not yet been explored. The TRADE-HF study will assess in CRT patients whether a strategy based on automatic management of atrial arrhythmias might be a valuable option to reduce the number of hospital admission and to reduce the progression the arrhythmia to a permanent form. Trial registration NCT00345592
- Published
- 2010
33. Persistent atrial fibrillation worsens heart rate variability, activity and heart rate, as shown by a continuous monitoring by implantable biventricular pacemakers in heart failure patients
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Andrea, Puglisi, Maurizio, Gasparini, Maurizio, Lunati, Massimo, Sassara, Luigi, Padeletti, Maurizio, Landolina, GIOVANNI LUCA BOTTO, Antonio, Vincenti, Stefano, Bianchi, Alessandra, Denaro, ANDREA GRAMMATICO, Giuseppe, Boriani, Sassone, Biagio, Puglisi A, Gasparini M, Lunati M, Sassara M, Padeletti L, Landolina M, Botto GL, Vincenti A, Bianchi S, Denaro A, Grammatico A, and Boriani G
- Subjects
Male ,Pacemaker, Artificial ,medicine.medical_specialty ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Socio-culturale ,Risk Assessment ,QRS complex ,Electrocardiography ,Risk Factors ,Heart Rate ,Physiology (medical) ,Internal medicine ,Heart rate ,Atrial Fibrillation ,Ambulatory ,medicine ,Prevalence ,Heart rate variability ,Humans ,Aged ,Heart Failure ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Atrial fibrillation ,medicine.disease ,Chronic Disease ,Electrocardiography, Ambulatory ,Female ,Italy ,Pacemaker ,Atrial fibrillation, Heart failure, Heart rate, Heart rate variability, Patient activity, Resynchronization therapy ,Heart failure ,Artificial ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Persistent AF Worsens Conditions of HF Patients. Background: Atrial fibrillation (AF) induces loss of atrial contribution, heart rate irregularity, and fast ventricular rate. Objectives: The objectives of the study were to accurately measure AF incidence and to investigate the mutual temporal patterns of AF and heart failure (HF) in patients indicated to cardiac resynchronization therapy. Methods: Four hundred ten consecutive patients (70% male, age 69 ± 11) with advanced HF (NYHA = 3.0 ± 0.6), low ejection fraction (EF = 27 ± 9%), and ventricular conduction delay (QRS = 165 ± 29 ms) received a biventricular pacemaker. Enrolled patients were divided into two groups: G1 = 249 patients with no AF history, G2 = 161 patients with history of paroxysmal/persistent AF. Results: In a median follow-up of 13 months, AF episodes longer than 5 minutes occurred in 105 of 249 (42.2%) G1 patients and 76 of 161 (47.2%) G2 patients, while AF episodes longer than one day occurred in 14 of 249 (5.6%) G1 patients and in 36 of 161 (22.4%) G2 patients. Device diagnostics monitored daily values of patient activity, night heart rate (NHR), and heart rate variability (HRV). Comparing 30-day periods before AF onset and during persistent AF, significant (P < 0.0001) changes were observed in patient activity, which decreased from 221 ± 13 to 162 ± 12 minutes, and in NHR, which increased from 68 ± 3 to 94 ± 7 bpm. HRV significantly decreased (from 75 ± 5 ms before AF onset to 60 ± 6 ms after AF termination). NHR during AF was significantly (P < 0.01) and inversely correlated (R2 = 0.73) with activity, with a significant lower activity associated with NHR ≥ 88 bpm. Conclusion: AF is frequent in HF patients. Persistent AF is associated with statistically significant decrease in patient activity and HRV and NHR increase.
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- 2008
34. Use of DOACs in frail elderly patients in light of class genericization.
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Botto GL, Capranzano P, Colonna P, Fornasari DMM, Sciatti E, and Riva L
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- Humans, Aged, Factor Xa Inhibitors therapeutic use, Factor Xa Inhibitors administration & dosage, Female, Male, Aged, 80 and over, Consensus, Italy epidemiology, Stroke, Atrial Fibrillation drug therapy, Frail Elderly, Delphi Technique, Drugs, Generic therapeutic use
- Abstract
Background: Frailty and comorbidity influence the therapeutic approach in everyday clinical practice. The DOACs genericization opens a reflection on their differences from a pharmacological and bioavailability point of view, particularly in elderly frail patients. The aim of this project was to create a national Delphi consensus on the topic of the use of DOACs for atrial fibrillation (AF) in such patients, in light of the genericization of the class., Methods and Results: The consensus dealt with 3 main topics: a) efficacy and safety of DOACs in elderly and/or frail patients; b) therapeutic choice in specific frailty scenarios; c) DOACs genericization. 56 cardiologists, two internists and two neurologists from Italy expressed their level of agreement on each statement by using a 5-point Likert scale (1: strongly disagree, 2: disagree, 3: uncertain, 4: agree, 5: strongly agree). A positive consensus was reached if the percentage of agreement (vote 1-2, positive consensus) or disagreement (votes 4-5, negative consensus) was >66%; otherwise, no consensus was reached. Results are displayed accordingly., Conclusions: After 10 years of everyday clinical management of DOACs for AF, specific elements differentiating a molecule from another, either for efficacy or for safety, are consolidated. However, some uncertainties still exist in particular contexts, such as chronic kidney disease or cancer patients. Clinicians have an unsure attitude towards generic drugs, because clinical practice is lacking as well as a proper knowledge of the topic. Albeit being an alternative, the choice of the generic drug must remain the responsibility of the clinician., Competing Interests: Declaration of competing interest GLB declared speaker fees (small amount) from Bayer Healthcare, Boheringer, Daiichi-Sankyo, Pfizer/BMS, Sanofi. PCa has nothing to declare. PCo participates in Daiichi Sankyo, Inc.-funded research; is a coauthor of ESC guidelines on AF (versions 2010 and 2012) and received institutional research grants from Bayer, Boehringer, and Daiichi Sankyo, Inc.; and speaker honoraria from Bayer, Boehringer Ingelheim, Pfizer-BMS, and Daiichi Sankyo, Inc. In the last two years DMMF has received fees for partecipations as expert in Advisory Boards or as speaker in Congress and meeting or as consultant, from the following companies: Abiogen, Alfasigma, Angelini, Agave, Bayer, Daiichi-Sankyo, Grunenthal, Janssen, Lundbeck, Molteni, Sandoz, SPA, Zambon. ES has nothing to declare. LR is a speaker and a scientific research partner for Bayer, BMS/Pfizer, Boehringer Ingelheim and Daiichi-Sankyo; no fees are directly received personally., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2024
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35. Closed loop stimulation reduces the incidence of atrial high-rate episodes compared with conventional rate-adaptive pacing in patients with sinus node dysfunctions.
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Pisanò ECL, Calvi V, Viscusi M, Rapacciuolo A, Lazzari L, Bontempi L, Pelargonio G, Arena G, Caccavo V, Wang CC, Merkely B, Lin LY, Oh IY, Bertaglia E, Saporito D, Menichelli M, Nicosia A, Carretta DM, Coppolino A, Ching CK, Del Castillo ÁM, Su X, Del Maestro M, Giacopelli D, Gargaro A, and Botto GL
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- Humans, Female, Male, Aged, Middle Aged, Incidence, Treatment Outcome, Time Factors, Risk Factors, Defibrillators, Implantable, Electrophysiologic Techniques, Cardiac, Accelerometry, Aged, 80 and over, Atrial Fibrillation physiopathology, Atrial Fibrillation diagnosis, Atrial Fibrillation therapy, Atrial Fibrillation epidemiology, Sick Sinus Syndrome therapy, Sick Sinus Syndrome physiopathology, Cardiac Pacing, Artificial methods, Pacemaker, Artificial, Ischemic Attack, Transient prevention & control, Ischemic Attack, Transient epidemiology, Heart Rate, Stroke prevention & control, Stroke epidemiology
- Abstract
Aims: Subclinical atrial fibrillation (AF) is associated with increased risk of progression to clinical AF, stroke, and cardiovascular death. We hypothesized that in pacemaker patients requiring dual-chamber rate-adaptive (DDDR) pacing, closed loop stimulation (CLS) integrated into the circulatory control system through intra-cardiac impedance monitoring would reduce the occurrence of atrial high-rate episodes (AHREs) compared with conventional DDDR pacing., Methods and Results: Patients with sinus node dysfunctions (SNDs) and an implanted pacemaker or defibrillator were randomly allocated to dual-chamber CLS (n = 612) or accelerometer-based DDDR pacing (n = 598) and followed for 3 years. The primary endpoint was time to the composite endpoint of the first AHRE lasting ≥6 min, stroke, or transient ischaemic attack (TIA). All AHREs were independently adjudicated using intra-cardiac electrograms. The incidence of the primary endpoint was lower in the CLS arm (50.6%) than in the DDDR arm (55.7%), primarily due to the reduction in AHREs lasting between 6 h and 7 days. Unadjusted site-stratified hazard ratio (HR) for CLS vs. DDDR was 0.84 [95% confidence interval (CI), 0.72-0.99; P = 0.035]. After adjusting for CHA2DS2-VASc score, the HR remained 0.84 (95% CI, 0.71-0.99; P = 0.033). In subgroup analyses of AHRE incidence, the incremental benefit of CLS was greatest in patients without atrioventricular block (HR, 0.77; P = 0.008) and in patients without AF history (HR, 0.73; P = 0.009). The contribution of stroke/TIA to the primary endpoint (1.3%) was low and not statistically different between study arms., Conclusion: Dual-chamber CLS in patients with SND is associated with a significantly lower AHRE incidence than conventional DDDR pacing., Competing Interests: Conflict of interest: G.L.B. received speaker’s fee from Abbott, Biotronik, Boston Scientific, Medtronic, and MicroPort. M.D.M., D.G., and A.G. are employees of Biotronik Italia S.p.A., an affiliate of Biotronik SE & Co. KG (study sponsor and manufacturer of investigational devices). All remaining authors have declared no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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36. High-density mapping of Koch's triangle during sinus rhythm and typical atrioventricular nodal re-entrant tachycardia, integrated with direct recording of atrio-ventricular node structure potential.
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Pandozi C, Botto GL, Loricchio ML, D'Ammando M, Lavalle C, Del Giorno G, Matteucci A, Mariani MV, Nicolis D, Segreti L, Papa AA, Casale MC, Galeazzi M, Russo M, Di Belardino N, Pelargonio G, Centurion Aznaran C, Malacrida M, Maddaluno F, Treglia S, Piccolo F, and Colivicchi F
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- Humans, Atrioventricular Node surgery, Heart Atria, Electrodes, Tachycardia, Atrioventricular Nodal Reentry diagnosis, Tachycardia, Atrioventricular Nodal Reentry surgery, Catheter Ablation methods
- Abstract
Background: The mechanism of typical slow-fast atrioventricular nodal re-entrant tachycardia (AVNRT) and its anatomical and electrophysiological circuit inside the right atrium (RA) and Koch's Triangle (KT) are not well known., Objective: To identify the potentials of the compact AV node and inferior extensions and to perform accurate mapping of the RA and KT in sinus rhythm (SR) and during AVNRT, to define the tachycardia circuit., Methods: Consecutive patients with typical AVNRT were enrolled in 12 Italian centers and underwent mapping and ablation by means of a basket catheter with small electrode spacing for ultrahigh-density mapping and a modified signal-filtering toolset to record the potentials of the AV nodal structures., Results: Forty-five consecutive cases of successful ablation of typical slow-fast AVNRT were included. The mean SR cycle length (CL) was 784.1 ± 6 ms and the mean tachycardia CL was 361.2 ± 54 ms. The AV node potential had a significantly shorter duration and higher amplitude in sinus rhythm than during tachycardia (60 ± 40 ms vs. 160 ± 40 ms, p < .001 and 0.3 ± 0.2 mV vs. 0.09 ± 0.12 mV, p < .001, respectively). The nodal potential duration extension was 169.4 ± 31 ms, resulting in a time-window coverage of 47.6 ± 9%. The recording of AV nodal structure potentials enabled us to obtain 100% coverage of the tachycardia CL during slow-fast AVNRT., Conclusion: Detailed recording of the potentials of nodal structures is possible by means of multipolar catheters for ultrahigh-density mapping, allowing 100% of the AVNRT CL to be covered. These results also have clinical implications for the ablation of right-septal and para-septal arrhythmias., (© 2024 Wiley Periodicals LLC.)
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- 2024
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37. Predicting worsening heart failure hospitalizations in patients with implantable cardioverter defibrillators: is it all about alerts? A pooled analysis of nine trials.
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Botto GL, Sinagra G, Bulava A, Gargaro A, Timmel T, Giacopelli D, D'Onofrio A, and Guédon-Moreau L
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- Humans, Hospitalization, Cardiac Complexes, Premature, Defibrillators, Implantable, Heart Failure diagnosis, Heart Failure therapy, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular therapy
- Abstract
Aims: To predict worsening heart failure hospitalizations (WHFHs) in patients with implantable defibrillators and remote monitoring, the HeartInsight algorithm (Biotronik, Berlin, Germany) calculates a heart failure (HF) score combining seven physiologic parameters: 24 h heart rate (HR), nocturnal HR, HR variability, atrial tachyarrhythmia, ventricular extrasystoles, patient activity, and thoracic impedance. We compared temporal trends of the HF score and its components 12 weeks before a WHFH with 12-week trends in patients without WHFH, to assess whether trends indicate deteriorating HF regardless of alert status., Methods and Results: Data from nine clinical trials were pooled, including 2050 patients with a defibrillator capable of atrial sensing, ejection fraction ≤ 35%, NYHA class II/III, no long-standing atrial fibrillation, and 369 WHFH from 259 patients. The mean HF score was higher in the WHFH group than in the no WHFH group (42.3 ± 26.1 vs. 30.7 ± 20.6, P < 0.001) already at the beginning of 12 weeks. The mean HF score further increased to 51.6 ± 26.8 until WHFH (+22% vs. no WHFH group, P = 0.003). As compared to the no WHFH group, the algorithm components either were already higher 12 weeks before WHFH (24 h HR, HR variability, thoracic impedance) or significantly increased until WHFH (nocturnal HR, atrial tachyarrhythmia, ventricular extrasystoles, patient activity)., Conclusion: The HF score was significantly higher at, and further increased during 12 weeks before WHFH, as compared to the no WHFH group, with seven components showing different behaviour and contribution. Temporal trends of HF score may serve as a quantitative estimate of HF condition and evolution prior to WHFH., Competing Interests: Conflict of interest: G.L.B. received speaker’s fee from Abbott, Biotronik, Boston Scientific, Medtronic, and Microport. A.B. received consultant fees and/or grant support from Abbott, Biotronik, and Boston Scientific. A.G. and D.G. are employees of Biotronik Italy. T.T. is employee of Biotronik SE & Co. KG, Berlin, Germany. L.G.-M. received fees for lectures and/or consulting from Novartis, Microport, Boston Scientific, and Medtronic outside the submitted work. Lille University Hospital Center received grants from BMS, Abbott, Biotronik, Boston Scientific, Microport, and Medtronic outside the submitted work. All remaining authors have declared no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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38. Integration of a Smartphone HF-Dedicated App in the Remote Monitoring of Heart Failure Patients with Cardiac Implantable Electronic Devices: Patient Access, Acceptance, and Adherence to Use.
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Ziacchi M, Molon G, Giudici V, Botto GL, Viscusi M, Brasca F, Santoro A, Curcio A, Manzo M, Mauro E, Biffi M, Costa A, Dell'Aquila A, Casale MC, and Boriani G
- Abstract
(200 w) Introduction. Remote monitoring (RM) of cardiac implantable electronic device (CIED) diagnostics helps to identify patients potentially at risk of worsening heart failure (HF). Additionally, knowledge of patient HF-related symptoms is crucial for decision making. Patient smartphone applications may represent an ideal option to remotely collect this information., Purpose: To assess real-world HF patient access, acceptance, and adherence to use of an HF-dedicated smartphone application (HF app)., Methods: In this study, 10 Italian hospitals administered a survey on smartphone/app use to HF patients with CIED. The subgroup who accepted it downloaded the HF app. Mean 1-year adherence of the HF app use was evaluated., Results: A total of 495 patients (67 ± 13 years, 79% males, 26% NYHA III-IV) completed the survey, of which 84% had access to smartphones and 85% were willing to use the HF app. In total, 311/495 (63%) downloaded the HF app. Patients who downloaded the HF app were younger and had higher school qualification. Patients who were ≥60 years old had higher mean 1-year adherence (54.1%) than their younger counterparts (42.7%; p < 0.001). Hospitals with RM-dedicated staff had higher mean 1-year patient adherence (64.0% vs. 33.5%; p < 0.001). Adherence to HF app decreased from 63.3% (weeks_1-13) to 42.2% (weeks_40-52, p < 0.001)., Conclusions: High access and acceptance of smartphones/apps by HF patients with CIED allow HF app use for RM of patient signs/symptoms. Younger patients with higher school qualifications are more likely to accept HF app; however, older patients have higher long-term adherence.
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- 2023
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39. Modern subcutaneous implantable defibrillator therapy in patients with cardiomyopathies and channelopathies: data from a large multicentre registry.
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Migliore F, Biffi M, Viani S, Pittorru R, Francia P, Pieragnoli P, De Filippo P, Bisignani G, Nigro G, Dello Russo A, Pisanò E, Palmisano P, Rapacciuolo A, Silvetti MS, Lavalle C, Curcio A, Rordorf R, Lovecchio M, Valsecchi S, D'Onofrio A, and Botto GL
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- Humans, Treatment Outcome, Death, Sudden, Cardiac etiology, Death, Sudden, Cardiac prevention & control, Registries, Defibrillators, Implantable adverse effects, Channelopathies complications, Channelopathies therapy, Cardiomyopathies complications, Cardiomyopathies therapy
- Abstract
Aims: Patients with cardiomyopathies and channelopathies are usually younger and have a predominantly arrhythmia-related prognosis; they have nearly normal life expectancy thanks to the protection against sudden cardiac death provided by the implantable cardioverter defibrillator (ICD). The subcutaneous ICD (S-ICD) is an effective alternative to the transvenous ICD and has evolved over the years. This study aimed to evaluate the rate of inappropriate shocks (IS), appropriate therapies, and device-related complications in patients with cardiomyopathies and channelopathies who underwent modern S-ICD implantation., Methods and Results: We enrolled consecutive patients with cardiomyopathies and channelopathies who had undergone implantation of a modern S-ICD from January 2016 to December 2020 and who were followed up until December 2022. A total of 1338 S-ICD implantations were performed within the observation period. Of these patients, 628 had cardiomyopathies or channelopathies. The rate of IS at 12 months was 4.6% [95% confidence interval (CI): 2.8-6.9] in patients with cardiomyopathies and 1.1% (95% CI: 0.1-3.8) in patients with channelopathies (P = 0.032). No significant differences were noted over a median follow-up of 43 months [hazard ratio (HR): 0.76; 95% CI: 0.45-1.31; P = 0.351]. The rate of appropriate shocks at 12 months was 2.3% (95% CI: 1.1-4.1) in patients with cardiomyopathies and 2.1% (95% CI: 0.6-5.3) in patients with channelopathies (P = 1.0). The rate of device-related complications was 0.9% (95% CI: 0.3-2.3) and 3.2% (95% CI: 1.2-6.8), respectively (P = 0.074). No significant differences were noted over the entire follow-up. The need for pacing was low, occurring in 0.8% of patients., Conclusion: Modern S-ICDs may be a valuable alternative to transvenous ICDs in patients with cardiomyopathies and channelopathies. Our findings suggest that modern S-ICD therapy carries a low rate of IS., Clinical Trial Registration: URL: http://clinicaltrials.gov/Identifier: NCT02275637., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2023
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40. Insertable cardiac monitoring results in higher rates of atrial fibrillation diagnosis and oral anticoagulation prescription after ischaemic stroke.
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Boriani G, Auricchio A, Botto GL, Joseph JM, Roberts GJ, Grammatico A, Nabutovsky Y, and Piccini JP
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- Humans, Female, Aged, United States epidemiology, Male, Medicare, Anticoagulants adverse effects, Prescriptions, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Atrial Fibrillation drug therapy, Stroke diagnosis, Stroke epidemiology, Stroke etiology, Brain Ischemia diagnosis, Brain Ischemia epidemiology, Brain Ischemia prevention & control, Ischemic Stroke
- Abstract
Aims: After an ischaemic stroke, atrial fibrillation (AF) detection allows for improved secondary prevention strategies. This study aimed to compare AF detection and oral anticoagulant (OAC) initiation in patients with an insertable cardiac monitor (ICM) vs. external cardiac monitor (ECM) after ischaemic stroke., Methods and Results: Medicare Fee-for-Service (FFS) insurance claims and Abbott Labs device registration data were used to identify patients hospitalized with an ischaemic stroke in 2017-2019 who received an ICM or ECM within 3 months. Patients with continuous Medicare FFS insurance and prescription drug enrolment in the prior year were included. Patients with prior AF, atrial flutter, cardiac devices, or OAC were excluded. Insertable cardiac monitor and ECM patients were propensity score matched 1:4 on demographics, comorbidities, and stroke hospitalization characteristics. The outcomes of interest were AF detection and OAC initiation evaluated with Kaplan-Meier and Cox proportional hazard regression analyses. A total of 5702 Medicare beneficiaries (ICM, n = 444; ECM, n = 5258) met inclusion criteria. The matched cohort consisted of 2210 Medicare beneficiaries (ICM, n = 442; ECM, n = 1768) with 53% female, mean age 75 years, and mean CHA₂DS₂-VASc score 4.6 (1.6). Insertable cardiac monitor use was associated with a higher probability of AF detection [(hazard ratio (HR) 2.88, 95% confidence interval (CI) (2.31, 3.59)] and OAC initiation [HR 2.91, CI (2.28, 3.72)] compared to patients monitored only with ECM., Conclusion: Patients with an ischaemic stroke monitored with an ICM were almost three times more likely to be diagnosed with AF and to be prescribed OAC compared to patients who received ECM only., Competing Interests: Conflict of interest: G.B. received small speaker’s fees from Abbott, Bayer, Boston, Boehringer, Daiichi Sankyo, Janssen, and Sanofi, outside of the submitted work. A.A, is a consultant to Abbott, Boston Scientific, Cairdac, EP Solutions, Hylomorph, Medtronic, and XSpline; has received speaker fees from Boston Scientific, Medtronic, Microport CRM, and Philips; participates in clinical trials sponsored by Abbott, Boston Scientific, EPD-Philips, EP Solutions, Medtronic, Philips, and XSpline; and holds intellectual properties with Boston Scientific, Biosense Webster, and Microport CRM. G.L.B. has received speaker fees (small amount) from Abbott, Biotronik, Boston Scientific, Medtronic, and Microport CRM. J.P.P. is supported by R01AG074185 from the National Institutes of Aging. He also receives grants from Abbott, the American Heart Association, the Association for the Advancement of Medical Instrumentation, Bayer, Boston Scientific, iRhythm, and Philips and serves as a consultant to Abbott, Abbvie, ARCA biopharma, Bayer, Boston Scientific, Element Science, LivaNova, Medtronic, Milestone, ElectroPhysiology Frontiers, Sanofi, Philips, and Up-to-Date. J.M.J., G.J.R., A.G., and Y.N. are employed by Abbott., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2023
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41. Procedure, management, and outcome of subcutaneous implantable cardioverter-defibrillator extraction in clinical practice.
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De Filippo P, Migliore F, Palmisano P, Nigro G, Ziacchi M, Rordorf R, Pieragnoli P, Di Grazia A, Ottaviano L, Francia P, Pisanò E, Tola G, Giammaria M, D'Onofrio A, Botto GL, Zucchelli G, Ferrari P, Lovecchio M, Valsecchi S, and Viani S
- Subjects
- Humans, Administration, Intravenous, Anti-Bacterial Agents, Hospitalization, Treatment Outcome, Defibrillators, Implantable
- Abstract
Aims: Subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy is expanding rapidly. However, there are few data on the S-ICD extraction procedure and subsequent patient management. The aim of this analysis was to describe the procedure, management, and outcome of S-ICD extractions in clinical practice., Methods and Results: We enrolled consecutive patients who required complete S-ICD extraction at 66 Italian centres. From 2013 to 2022, 2718 patients undergoing de novo implantation of an S-ICD were enrolled. Of these, 71 required complete S-ICD system extraction (17 owing to infection). The S-ICD system was successfully extracted in all patients, and no complications were reported; the median procedure duration was 40 (25th-75th percentile: 20-55) min. Simple manual traction was sufficient to remove the lead in 59 (84%) patients, in whom lead-dwelling time was shorter [20 (9-32) months vs. 30 (22-41) months; P = 0.032]. Hospitalization time was short in the case of both non-infectious [2 (1-2) days] and infectious indications [3 (1-6) days]. In the case of infection, no patients required post-extraction intravenous antibiotics, the median duration of any antibiotic therapy was 10 (10-14) days, and the re-implantation was performed during the same procedure in 29% of cases. No complications arose over a median of 21 months., Conclusion: The S-ICD extraction was safe and easy to perform, with no complications. Simple traction of the lead was successful in most patients, but specific tools could be needed for systems implanted for a longer time. The peri- and post-procedural management of S-ICD extraction was free from complications and not burdensome for patients and healthcare system., Clinical Trial Registration: URL: http://clinicaltrials.gov/Identifier: NCT02275637., Competing Interests: Conflict of interest: R.R. received speaker fees from Abbot and Boston Scientific. L.O. is a consultant for Boston Scientific. P.F. received speaker fees from Boston Scientific and research or educational grants from Abbott and Boston Scientific. G.L.B. reports speaker fees (small amount) from Boston Scientific, Medtronic, Biotronik, Abbot, Microport, and Zoll. M.L. and S.V. are employees of Boston Scientific. The other authors report no conflicts., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2023
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42. Reduction in inappropriate therapies through device programming in subcutaneous implantable defibrillator patients: data from clinical practice.
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Rordorf R, Viani S, Biffi M, Pieragnoli P, Migliore F, D'Onofrio A, Nigro G, Francia P, Ferrari P, Dello Russo A, Bisignani A, Ottaviano L, Palmisano P, Caravati F, Pisanò E, Pani A, Botto GL, Lovecchio M, Valsecchi S, and Vicentini A
- Subjects
- Humans, Follow-Up Studies, Prospective Studies, Electric Countershock, Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac therapy, Defibrillators, Implantable adverse effects, Tachycardia, Ventricular diagnosis
- Abstract
Aims: In subcutaneous implantable cardioverter defibrillator (S-ICD) recipients, the UNTOUCHED study demonstrated a very low inappropriate shock rate on programming a conditional zone between 200 and 250 bpm and a shock zone for arrhythmias >250 bpm. The extent to which this programming approach is adopted in clinical practice is still unknown, as is its impact on the rates of inappropriate and appropriate therapies., Methods and Results: We assessed ICD programming on implantation and during follow-up in a cohort of 1468 consecutive S-ICD recipients in 56 Italian centres. We also measured the occurrence of inappropriate and appropriate shocks during follow-up. On implantation, the median programmed conditional zone cut-off was set to 200 bpm (IQR: 200-220) and the shock zone cut-off was 230 bpm (IQR: 210-250). During follow-up, the conditional zone cut-off rate was not significantly changed, while the shock zone cut-off was changed in 622 (42%) patients and the median value increased to 250 bpm (IQR: 230-250) (P < 0.001). UNTOUCHED-like programming of detection cut-offs was adopted in 426 (29%) patients immediately after device implantation, and in 714 (49%, P < 0.001) at the last follow-up. UNTOUCHED-like programming was independently associated with fewer inappropriate shocks (hazard ratio 0.50, 95%CI 0.25-0.98, P = 0.044), and had no impact on appropriate and ineffective shocks., Conclusions: In recent years, S-ICD implanting centres have increasingly programmed high arrhythmia detection cut-off rates, at the time of implantation in the case of new S-ICD recipients, and during follow-up in the case of pre-existing implants. This has contributed significantly to reducing the incidence of inappropriate shocks in clinical practice. Rordorf: Programming of the S-ICD., Clinical Trial Registration: URL: http://clinicaltrials.gov/Identifier: NCT02275637., Competing Interests: Conflict of interest: R.R. received speaker fees from Abbot and Boston Scientific. P.F. received speaker fees from Boston Scientific and research or educational grants from Abbott and Boston Scientific. G.L.B. reports speaker fees (small amount) from Boston Scientific, Medtronic, Biotronik, Abbot, Microport, Zoll. M.L. and S.V. are employees of Boston Scientific. The other authors report no conflicts., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2023
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43. Intermuscular technique for implantation of the subcutaneous implantable defibrillator: a propensity-matched case-control study.
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Botto GL, Ziacchi M, Nigro G, D'Onofrio A, Dello Russo A, Francia P, Viani S, Pisanò E, Bisignani G, Caravati F, Migliore F, De Filippo P, Ottaviano L, Rordorf R, Manzo M, Canevese FL, Lovecchio M, Valsecchi S, and Checchi L
- Subjects
- Humans, Case-Control Studies, Death, Sudden, Cardiac etiology, Retrospective Studies, Treatment Outcome, Defibrillators, Implantable adverse effects
- Abstract
Aims: A previous randomized study demonstrated that the subcutaneous implantable cardioverter defibrillator (S-ICD) was noninferior to transvenous ICD with respect to device-related complications and inappropriate shocks. However, that was performed prior to the widespread adoption of pulse generator implantation in the intermuscular (IM) space instead of the traditional subcutaneous (SC) pocket. The aim of this analysis was to compare survival from device-related complications and inappropriate shocks between patients who underwent S-ICD implantation with the generator positioned in an IM position in comparison with an SC pocket., Methods and Results: We analysed 1577 consecutive patients who had undergone S-ICD implantation from 2013 to 2021 and were followed up until December 2021. Subcutaneous patients (n = 290) were propensity matched with patients of the IM group (n = 290), and their outcomes were compared. : During a median follow-up of 28 months, device-related complications were reported in 28 (4.8%) patients and inappropriate shocks were reported in 37 (6.4%) patients. The risk of complication was lower in the matched IM group than in the SC group [hazard ratio 0.41, 95% confidence interval (CI) 0.17-0.99, P = 0.041], as well as the composite of complications and inappropriate shocks (hazard ratio 0.50, 95% CI 0.30-0.86, P = 0.013). The risk of appropriate shocks was similar between groups (hazard ratio 0.90, 95% CI 0.50-1.61, P = 0.721). There was no significant interaction between generator positioning and variables such as gender, age, body mass index, and ejection fraction., Conclusion: Our data showed the superiority of the IM S-ICD generator positioning in reducing device-related complications and inappropriate shocks., Clinical Trial Registration: Clinical Trial Registration: ClinicalTrials.gov; NCT02275637., Competing Interests: Conflict of interest: M.L. and S.V. are employees of Boston Scientific. G.L.B. received speaker’s fee from Abbott, Biotronik, Boston Scientific, Medtronic, and Microport; P.F. received speaker’s fees and educational grants from Boston Scientific and research grants from Abbott. R.R. received speaker’s fees from Abbot and Boston Scientific. The other authors report no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2023
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44. Think S-ICD first: The time has come.
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Botto GL, Canevese FL, and Casale MC
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- Humans, Treatment Outcome, Death, Sudden, Cardiac, Defibrillators, Implantable
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- 2023
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45. Sudden cardiac death while waiting: do we need the wearable cardioverter-defibrillator?
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Israel C, Staudacher I, Leclercq C, Botto GL, Scherr D, Fach A, Duru F, Zylla MM, Katus HA, and Thomas D
- Subjects
- Humans, Death, Sudden, Cardiac etiology, Death, Sudden, Cardiac prevention & control, Electric Countershock adverse effects, Defibrillators, Randomized Controlled Trials as Topic, Defibrillators, Implantable adverse effects, Cardiomyopathies complications, Myocardial Infarction complications, Wearable Electronic Devices adverse effects
- Abstract
Sudden cardiac death (SCD) is the most frequent cause of cardiovascular death in industrialized nations. Patients with cardiomyopathy are at increased risk for SCD and may benefit from an implantable cardioverter-defibrillator (ICD). The risk of SCD is highest in the first months after myocardial infarction or first diagnosis of severe non-ischemic cardiomyopathy. On the other hand, left ventricular function may improve in a subset of patients to such an extent that an ICD might no longer be needed. To offer protection from a transient risk of SCD, the wearable cardioverter-defibrillator (WCD) is available. Results of the first randomized clinical trial investigating the role of the WCD after myocardial infarction were recently published. This review is intended to provide insight into data from the VEST trial, and to put these into perspective with studies and clinical experience. As a non-invasive, temporary therapy, the WCD may offer advantages over early ICD implantation. However, recent data demonstrate that patient compliance and education play a crucial role in this new concept of preventing SCD., (© 2022. The Author(s).)
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- 2022
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46. Practical considerations, indications, and future perspectives for leadless and extravascular cardiac implantable electronic devices: a position paper by EHRA/HRS/LAHRS/APHRS.
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Boersma LV, El-Chami M, Steinwender C, Lambiase P, Murgatroyd F, Mela T, Theuns DAMJ, Khelae SK, Kalil C, Zabala F, Stuehlinger M, Lenarczyk R, Clementy N, Tamirisa KP, Rinaldi CA, Knops R, Lau CP, Crozier I, Boveda S, Defaye P, Deharo JC, Botto GL, Vassilikos V, Oliveira MM, Tse HF, Figueroa J, Stambler BS, Guerra JM, Stiles M, and Marques M
- Subjects
- Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac therapy, Electronics, Heart, Humans, Defibrillators, Implantable
- Abstract
Competing Interests: Conflict of interest: The authors have provided declaration of interest information for all relationships that might be perceived as real or potential sources of conflicts of interest. The full disclosures can be viewed in the supplementary material for this article, available online at http://academic.oup.com/europace/article-lookup/doi/10.1093/europace/euac066#supplementary-data.
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- 2022
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47. The Interplay of PR Interval and AV Pacing Delays Used for Cardiac Resynchronization Therapy in Heart Failure Patients: Association with Clinical Response in a Retrospective Analysis of a Large Observational Study.
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Gasparini M, Biffi M, Landolina M, Cattafi G, Rordorf R, Botto GL, Battista Forleo G, Morani G, Santini L, Dello Russo A, Rossillo A, Meloni S, Grammatico A, Vitolo M, and Boriani G
- Abstract
Background. Cardiac resynchronization therapy (CRT) is a treatment for heart failure (HF) patients with prolonged QRS and impaired left ventricular (LV) systolic function. We aim to evaluate how the baseline PR interval is associated with outcomes (all-cause death or HF hospitalizations) and LV reverse remodeling (>15% relative reduction in LV end-systolic volume). Methods. Among 2224 patients with CRT defibrillators, 1718 (77.2%) had a device programmed at out-of-the-box settings (sensed AV delay: 100 ms and paced AV delay: 130 ms). Results. In this cohort of 1718 patients (78.7% men, mean age 66 years, 71.6% in NYHA class III/IV, LVEF = 27 ± 6%), echocardiographic assessment at 6-month follow-up showed that LV reverse remodeling was not constant as a function of the PR interval; in detail, it occurred in 56.4% of all patients but was more frequent (76.6%) in patients with a PR interval of 160 ms. In a median follow-up of 20 months, the endpoint of death or HF hospitalizations occurred in 304/1718 (17.7%) patients; in the multivariable regression analysis it was significantly less frequent when the PR interval was between 150 and 170 ms (hazard ratio = 0.79, 95% confidence interval (CI): 0.63−0.99, p = 0.046). The same PR range was associated with higher probability of CRT response (odds ratio = 2.51, 95% CI: 1.41−4.47, p = 0.002). Conclusions. In a large population of CRT patients, with fixed AV pacing delays, specific PR intervals are associated with significant benefits in terms of LV reverse remodeling and lower morbidity. These observational data suggest the importance of optimizing pacing programming as a function of the PR interval to maximize CRT response and patient outcome.
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- 2022
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48. International cohort study on the effectiveness of dronedarone and other antiarrhythmic drugs for atrial fibrillation in real-world practice (EFFECT-AF).
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Khachatryan A, Merino JL, de Abajo FJ, Botto GL, Kirchhof P, Breithardt G, Stambler B, Abenhaim L, and Grimaldi-Bensouda L
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- Aged, Anti-Arrhythmia Agents adverse effects, Cohort Studies, Dronedarone adverse effects, Female, Humans, Male, Amiodarone adverse effects, Atrial Fibrillation chemically induced, Atrial Fibrillation diagnosis, Atrial Fibrillation drug therapy
- Abstract
Aims: To evaluate the effectiveness and safety of dronedarone compared with other commonly used antiarrhythmic drugs (AADs) for preventing atrial fibrillation (AF) recurrences., Methods and Results: An international observational cohort study in Germany, Spain, Italy, and the USA enrolling patients with AF receiving AAD therapy. Patients with New York Heart Association (NYHA) Class IV heart failure were excluded. Participants were followed for up to 18 months, regardless of discontinuation or subsequent AAD switches. Atrial fibrillation recurrence was captured by hospitalization, emergency room visit, or electrocardiogram-based documentation of AF. Confounding bias was controlled for in the analysis of AF recurrence using multivariate models of 19 variables for adjustment. A total of 1009 participants [mean age 67.2 (10.8) years, male to female ratio 1.3] were recruited from 170 centres, 693 (69%) of which were from across Europe and the remaining 316 (31%) from the USA. At the time of enrolment, participants were taking dronedarone (51%) or other AADs (49%) [flecainide or propafenone (42%), sotalol (11%), and amiodarone (47%)]. No significant differences in the risk of first confirmed AF recurrence with dronedarone vs. other AADs [crude hazard ratio (HR) 1.10 (95% confidence interval 0.85-1.42); adjusted HR 1.16 (0.87-1.55)] were found, irrespective of whether univariate or multivariate models were used. Reported safety events were in accordance with the known safety profile of dronedarone., Conclusion: In this population of patients from either Europe or the USA receiving dronedarone or another AAD, the effectiveness of dronedarone was comparable to that observed for other AADs in preventing first AF recurrence., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2022
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49. Longevity of model 3501 subcutaneous implantable cardioverter-defibrillator leads in clinical practice.
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Viani S, Migliore F, Ottaviano L, Biffi M, Ammendola E, Ricciardi G, Francia P, D'Onofrio A, Bisignani G, Russo AD, De Filippo P, Solimene F, Scalone A, Caravati F, Rordorf R, Calvi VI, Botto GL, and Bongiorni MG
- Subjects
- Defibrillators, Implantable
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- 2022
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50. The value of wearable cardioverter defibrillator in adult patients with recent myocardial infarction: Economic and clinical implications from a health technology assessment perspective.
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Botto GL, Mantovani LG, Cortesi PA, De Ponti R, D'Onofrio A, Biffi M, Capucci A, Casu G, Notarstefano P, Scaglione M, Zanotto G, and Boriani G
- Subjects
- Adult, Death, Sudden, Cardiac epidemiology, Death, Sudden, Cardiac etiology, Death, Sudden, Cardiac prevention & control, Defibrillators adverse effects, Electric Countershock, Humans, Technology Assessment, Biomedical, Defibrillators, Implantable adverse effects, Myocardial Infarction complications, Myocardial Infarction diagnosis, Myocardial Infarction therapy, Wearable Electronic Devices adverse effects
- Abstract
Aims: Sudden cardiac death (SCD) causes high mortality and substantial societal burdens for healthcare systems (HSs). The risk of SCD is significantly increased in patients with reduced left ventricular ejection fraction after myocardial infarction (MI). Current guidelines recommend re-evaluation of cardioverter-defibrillator implantation 40 days post-MI, earliest. Medical therapy alone does not provide sufficient protection against SCD, especially in the first month post-MI, and needs time. Consequently, there is a gap in care of high-risk patients upon hospital discharge. The wearable cardioverter defibrillator (WCD) is a proven safe, effective therapy, which temporarily protects from SCD. Little information on WCD cost-effectiveness exists. We conducted this research to demonstrate the medical need of the device in the post-MI setting defining WCD cost-effectiveness., Methods & Results: Based on a randomized clinical trials (RCTs) and Italian and international data, we developed a Markov-model comparing costs, patient survival, and quality-of-life, and calculated the Incremental Cost-Effectiveness Ratio (ICER) of a WCD vs. current standard of care in post-MI patients. The rather conservative base case analysis - based on the RCT intention-to-treat results - produced an ICER of €47,709 per Quality Adjusted Life Year (QALY) gained, which is far lower than the accepted threshold of €60,000 in the Italian National HS. The ICER per Life Year (LY) gained was €38,276., Conclusion: WCD utilization in post-MI patients is clinically beneficial and cost-effective. While improving guideline directed patient care, the WCD can also contribute to a more efficient use of resources in the Italian HS, and potentially other HSs as well., (Copyright © 2022 Elsevier B.V. All rights reserved.)
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- 2022
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