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1. Valsartan for prevention of recurrent atrial fibrillation

Author

GISSI AF Investigators, Disertori M, Latini R, Barlera S, Franzosi MG, Staszewsky L, Maggioni AP, Lucci D, Di Pasquale G, Tognoni G, Delise P, Bertocchi F, Maiocchi G, Geraci E, Correale E, Lombardi F, Mugelli A, Urso R, Scardi S, Fabbri G, Bartolomei B, Barbato G, Carbonieri E, Ciricugno S, Cosmi F, Pratola C, Rossi MG, Sciarra L, Zeni P, Ceseri M, Atzori A, Bambi F, Baviera M, Bianchini F, Fenicia E, Gianfriddo M, Lonardo G, Luise A, Nota R, Orlando ME, Petrolo R, Pierattini C, Pierota V, Ragno A, Serio C, Tafi A, Tellaroli E, Masson S, Vago T, Gramenzi S, Orso F, Suliman I, Nicolis E, Casola C, Dall'Osso D, Gorini M, Bianchini E, Cabiddu S, Cangioli I, Carnaghi A, Cipressa ML, Cipressa L, Galbiati L, Lorimer A, Priami P, Moccetti T, Vaghi F, Capello AF, Rossetti G, Viada E, Morena L, Delucchi M, Reynaud SG, Allemano P, Massobrio N, Gavazzi A, Taddei F, Mor DA, Bortolini F, Lorini M, Inama G, Durin O, Pirelli S, Spotti A, Procopio R, Cuzzucrea D, Gentile G, Margonato A, Bassanelli G, Tavazzi L, Buzzi MP, Rordorf R, Gualco A, Opasich C, Gronda E, Genovese L, Mattioli R, Donatelli F, Uriarte JA, Rauhe W, Bertagnolli C, Canestrini S, Stefenelli C, Cioffi G, Giovanelli C, Rigatelli G, Boni S, Pasini A, Sitta N, Sacchetta A, Borgese L, Sciascia R, Targa L, Raviele A, Madalosso M, Bertaglia E, Zoppo FC, Capanna M, Fiorencis R, Baracca E, Rossi R, Rossi I, Trappolin R, Morgera T, Barducci E, Baldin MG, Gobbo G, Zardo F, Hrovatin E, Mos L, Vriz O, Sinagra G, Aleksova A, Mazzone C, Fresco C, Rubartelli P, Moroni LA, Camerieri A, Piana M, Mureddu R, Bertoli D, Petacchi R, Pancaldi LG, Gabrieli L, Urbinati S, Pedone C, Di Niro M, Brunelli A, Bosi S, Censi S, Moruzzi P, Pastori P, Modena MG, Malavasi V, Mezzetti M, Melandri F, Zuppiroli A, Fazi A, Testa R, Venturini E, Mazzinghi F, Cosmi D, Santoro GM, Minneci C, Galli M, Paperini L, Bovenzi FM, Cortigiani L, Cocchieri M, Severini D, Arcuri GM, Bagliani G, Bernardinangeli M, Proietti G, Bocconcelli P, Pierantozzi A, Monti F, Giamundo L, Tancredi P, Rossini E, Bianchi C, Bettiol F, Giovannini E, Fera MS, Santini M, Bianconi L, Boccanelli A, Morosetti P, Volpe M, Facciolo C, Vacri A, Romanazzi F, Napoletano C, Piccioni LL, Candelmo F, De Marco G, Arnese MR, Vetrano A, Prinzi D, De Rosa P, Capuano V, Torre S, D'Onofrio A, Ammendola E, Battista R, De Fusco A, Molero U, Iervoglini A, Stefanelli S, Fattore L, Bosco B, Liguori A, Padula G, De Luca I, Sorino M, Colonna P, D'Agostino C, Pierfelice O, Pettinati G, Muscella A, De Lorenzi E, Falco M, Giannattasio C, Baldi N, Clemente MA, D'Alessandro B, Truncellito L, Arabia F, Ciconte VA, Perticone F, Ruberto C, Buffon A, Tomaselli C, De Rosa F, Mazza S, Zampaglione G, Pirozzi AM, Butera A, Levato M, Musacchio D, Polimeni RM, Lacquaniti V, Pulitanò G, Ruggeri A, Provenzano A, Cuccurullo O, Musolino M, Marrari A, Anastasio L, Schiavello M, Comito MG, Gulizia MM, Francese GM, Vasquez L, Coppolino C, Casale A, D'Urso G, Oliva G, Giordano U, Andolina S, Sanfilippo N, Ingrillì F, Accardo S, Grasso S, Buffa L, Serra E., CHIARIELLO, MASSIMO, PERRONE FILARDI, PASQUALE, Delise, P., Bertocchi, F., Maiocchi, G., Geraci, E., Correale, E., Lombardi, F., Mugelli, A., Urso, R., Scardi, S., Fabbri, G., Bartolomei, B., Barbato, G., Carbonieri, E., Ciricugno, S., Cosmi, F., Pratola, C., Rossi, M. G., Sciarra, L., Zeni, P., Ceseri, M., Atzori, A., Bambi, F., Baviera, M., Bianchini, F., Fenicia, E., Gianfriddo, M., Lonardo, G., Luise, A., Nota, R., Orlando, M. E., Petrolo, R., Pierattini, C., Pierota, V., Ragno, A., Serio, C., Tafi, A., Tellaroli, E., Masson, S., Vago, T., Gramenzi, S., Orso, F., Suliman, I., Nicolis, E., Casola, C., Dall'Osso, D., Gorini, M., Bianchini, E., Cabiddu, S., Cangioli, I., Carnaghi, A., Cipressa, M. L., Cipressa, L., Galbiati, L., Lorimer, A., Priami, P., Moccetti, T., Vaghi, F., Capello, A. F., Rossetti, G., Viada, E., Morena, L., Delucchi, M., Reynaud, S. G., Allemano, P., Massobrio, N., Gavazzi, A., Taddei, F., Mor, D. A., Bortolini, F., Lorini, M., Inama, G., Durin, O., Pirelli, S., Spotti, A., Procopio, R., Cuzzucrea, D., Gentile, G., Margonato, A., Bassanelli, G., Tavazzi, L., Buzzi, M. P., Rordorf, R., Gualco, A., Opasich, C., Gronda, E., Genovese, L., Mattioli, R., Donatelli, F., Uriarte, J. A., Rauhe, W., Bertagnolli, C., Canestrini, S., Stefenelli, C., Cioffi, G., Giovanelli, C., Rigatelli, G., Boni, S., Pasini, A., Sitta, N., Sacchetta, A., Borgese, L., Sciascia, R., Targa, L., Raviele, A., Madalosso, M., Bertaglia, E., Zoppo, F. C., Capanna, M., Fiorencis, R., Baracca, E., Rossi, R., Rossi, I., Trappolin, R., Morgera, T., Barducci, E., Baldin, M. G., Gobbo, G., Zardo, F., Hrovatin, E., Mos, L., Vriz, O., Sinagra, G., Aleksova, A., Mazzone, C., Fresco, C., Rubartelli, P., Moroni, L. A., Camerieri, A., Piana, M., Mureddu, R., Bertoli, D., Petacchi, R., Pancaldi, L. G., Gabrieli, L., Urbinati, S., Pedone, C., Di Niro, M., Brunelli, A., Bosi, S., Censi, S., Moruzzi, P., Pastori, P., Modena, M. G., Malavasi, V., Mezzetti, M., Melandri, F., Zuppiroli, A., Fazi, A., Testa, R., Venturini, E., Mazzinghi, F., Cosmi, D., Santoro, G. M., Minneci, C., Galli, M., Paperini, L., Bovenzi, F. M., Cortigiani, L., Cocchieri, M., Severini, D., Arcuri, G. M., Bagliani, G., Bernardinangeli, M., Proietti, G., Bocconcelli, P., Pierantozzi, A., Monti, F., Giamundo, L., Tancredi, P., Rossini, E., Bianchi, C., Bettiol, F., Giovannini, E., Fera, M. S., Santini, M., Bianconi, L., Boccanelli, A., Morosetti, P., Volpe, M., Facciolo, C., Vacri, A., Romanazzi, F., Napoletano, C., Piccioni, L. L., Candelmo, F., De Marco, G., Arnese, M. R., Vetrano, A., Prinzi, D., De Rosa, P., Capuano, V., Torre, S., D'Onofrio, A., Ammendola, E., Chiariello, M., Filardi, Pp., Battista, R., De Fusco, A., Molero, U., Iervoglini, A., Stefanelli, S., Fattore, L., Bosco, B., Liguori, A., Padula, G., De Luca, I., Sorino, M., Colonna, P., D'Agostino, C., Pierfelice, O., Pettinati, G., Muscella, A., De Lorenzi, E., Falco, M., Giannattasio, C., Baldi, N., Clemente, M. A., D'Alessandro, B., Truncellito, L., Arabia, F., Ciconte, V. A., Perticone, F., Ruberto, C., Buffon, A., Tomaselli, C., De Rosa, F., Mazza, S., Zampaglione, G., Pirozzi, A. M., Butera, A., Levato, M., Musacchio, D., Polimeni, R. M., Lacquaniti, V., Pulitano, G., Ruggeri, A., Provenzano, A., Cuccurullo, O., Musolino, M., Marrari, A., Anastasio, L., Schiavello, M., Comito, M. G., Gulizia, M. M., Francese, G. M., Vasquez, L., Coppolino, C., Casale, A., D'Urso, G., Oliva, G., Giordano, U., Andolina, S., Sanfilippo, N., Ingrilli, F., Accardo, S., Grasso, S., Buffa, L., Serra, E., Disertori, Marcello, Latini, Roberto, Barlera, Simona, Franzosi, Maria Grazia, Staszewsky, Lidia, Maggioni, Aldo Pietro, Lucci, Donata, Di Pasquale, Giuseppe, Tognoni, Gianni, GISSI AF, Investigator, Disertori, M, Latini, R, Barlera, S, Franzosi, Mg, Staszewsky, L, Maggioni, Ap, Lucci, D, Di Pasquale, G, Tognoni, G, Delise, P, Bertocchi, F, Maiocchi, G, Geraci, E, Correale, E, Lombardi, F, Mugelli, A, Urso, R, Scardi, S, Fabbri, G, Bartolomei, B, Barbato, G, Carbonieri, E, Ciricugno, S, Cosmi, F, Pratola, C, Rossi, Mg, Sciarra, L, Zeni, P, Ceseri, M, Atzori, A, Bambi, F, Baviera, M, Bianchini, F, Fenicia, E, Gianfriddo, M, Lonardo, G, Luise, A, Nota, R, Orlando, Me, Petrolo, R, Pierattini, C, Pierota, V, Ragno, A, Serio, C, Tafi, A, Tellaroli, E, Masson, S, Vago, T, Gramenzi, S, Orso, F, Suliman, I, Nicolis, E, Casola, C, Dall'Osso, D, Gorini, M, Bianchini, E, Cabiddu, S, Cangioli, I, Carnaghi, A, Cipressa, Ml, Cipressa, L, Galbiati, L, Lorimer, A, Priami, P, Moccetti, T, Vaghi, F, Capello, Af, Rossetti, G, Viada, E, Morena, L, Delucchi, M, Reynaud, Sg, Allemano, P, Massobrio, N, Gavazzi, A, Taddei, F, Mor, Da, Bortolini, F, Lorini, M, Inama, G, Durin, O, Pirelli, S, Spotti, A, Procopio, R, Cuzzucrea, D, Gentile, G, Margonato, A, Bassanelli, G, Tavazzi, L, Buzzi, Mp, Rordorf, R, Gualco, A, Opasich, C, Gronda, E, Genovese, L, Mattioli, R, Donatelli, F, Uriarte, Ja, Rauhe, W, Bertagnolli, C, Canestrini, S, Stefenelli, C, Cioffi, G, Giovanelli, C, Rigatelli, G, Boni, S, Pasini, A, Sitta, N, Sacchetta, A, Borgese, L, Sciascia, R, Targa, L, Raviele, A, Madalosso, M, Bertaglia, E, Zoppo, Fc, Capanna, M, Fiorencis, R, Baracca, E, Rossi, R, Rossi, I, Trappolin, R, Morgera, T, Barducci, E, Baldin, Mg, Gobbo, G, Zardo, F, Hrovatin, E, Mos, L, Vriz, O, Sinagra, G, Aleksova, A, Mazzone, C, Fresco, C, Rubartelli, P, Moroni, La, Camerieri, A, Piana, M, Mureddu, R, Bertoli, D, Petacchi, R, Pancaldi, Lg, Gabrieli, L, Urbinati, S, Pedone, C, Di Niro, M, Brunelli, A, Bosi, S, Censi, S, Moruzzi, P, Pastori, P, Modena, Mg, Malavasi, V, Mezzetti, M, Melandri, F, Zuppiroli, A, Fazi, A, Testa, R, Venturini, E, Mazzinghi, F, Cosmi, D, Santoro, Gm, Minneci, C, Galli, M, Paperini, L, Bovenzi, Fm, Cortigiani, L, Cocchieri, M, Severini, D, Arcuri, Gm, Bagliani, G, Bernardinangeli, M, Proietti, G, Bocconcelli, P, Pierantozzi, A, Monti, F, Giamundo, L, Tancredi, P, Rossini, E, Bianchi, C, Bettiol, F, Giovannini, E, Fera, M, Santini, M, Bianconi, L, Boccanelli, A, Morosetti, P, Volpe, M, Facciolo, C, Vacri, A, Romanazzi, F, Napoletano, C, Piccioni, Ll, Candelmo, F, De Marco, G, Arnese, Mr, Vetrano, A, Prinzi, D, De Rosa, P, Capuano, V, Torre, S, D'Onofrio, A, Ammendola, E, Chiariello, Massimo, PERRONE FILARDI, Pasquale, Battista, R, De Fusco, A, Molero, U, Iervoglini, A, Stefanelli, S, Fattore, L, Bosco, B, Liguori, A, Padula, G, De Luca, I, Sorino, M, Colonna, P, D'Agostino, C, Pierfelice, O, Pettinati, G, Muscella, A, De Lorenzi, E, Falco, M, Giannattasio, C, Baldi, N, Clemente, Ma, D'Alessandro, B, Truncellito, L, Arabia, F, Ciconte, Va, Perticone, F, Ruberto, C, Buffon, A, Tomaselli, C, De Rosa, F, Mazza, S, Zampaglione, G, Pirozzi, Am, Butera, A, Levato, M, Musacchio, D, Polimeni, Rm, Lacquaniti, V, Pulitanò, G, Ruggeri, A, Provenzano, A, Cuccurullo, O, Musolino, M, Marrari, A, Anastasio, L, Schiavello, M, Comito, Mg, Gulizia, Mm, Francese, Gm, Vasquez, L, Coppolino, C, Casale, A, D'Urso, G, Oliva, G, Giordano, U, Andolina, S, Sanfilippo, N, Ingrillì, F, Accardo, S, Grasso, S, and Buffa, L

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Tetrazoles, Cardiomegaly, Comorbidity, Placebo, Cardioversion, Double-Blind Method, Recurrence, Multicenter trial, Internal medicine, Angiotensin II Type 1 Receptor Blocker, Cardiovascular Disease, Atrial Fibrillation, medicine, Left atrial enlargement, Diabetes Mellitus, Humans, Sinus rhythm, cardiovascular diseases, Prospective Studies, Tetrazole, Proportional Hazards Models, Aged, business.industry, Medicine (all), Hazard ratio, Atrial fibrillation, Diabetes Mellitu, Valine, General Medicine, Middle Aged, medicine.disease, valsartan, atrial fibrillation, Prospective Studie, Valsartan, Cardiovascular Diseases, cardiovascular system, Cardiology, Proportional Hazards Model, Female, business, Angiotensin II Type 1 Receptor Blockers, medicine.drug, Human
Abstract

BACKGROUND: Atrial fibrillation is the most common cardiac arrhythmia, and no current therapy is ideal for control of this condition. Experimental studies suggest that angiotensin II-receptor blockers (ARBs) can influence atrial remodeling, and some clinical studies suggest that they may prevent atrial fibrillation. METHODS: We conducted a large, randomized, prospective, placebo-controlled, multicenter trial to test whether the ARB valsartan could reduce the recurrence of atrial fibrillation. We enrolled patients who were in sinus rhythm but had had either two or more documented episodes of atrial fibrillation in the previous 6 months or successful cardioversion for atrial fibrillation in the previous 2 weeks. To be eligible, patients also had to have underlying cardiovascular disease, diabetes, or left atrial enlargement. Patients were randomly assigned to receive valsartan or placebo. The two primary end points were the time to a first recurrence of atrial fibrillation and the proportion of patients who had more than one recurrence of atrial fibrillation over the course of 1 year. RESULTS: A total of 1442 patients were enrolled in the study. Atrial fibrillation recurred in 371 of the 722 patients (51.4%) in the valsartan group, as compared with 375 of 720 (52.1%) in the placebo group (adjusted hazard ratio, 0.97; 96% confidence interval [CI], 0.83 to 1.14; P = 0.73). More than one episode of atrial fibrillation occurred in 194 of 722 patients (26.9%) in the valsartan group and in 201 of 720 (27.9%) in the placebo group (adjusted odds ratio, 0.89; 99% CI, 0.64 to 1.23; P = 0.34). The results were similar in all predefined subgroups of patients, including those who were not receiving angiotensin-converting-enzyme inhibitors. CONCLUSIONS: Treatment with valsartan was not associated with a reduction in the incidence of recurrent atrial fibrillation. (ClinicalTrials.gov number, NCT00376272.) Copyright © 2009 Massachusetts Medical Society.

Published
2009

2. Valsartan for prevention of recurrent atrial fibrillation (New England Journal of Medicine (2009) 360, (1606-1617))

Author

Delise, P., Bertocchi, F., Maiocchi, G., Geraci, E., Correale, E., Lombardi, F., Mugelli, A., Urso, R., Scardi, S., Fabbri, G., Bartolomei, B., Barbato, G., Carbonieri, E., Ciricugno, S., Cosmi, F., Pratola, C., Rossi, M. G., Sciarra, L., Zeni, P., Ceseri, M., Atzori, A., Bambi, F., Baviera, M., Bianchini, F., Fenicia, E., Gianfriddo, M., Lonardo, G., Luise, A., Nota, R., Orlando, M. E., Petrolo, R., Pierattini, C., Pierota, V., Ragno, A., Serio, C., Tafi, A., Tellaroli, E., Masson, S., Vago, T., Gramenzi, S., Orso, F., Suliman, I., Nicolis, E., Casola, C., Dall Osso, D., Gorini, M., Bianchini, E., Cabiddu, S., Cangioli, I., Carnaghi, A., Cipressa, M. L., Cipressa, L., Galbiati, L., Lorimer, A., Priami, P., Moccetti, T., Vaghi, F., Capello, A. F., Rossetti, G., Viada, E., Morena, L., Delucchi, M., Reynaud, S. G., Allemano, P., Massobrio, N., Gavazzi, A., Taddei, F., Mor, D. A., Bortolini, F., Lorini, M., Inama, G., Durin, O., Pirelli, S., Spotti, A., Procopio, R., Cuzzucrea, D., Gentile, G., Margonato, A., Bassanelli, G., Tavazzi, L., Buzzi, M. P., Rordorf, R., Gualco, A., Opasich, C., Gronda, E., Genovese, L., Mattioli, R., Donatelli, F., Uriarte, J. A., Rauhe, W., Bertagnolli, C., Canestrini, S., Stefenelli, C., Cioffi, G., Giovanelli, C., Rigatelli, G., Boni, S., Pasini, A., Sitta, N., Sacchetta, A., Borgese, L., Sciascia, R., Targa, L., Raviele, A., Madalosso, M., Bertaglia, E., Franco Zoppo, Capanna, M., Fiorencis, R., Baracca, E., Rossi, R., Rossi, I., Trappolin, R., Morgera, T., Barducci, E., Baldin, M. G., Gobbo, G., Zardo, F., Hrovatin, E., Mos, L., Vriz, O., Sinagra, G., Aleksova, A., Mazzone, C., Fresco, C., Rubartelli, P., Moroni, L. A., Camerieri, A., Piana, M., Mureddu, R., Bertoli, D., Petacchi, R., Pancaldi, L. G., Gabrieli, L., Urbinati, S., Pedone, C., Di Niro, M., Brunelli, A., Bosi, S., Censi, S., Moruzzi, P., Pastori, P., Modena, M. G., Malavasi, V., Mezzetti, M., Melandri, F., Zuppiroli, A., Fazi, A., Testa, R., Venturini, E., Mazzinghi, F., Cosmi, D., Santoro, G. M., Minneci, C., Galli, M., Paperini, L., Bovenzi, F. M., Cortigiani, L., Cocchieri, M., Severini, D., Arcuri, G. M., Bagliani, G., Bernardinangeli, M., Proietti, G., Bocconcelli, P., Pierantozzi, A., Monti, F., Giamundo, L., Tancredi, P., Rossini, E., Bianchi, C., Bettiol, F., Giovannini, E., Fera, M. S., Santini, M., Bianconi, L., Boccanelli, A., Morosetti, P., Volpe, M., Facciolo, C., Vacri, A., Romanazzi, F., Napoletano, C., Piccioni, L. L., Candelmo, F., Marco, G., Arnese, M. R., Vetrano, A., Prinzi, D., Rosa, P., Capuano, V., Torre, S., D Onofrio, A., Ammendola, E., Chiariello, M., Filardi, Pp, Battista, R., Fusco, A., Molero, U., Iervoglini, A., Stefanelli, S., Fattore, L., Bosco, B., Liguori, A., Padula, G., Luca, I., Sorino, M., Colonna, P., D Agostino, C., Pierfelice, O., Pettinati, G., Muscella, A., Lorenzi, E., Falco, M., Giannattasio, C., Baldi, N., Clemente, M. A., D Alessandro, B., Truncellito, L., Arabia, F., Ciconte, V. A., Perticone, F., Ruberto, C., Buffon, A., Tomaselli, C., Rosa, F., Mazza, S., Zampaglione, G., Pirozzi, A. M., Butera, A., Levato, M., Musacchio, D., Polimeni, R. M., Lacquaniti, V., Pulitano, G., Ruggeri, A., Provenzano, A., Cuccurullo, O., Musolino, M., Marrari, A., Anastasio, L., Schiavello, M., Comito, M. G., Gulizia, M. M., Francese, G. M., Vasquez, L., Coppolino, C., Casale, A., D Urso, G., Oliva, G., Giordano, U., Andolina, S., Sanfilippo, N., Ingrilli, F., Accardo, S., Grasso, S., Buffa, L., Serra, E., Disertori, M., Latini, R., Barlera, S., Franzosi, M. G., Staszewsky, L., Maggioni, A. P., Lucci, D., Di Pasquale, G., Tognoni, G., Delise, P., Bertocchi, F., Maiocchi, G., Geraci, E., Correale, E., Lombardi, F., Mugelli, A., Urso, R., Scardi, S., Fabbri, G., Bartolomei, B., Barbato, G., Carbonieri, E., Ciricugno, S., Cosmi, F., Pratola, C., Rossi, M. G., Sciarra, L., Zeni, P., Ceseri, M., Atzori, A., Bambi, F., Baviera, M., Bianchini, F., Fenicia, E., Gianfriddo, M., Lonardo, G., Luise, A., Nota, R., Orlando, M. E., Petrolo, R., Pierattini, C., Pierota, V., Ragno, A., Serio, C., Tafi, A., Tellaroli, E., Masson, S., Vago, T., Gramenzi, S., Orso, F., Suliman, I., Nicolis, E., Casola, C., Dall'Osso, D., Gorini, M., Bianchini, E., Cabiddu, S., Cangioli, I., Carnaghi, A., Cipressa, M. L., Cipressa, L., Galbiati, L., Lorimer, A., Priami, P., Moccetti, T., Vaghi, F., Capello, A. F., Rossetti, G., Viada, E., Morena, L., Delucchi, M., Reynaud, S. G., Allemano, P., Massobrio, N., Gavazzi, A., Taddei, F., Mor, D. A., Bortolini, F., Lorini, M., Inama, G., Durin, O., Pirelli, S., Spotti, A., Procopio, R., Cuzzucrea, D., Gentile, G., Margonato, A., Bassanelli, G., Tavazzi, L., Buzzi, M. P., Rordorf, R., Gualco, A., Opasich, C., Gronda, E., Genovese, L., Mattioli, R., Donatelli, F., Uriarte, J. A., Rauhe, W., Bertagnolli, C., Canestrini, S., Stefenelli, C., Cioffi, G., Giovanelli, C., Rigatelli, G., Boni, S., Pasini, A., Sitta, N., Sacchetta, A., Borgese, L., Sciascia, R., Targa, L., Raviele, A., Madalosso, M., Bertaglia, E., Zoppo, F. C., Capanna, M., Fiorencis, R., Baracca, E., Rossi, R., Rossi, I., Trappolin, R., Morgera, T., Barducci, E., Baldin, M. G., Gobbo, G., Zardo, F., Hrovatin, E., Mos, L., Vriz, O., Sinagra, G., Aleksova, A., Mazzone, C., Fresco, C., Rubartelli, P., Moroni, L. A., Camerieri, A., Piana, M., Mureddu, R., Bertoli, D., Petacchi, R., Pancaldi, L. G., Gabrieli, L., Urbinati, S., Pedone, C., Di Niro, M., Brunelli, A., Bosi, S., Censi, S., Moruzzi, P., Pastori, P., Modena, M. G., Malavasi, V., Mezzetti, M., Melandri, F., Zuppiroli, A., Fazi, A., Testa, R., Venturini, E., Mazzinghi, F., Cosmi, D., Santoro, G. M., Minneci, C., Galli, M., Paperini, L., Bovenzi, F. M., Cortigiani, L., Cocchieri, M., Severini, D., Arcuri, G. M., Bagliani, G., Bernardinangeli, M., Proietti, G., Bocconcelli, P., Pierantozzi, A., Monti, F., Giamundo, L., Tancredi, P., Rossini, E., Bianchi, C., Bettiol, F., Giovannini, E., Fera, M. S., Santini, M., Bianconi, L., Boccanelli, A., Morosetti, P., Volpe, M., Facciolo, C., Vacri, A., Romanazzi, F., Napoletano, C., Piccioni, L. L., Candelmo, F., De Marco, G., Arnese, M. R., Vetrano, A., Prinzi, D., De Rosa, P., Capuano, V., Torre, S., D'Onofrio, A., Ammendola, E., Chiariello, M., Filardi, Pp., Battista, R., De Fusco, A., Molero, U., Iervoglini, A., Stefanelli, S., Fattore, L., Bosco, B., Liguori, A., Padula, G., De Luca, I., Sorino, M., Colonna, P., D'Agostino, C., Pierfelice, O., Pettinati, G., Muscella, A., De Lorenzi, E., Falco, M., Giannattasio, C., Baldi, N., Clemente, M. A., D'Alessandro, B., Truncellito, L., Arabia, F., Ciconte, V. A., Perticone, F., Ruberto, C., Buffon, A., Tomaselli, C., De Rosa, F., Mazza, S., Zampaglione, G., Pirozzi, A. M., Butera, A., Levato, M., Musacchio, D., Polimeni, R. M., Lacquaniti, V., Pulitano, G., Ruggeri, A., Provenzano, A., Cuccurullo, O., Musolino, M., Marrari, A., Anastasio, L., Schiavello, M., Comito, M. G., Gulizia, M. M., Francese, G. M., Vasquez, L., Coppolino, C., Casale, A., D'Urso, G., Oliva, G., Giordano, U., Andolina, S., Sanfilippo, N., Ingrilli, F., Accardo, S., Grasso, S., Buffa, L., Serra, E., Disertori, Marcello, Latini, Roberto, Barlera, Simona, Franzosi, Maria Grazia, Staszewsky, Lidia, Maggioni, Aldo Pietro, Lucci, Donata, Di Pasquale, Giuseppe, and Tognoni, Gianni

Subjects
Medicine (all)
Published
2009

3. Valsartan for prevention of recurrent atrial

Author

Disertori, M, Latini, R, Maggioni, Ap, Barlera, S, Di Pasquale, G, Franzosi, Mg, Lucci, D, Staszewsky, L, Tognoni, G, Delise, P, Bertocchi, F, Maiocchi, G, Geraci, E, Correale, E, Lombardi, F, Mugelli, A, Urso, R, Scardi, S, Fabbri, G, Bartolomei, B, Barbato, G, Carbonieri, E, Ciricugno, S, Cosmi, F, Pratola, C, Rossi, Mg, Sciarra, L, Zeni, P, Ceseri, M, Atzori, A, Bambi, F, Baviera, M, Bianchini, F, Cfenicia, E, Gianfriddo, M, Lonardo, G, Luise, A, Nota, R, Orlando, Me, Petrolo, R, Pierattini, C, Pierota, V, Ragno, A, Serio, C, Tafi, A, Tellaroli, E, Masson, S, Vago, T, Gramenzi, S, Orso, F, Suliman, I, Nicolis, E, Casola, C, Dall'Osso, D, Gorini, M, Bianchini, E, Cabiddu, S, Cangioli, I, Carnaghi, A, Cipressa, Ml, Cipressa, L, Galbiati, L, Lorimer, A, Priami, P, Moccetti, T, Vaghi, F, Capello, Af, Rossetti, G, Viada, E, Morena, L, Delucchi, M, Reynaud SG, Allemano, P, Massobrio, N, Gavazzi, A, Taddei, F, Mor, Da, Bortolini, F, Lorini, M, Inama, G, Durin, O, Pirelli, S, Spotti, A, Procopio, R, Cuzzucrea, D, Gentile, G, Margonato, A, Bassanelli, G, Tavazzi, L, Buzzi, Mp, Rordorf, R, Gualco, A, Opasich, C, Gronda, E, Genovese, L, Mattioli, R, Donatelli, F, Uriarte, Ja, Rauhe, W, Bertagnolli, C, Canestrini, S, Stefenelli, C, Cioffi, G, Giovanelli, C, Rigatelli, G, Boni, S, Pasini, A, Sitta, N, Sacchetta, A, Borgese, L, Sciascia, R, Targa L, Raviele, A, Madalosso, M, Bertaglia, E, Zoppo, Fc, Capanna, M, Fiorencis, R, Baracca, E, Rossi, R, Rossi, I, Trappolin, R, Morgera, T, Barducci, E, Baldin, Mg, Gobbo, G, Zardo, F, Hrovatin, E, Mos, L, Vriz, O, Sinagra, G, Aleksova, A, Mazzone, C, Fresco, C, Rubartelli, P, Moroni, La, Camerieri, A, Piana, M, Mureddu, R, Bertoli, D, Petacchi, R, Pancaldi, Lg, Gabrieli, L, Urbinati, S, Pedone, C, Di Niro, M, Brunelli, A, Bosi, S, Censi, S, Moruzzi, P, Pastori, P, Modena, Mg, Malavasi, V, Mezzetti, M, Melandri, F, Zuppiroli, A, Fazi, A, Testa, R, Venturini, E, Mazzinghi, F, Cosmi, D, Santoro, Gm, Minneci, C, Galli, M, Paperini, L, Bovenzi, Fm, Cortigiani, L, Cocchieri, M, Severini, D, Arcuri, Gm, Bagliani, G, Bernardinangeli, M, Proietti, G, Bocconcelli, P, Pierantozzi, A, Monti, F, Giamundo, L, Tancredi, P, Rossini, E, Bianchi, C, Bettiol, F, Giovannini, E, Fera, Ms, Santini, M, Bianconi, L, Boccanelli, A, Morosetti, P, Volpe, M, Facciolo, C, Vacri, A, Romanazzi, F, Napoletano, C, Piccioni, Ll, Candelmo, F, De Marco, G, Arnese, Mr, Vetrano, A, Prinzi, D, De Rosa, P, Capuano, V, Torre, S, D'Onofrio, A, Ammendola, E, Chiariello, M, Filardi, Pp, Battista, R, De Fusco, A, Molero, U, Iervoglini, A, Stefanelli, S, Fattore, L, Bosco, B, Liguori, A, Padula, G, De Luca, I, Sorino, M, Colonna, P, D'Agostino, C, Pierfelice, O, Pettinati, G, Muscella, A, De Lorenzi, E, Falco, M, Giannattasio, C, Baldi, N, Clemente, Ma, D'Alessandro, B, Truncellito, L, Arabia, F, Ciconte, Va, Perticone, F, Ruberto, C, Buffon, A, Tomaselli, C, De Rosa, F, Mazza, S, Zampaglione, G, Pirozzi, Am, Butera, A, Levato, M, Musacchio, D, Polimeni, Rm, Lacquaniti, V, Pulitanò, G, Ruggeri, A, Provenzano, A, Cuccurullo, O, Musolino, M, Marrari, A, Anastasio, L, Schiavello, M, Comito, Mg, Gulizia, Mm, Francese GM, Vasquez, L, Coppolino, C, Casale, A, D'Urso, G, Oliva, G, Giordano, U, Andolina, S, Sanfilippo, N, Ingrillì, F, Accardo, S, Grasso, S, Buffa, L, Bambi, Serra E., Baviera, M., Bianchini, F., Fenicia, E., Gianfriddo, M., Lonardo, G., Luise, A., Nota, R., Orlando, M. E., Petrolo, R., Pierattini, C., Pierota, V., Ragno, A., Serio, C., Tafi, A., Tellaroli, E., Masson, Core Laboratories — S., Latini, R., Vago (Biomarkers), T., Staszewsky, L., Gramenzi (Echocardiography), S., Orso, F., Suliman (Electrocardiography), I., Nicolis, Database Management and Statistics — E., Casola, C., Barlera, S., Dall'Osso, D., Gorini, M., Lucci, D., Regulatory, Administrative, Bianchini, and Secretariat — E., Cabiddu, S., Cangioli, I., Carnaghi, A., Cipressa, M. L., Cipressa, L., Galbiati, L., Lorimer, A., Priami, P., Moccetti, Participating Centers and Investigators — Switzerland: Lugano (T., Rossi, M. G., Vaghi), F., Capello), Italy: Piemonte: Asti (A. F. L., Rossetti, Cuneo (G., Viada, E., Morena), L., Delucchi, Saluzzo (M., Reynaud, S. G., Allemano), P., Massobrio), Torino Valdese (N., Gavazzi, Lombardia: Bergamo (A., Taddei), F., Mor), Brescia (D. A., Bortolini, Chiari (F., Lorini), M., Inama, Crema (G., Durin), O., Pirelli, Cremona (S., Spotti, A., Procopio), R., Cuzzucrea, Giussano (D., Gentile), G., Margonato, Milano San Raffaele (A., Bassanelli), G., Tavazzi, Pavia San Matteo (L., Buzzi, M. P., Rordorf), R., Gualco, Pavia Fondazione Salvatore Maugeri (A., Opasich), C., Gronda, Rozzano (E., Genovese), L., Mattioli, Sesto San Giovanni (R., Donatelli), F., Salerno Uriarte), Varese (J. A., Rauhe), P. A. Bolzano: Bolzano (W., Bertagnolli, P. A. Trento: Cles (C., Canestrini), S., Stefenelli, Trento Villa Bianca (C., Cioffi), G., Disertori, Trento Santa Chiara (M., Zeni, P., Giovanelli), C., Rigatelli, Veneto: Bovolone (G., Boni, S., Pasini), A., Sitta), Conegliano Santa Maria dei Battuti (N., Sacchetta, Conegliano Veneto De Gironcoli (A., Borgese, L., Sciascia), R., Targa), Este (L., Raviele, Mestre (A., Madalosso), M., Bertaglia, Mirano (E., Zoppo), F. C., Capanna, Porto Viro (M., Fiorencis), R., Baracca), Rovigo (E., Rossi, San Bonifacio (R., Carbonieri, E., Rossi), I., Trappolin), Villafranca di Verona (R., Morgera, Friuli Venezia Giulia: Monfalcone (T., Barducci), E., Baldin, Palmanova (M. G., Gobbo), G., Zardo, Pordenone (F., Hrovatin), E., Mos, San Daniele del Friuli (L., Vriz), O., Sinagra, Trieste Az. Ospedaliera-Universitaria Ospedali Riuniti (G., Aleksova), A., Scardi, Trieste Az. Servizi Sanitari n. 1 Triestina (S., Mazzone), C., Fresco), Udine (C., Rubartelli, Liguria: Genova-Sampierdarena (P., Moroni), L. A., Camerieri), Genova-Voltri (A., Piana), Imperia (M., Mureddu), Pietra Ligure (R., Bertoli, Sarzana-Loc. S. Caterina (D., Petacchi), R., Pancaldi, Emilia Romagna: Bentivoglio (L. G., Gabrieli), L., Urbinati, Bologna Bellaria (S., Pedone), C., Di Pasquale, Bologna Maggiore (G., Di Niro, M., Brunelli), A., Bosi, Cotignola (S., Censi), S., Pratola), Ferrara (C., Moruzzi, Fidenza (P., Pastori), P., Modena, Modena (M. G., Malavasi), V., Mezzetti), Rimini (M., Melandri), Sassuolo (F., Zuppiroli, Toscana: Bagno a Ripoli (A., Fazi), A., Testa, Cecina (R., Venturini, E., Mazzinghi), F., Cosmi, Cortona (F., Cosmi), D., Santoro, Firenze Nuovo Osp. S Giovanni di Dio (G. M., Minneci), C., Galli, Livorno (M., Paperini), L., Bovenzi, Lucca (F. M., Cortigiani), L., Cocchieri, Umbria: Città di Castello (M., Severini, D., Arcuri), G. M., Bagliani), Foligno (G., Bernardinangeli, Terni (M., Proietti, G., Proietti), G., Bocconcelli, Marche: Pesaro (P., Pierantozzi), A., Monti, Lazio: Albano Laziale (F., Giamundo), L., Tancredi, Formia (P., Rossini), E., Bianchi), Roma Centro Traumatologico Ortopedico (C., Roma San Camillo, Bettiol), Cardiologia Riabilitativa e Preventiva (F., Giovannini, Cardiologia I (E., Fera), M. S., Santini, Roma San Filippo Neri (M., Bianconi), L., Boccanelli, Roma San Giovanni (A., Morosetti), P., Volpe, Roma Sant'Andrea (M., Facciolo), C., Vacri, Abruzzo: Penne (A., Romanazzi), F., Napoletano, Teramo (C., Piccioni), L. L., Candelmo), Campania: Avellino (F., De Marco, Aversa (G., Arnese), M. R., Vetrano), Caserta (A., Prinzi, Giugliano in Campania (D., De Rosa), P., Capuano, Mercato San Severino (V., Torre), S., D'Onofrio, Napoli Azienda Ospedaliera Monaldi (A., Ammendola), E., Chiariello, Napoli Policlinico Universitario Federico II (M., Perrone Filardi), P., Battista, Piedimonte Matese (R., De Fusco), A., Molero), Pozzuoli (U., Iervoglini, San Felice a Cancello (A., Stefanelli), S., Fattore, Santa Maria Capua Vetere (L., Bosco), B., Liguori, Vallo della Lucania (A., Padula), G., De Luca, Puglia: Bari Ospedale Consorziale Policlinico (I., Sorino, M., Colonna), P., D'Agostino, Bari-Carbonara (C., Pierfelice), O., Pettinati, Casarano (G., Muscella), A., De Lorenzi, Scorrano (E., Falco), M., Giannattasio), Taranto Villa Verde (C., Baldi), Taranto Santissima Annunziata (N., Clemente), Basilicata: Matera (M. A., D'Alessandro, Policoro (B., Truncellito), L., Arabia, Calabria: Catanzaro Pugliese (F., Ciconte), V. A., Perticone, Catanzaro Germaneto (F., Ruberto), C., Buffon, Cosenza Santissima Annunziata (A., Tomaselli), C., De Rosa, Cosenza Mariano Santo (F., Mazza), S., Zampaglione, Crotone (G., Pirozzi), A. M., Butera, Lamezia Terme (A., Levato), M., Musacchio), Paola (D., Polimeni, Polistena (R. M., Lacquaniti), V., Pulitanò, Reggio Calabria (G., Ruggeri), A., Provenzano), Rogliano (A., Cuccurullo), San Marco Argentano (O., Musolino, Scilla (M., Marrari), A., Anastasio, Soriano Calabro (L., Schiavello), M., Comito), Vibo Valentia (M. G. A., Gulizia, Sicilia: Catania (M. M., Francese), G. M., Vasquez, Milazzo (L., Coppolino), C., Casale, Nicosia (A., D'Urso), G., Oliva, Palermo Civico e Benfratelli (G., Giordano, U., Andolina), S., Sanfilippo, Palermo Villa Sofia (N., Ingrillì), F., Accardo), Palermo Buccheri La Ferla (S., Grasso, Palermo Cervello (S., Buffa), L., and Sardegna: Cagliari Brotzu, (E. Serra).

Published
2009

7. ITALIAN MULTICENTER CLINICAL-EXPERIENCE WITH ENDOCARDIAL DEFIBRILLATION - ACUTE AND LONG-TERM RESULTS IN 307 PATIENTS

Author

Raviele, A, Gasparini, G, Capestro, F, Renzi, R, Favale, S, Rizzon, P, Capucci, A, Boriani, G, Marchini, A, Verlato, R, Corrado, Domenico, Carli, L, Abbate, M, Calcaterra, V, Leone, G, Paparella, N, Alboni, P, Derosa, F, Plastina, F, Daulerio, M, Tirella, G, Benedini, G, Musso, G, Mureddu, R, Brignole, M, Oddone, D, Arlotti, M, Lotto, A, Lunati, M, Gasparini, M, Marzegalli, M, Bernasconi, M, Vincenti, A, Ciro, A, Musto, B, Donofrio, A, Renzulli, A, Cotrufo, M, Occhetta, E, Plebani, L, Deponti, R, Salerno, Ja, Bongiorni, Mg, Biagini, A, Pulitano, G, Adornato, E, Pennisi, V, Dini, P, Adinolfi, E, Bellocci, F, Zecchi, P, Auricchio, A, Scafuri, A, Potenza, D, Fanelli, R, Fazzari, M, Pistis, G, Libero, L, Giustetto, C, Vergara, G, Furlanello, F, Petz, E, Morgera, T, Proclemer, A, Feruglio, Ga, Onofri, M, Caico, S, Vicentini, A, Peranzoni, G, and Ometto, R.

Subjects
medicine.medical_specialty, Ejection fraction, business.industry, Defibrillation, medicine.medical_treatment, General Medicine, Ventricular tachycardia, medicine.disease, Sudden death, Defibrillation threshold, Internal medicine, Shock (circulatory), Multicenter trial, Ventricular fibrillation, medicine, Cardiology, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract

This study presents the acute and long-term results of 307 patients (267 men, mean age 57.5 years, 205 suffering from coronary artery disease, mean left ventricular ejection fraction 33.3%) with malignant ventricular tachyarrhythmias who underwent attempted transvenous ICD implantation with the CPI Endotak lead system in 37 Italian centers. Transvenous ICD implantation was ultimately accomplished in 306 (99.7%) patients. These included 19 subjects with high (< 10 J below output energy of implanted device) defibrillation threshold (DFT) at implant. One hundred sixty-four patients (53%) were implanted with the endocardial lead alone, while 142 also received an SQ patch or SQ array. The mean DFT (not always step-down DFT) at implant was 16.9 +/- 5.7 joules; 15.3 +/- 5.2 joules with biphasic shock and 19.6 +/- 5.4 joules with monophasic shock; P < 0.0001. A significantly higher percentage of patients tested with a biphasic shock could be implanted with adequate safety margin and without an additional SQ patch or SQ array (98% and 81%, respectively). No perioperative deaths occurred. During the mean follow-up of 14.5 +/- 10.2 months, 140 patients (52%) received at least one appropriate shock. An inappropriate shock was observed in 26% of episodes. The 1- and 3-year actuarial incidence of sudden death was 2% and 4%, respectively, and that of total death was 10% and 20%, respectively. A pocket infection requiring ICD explantation occurred in 4 patients (1.4%) and an endocardial lead dislodgment in 11 patients (3.6%). Two patients (0.3%) showed a sensing pin disconnection and six patients (2.3%) had a lead insulation break. The results of this Italian multicenter trial indicate that the CPI Endotak lead system is a simple, safe, and reliable system for endocardial defibrillation. When compared to epicardial leads, it clearly reduces the perioperative mortality and morbidity, while maintaining a similar efficacy in preventing sudden death and terminating ventricular arrhythmias.

Published
1995

11. Head-up tilt testing potentiated with oral nitroglycerin; a randomized trial of the contribution of a drug-free phase and a nitroglycerin phase in the diagnosis of neurally mediated syncope.

Author

Bartoletti, A., Gaggioli, G., Menozzi, C., Bottoni, N., Del Rosso, A., Mureddu, R., Musso, G., Foglia-Manzillo, G., Bonfigli, B., and Brignole, M.

Abstract

Background Since the pharmacological challenge with nitroglycerin (NTG) follows the initial drug-free phase in current tilt testing protocols, the eVects of nitroglycerin alone and the appropriate duration of the basal phase are unknown. Methods To optimize the test, a randomized intra-patient comparison of two protocols was undertaken: a conventional nitroglycerin test (cHUT) consisting of passive upright posture at 60° for 45 min followed, if negative, by sublingual NTG 0·4 mg spray, with the test continued for 20 min; and, accelerated nitroglycerin test (aHUT) consisting of passive upright posture at 60° for 5 min—to rule out orthostatic hypotension — followed by sublingual NTG 0·4 mg spray, with the test continued for 20 min. Eighty-four consecutive patients (33 males; mean age 55 ± 22) with unexplained syncope underwent both cHUT and aHUT in a randomized sequence with a 24–72 h interval between them. Additionally, 25 age-matched control subjects underwent aHUT. Results In the drug-free phase, cHUT was positive in 15/84 patients (18%) and aHUT in 1/84 patients (1%). After NTG, cHUT and aHUT showed the same positivity rate of 33% (28/84 patients). The overall positivity rate was therefore higher with cHUT than with aHUT (51% vs 35%, P=0·04). Times to syncope were 29 ± 12 min, (range 2–44) for cHUT drug-free phase, 5 ± 2 min (range 2–9) for cHUT NTG phase, and 5 ± 2 min (range 2–9) for aHUT. Only one (4%) of the control subjects had a positive response to aHUT. Conclusions The contribution of NTG to the diagnosis is independent of the presence of an unmedicated phase. The appropriate duration of the NTG phase is 10 min. aHUT has good specificity, but a positivity rate lower than cHUT; thus a drug-free phase is necessary to increase the sensitivity of the test. [ABSTRACT FROM PUBLISHER]

Published
1999
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14. Effects of chronic vasodilator therapy to enhance susceptibility to vasovagal syncope during upright tilt testing.

Author

Gaggioli G, Bottoni N, Mureddu R, Foglia-Manzillo G, Mascioli G, Bartoli P, Musso G, Menozzi C, Brignole M, Gaggioli, G, Bottoni, N, Mureddu, R, Foglia-Manzillo, G, Mascioli, G, Bartoli, P, Musso, G, Menozzi, C, and Brignole, M

Abstract

To evaluate the effect of chronic vasodilator therapy on susceptibility to vasovagal syncope, 45 patients with syncope and a positive response to tilt testing were randomly assigned to continue or to discontinue vasodilators. The study result demonstrated that chronic vasodilator therapy enhances susceptibility to vasovagal reaction during upright tilt testing. [ABSTRACT FROM AUTHOR]

Published
1997
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15. Optimization of coronary sinus lead placement targeted to right-to-left delay in patients undergoing cardiac resynchronization therapy.

Author

Oddone D, Solari D, Arena G, Mureddu R, Nangah R, Giorgi D, Senatore G, Bottoni N, Giaccardi M, Laffi M, Giammaria M, Sitta N, Marras E, Cipolla E, Di Lorenzo F, Carpi R, and Brignole M

Subjects
Aged, Aged, 80 and over, Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac physiopathology, Disease Progression, Female, Heart Failure diagnosis, Heart Failure physiopathology, Humans, Italy, Male, Middle Aged, Patient Admission, Prospective Studies, Recovery of Function, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Arrhythmias, Cardiac therapy, Cardiac Resynchronization Therapy adverse effects, Cardiac Resynchronization Therapy Devices, Coronary Sinus physiopathology, Heart Failure therapy
Abstract

Aims: Anatomical placement of the coronary sinus (CS) lead in basal or mid-ventricular positions of the posterior and lateral walls is associated with a better clinical outcome of cardiac resynchronization therapy (CRT). We hypothesized that optimization of CS lead placement targeted the right-to-left electrical delay (RLD) predicts an additional clinical benefit., Methods and Results: The CS lead was placed according to current standards in 90 patients (Conventional group) and at the site of the longest RLD in 121 patients (RLD group). Non-responders were defined as those who died or underwent hospitalization for heart failure or did not improve in their Clinical Composite Score within 6 months. There were 67 (32%) non-responders. Compared with Conventional group, the final CS pacing site was more frequently in the basal segments in the RLD group (40% vs. 23%, P = 0.007); moreover, the RLD ratio (%RLD) of the total QRS width was longer (77 ± 13 vs. 73 ± 15, P = 0.05) and biventricular QRS shortened more from the baseline (-31 ± 21 ms vs. -21 ± 26 ms, P = 0.004). Nevertheless, the rate of non-responders was similar in the RLD and Conventional groups (35% vs. 28%, P = 0.30), as was %RLD (76 ± 16 vs. 75 ± 13, P = 0.66). QRS width during right ventricular (RV) pacing was an independent predictors of adverse outcome, with a 2% increase in the risk of failure for each 1 ms increase in QRS (P = 0.006)., Conclusion: Optimization of CS lead placement targeted to latest electrical activation does not provide additional clinical benefit to anatomical placement in basal or mid-ventricular positions of the posterior and lateral walls. QRS width during RV pacing was a strong predictor of CRT failure., Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT03204864., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.)

Published
2019
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16. Optimization of coronary sinus lead placement targeted to the longest right-to-left delay in patients undergoing cardiac resynchronization therapy: The Optimal Pacing SITE 2 (OPSITE 2) acute study and protocol.

Author

Oddone D, Solari D, Nangah R, Arena G, Mureddu R, Giorgi D, Sitta N, Bottoni N, Senatore G, Giaccardi M, Giammaria M, Themistoclakis S, Laffi M, Cipolla E, Di Lorenzo F, Carpi R, and Brignole M

Subjects
Aged, Cardiac Resynchronization Therapy standards, Clinical Protocols, Female, Heart Failure physiopathology, Humans, Male, Prospective Studies, Time Factors, Cardiac Resynchronization Therapy methods, Coronary Sinus, Heart Failure therapy, Heart Ventricles physiopathology
Abstract

Aims: Left ventricular (LV) lead positioning at the site of delayed electrical activation is associated with better response to cardiac resynchronization therapy (CRT). We hypothesized that a long electrical conduction delay between right ventricular (RV) and coronary sinus (CS) leads during RV pacing (RLD index) is correlated with a better clinical outcome METHODS AND RESULTS: RLD is measured intraprocedurally, during RV pacing, as the time interval between the intracardiac electrograms of RV and CS leads. Initially, we did a prove-of-concept, feasibility, acute study in 97 patients who underwent CRT implantation. The CS lead position was assessed in the 40° right anterior oblique and 40° left anterior oblique views and assigned to one of 11 prespecified segments of a schematic eyeball depiction of the LV walls. Acute outcomes were QRS width during biventricular (BIV) pacing. The longest RLD were found in the basal and mid lateral segments; these accounted for 82% and 78%, respectively, of the total QRS width (%RLD). %RLD was inversely correlated with BIV-paced QRS (P  =  0.0001). A similar slope was present either in the 78 patients with preserved atrioventricular (AV) conduction and in the 19 without AV conduction (- 0.34 vs - 0.27, P  =  0.7)., Conclusion: We showed that RLD can be used to guide lead placement at the time of CRT implantation and that it is correlated with BIV-QRS width, an indirect predictor of clinical outcome. Based on these findings we started the prospective, multicenter Optimal Pacing SITE 2 (OPSITE 2) trial with the objective to demonstrate a relationship between RLD and clinical outcomes assessed as death, hospitalization for heart failure, New York Heart Association class, and clinical composite score. The protocol is provided., (© 2017 Wiley Periodicals, Inc.)

Published
2017
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17. Three-Dimensional Electroanatomic Mapping System-Enhanced Cardiac Resynchronization Therapy Device Implantation: Results From a Multicenter Registry.

Author

Del Greco M, Maines M, Marini M, Colella A, Zecchin M, Vitali-Serdoz L, Blandino A, Barbonaglia L, Allocca G, Mureddu R, Marenna B, Rossi P, Vaccari D, Chianca R, Indiani S, DI Matteo I, Angheben C, and Zorzi A

Subjects
Action Potentials, Aged, Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac physiopathology, Case-Control Studies, Coronary Angiography, Feasibility Studies, Female, Fluoroscopy, Heart Failure diagnosis, Heart Failure physiopathology, Heart Rate, Humans, Image Interpretation, Computer-Assisted, Italy, Male, Patient-Specific Modeling, Predictive Value of Tests, Radiography, Interventional, Registries, Signal Processing, Computer-Assisted, Time Factors, Treatment Outcome, Ventricular Function, Left, Arrhythmias, Cardiac therapy, Cardiac Resynchronization Therapy, Cardiac Resynchronization Therapy Devices, Electrophysiologic Techniques, Cardiac, Heart Failure therapy, Imaging, Three-Dimensional, Therapy, Computer-Assisted instrumentation
Abstract

Introduction: Cardiac resynchronization therapy (CRT) device implantation guided by an electroanatomic mapping system (EAMS) is an emerging technique that may reduce fluoroscopy and angiography use and provide information on coronary sinus (CS) electrical activation. We evaluated the outcome of the EAMS-guided CRT implantation technique in a multicenter registry., Methods: During the period 2011-2014 we enrolled 125 patients (80% males, age 74 [71-77] years) who underwent CRT implantation by using the EnSite system to create geometric models of the patient's cardiac chambers, build activation mapping of the CS, and guide leads positioning. Two hundred and fifty patients undergoing traditional CRT implantation served as controls. Success and complication rates, fluoroscopy and total procedure times in the overall study population and according to center experience were collected. Centers that performed ≥10 were defined as highly experienced., Results: Left ventricular lead implantation was successful in 122 (98%) cases and 242 (97%) controls (P = 0.76). Median fluoroscopy time was 4.1 (0.3-10.4) minutes in cases versus 16 (11-26) minutes in controls (P < 0.001). Coronary sinus angiography was performed in 33 (26%) cases and 208 (83%) controls (P < 0.001). Complications occurred in 5 (4%) cases and 17 (7%) controls (P = 0.28). Median fluoroscopy time (median 11 minutes vs. 3 minutes, P < 0.001) and CS angiography rate (55% vs. 21%, P < 0.001) were significantly higher in low experienced centers, while success rate and complications rate were similar., Conclusions: EAMS-guided CRT implantation proved safe and effective in both high- and low-experienced centers and allowed to reduce fluoroscopy use by ≈75% and angiography rate by ≈70%., (© 2016 Wiley Periodicals, Inc.)

Published
2017
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18. Comparison between IEGM-based approach and echocardiography in AV/PV and VV delay optimization in CRT-D recipients (Quicksept study).

Author

Giammaria M, Quirino G, Cecchi E, Senatore G, Pistelli P, Bocchiardo M, Mureddu R, Diotallevi P, Occhetta E, Magnani A, Bensoni M, Checchinato C, Conti V, Badolati S, and Mazza A

Abstract

Background: AtrioVentricular (AV) and InterVentricular (VV) delay optimization can improve ventricular function in Cardiac Resynchronization Therapy (CRT) and is usually performed by means of echocardiography. St Jude Medical has developed an automated algorhythm which calculates the optimal AV and VV delays (QuickOpt™) based on Intracardiac ElectroGrams, (IEGM), within 2 min. So far, the efficacy of the algorhythm has been tested acutely with standard lead position at right ventricular (RV) apex. Aim of this project is to evaluate the algorhythm performance in the mid- and long-term with RV lead located in mid-septum., Methods: AV and VV delays optimization data were collected in 13 centers using both echocardiographic and QuickOpt™ guidance in CRTD implanted patients provided with this algorhythm. Measurements of the aortic Velocity Time Integral (aVTI) were performed with both methods in a random order at pre-discharge, 6-month and 12-month follow-up., Results: Fifty-three patients were studied (46 males; age 68 ± 10y; EF 28 ± 7%). Maximum aVTI obtained by echocardiography at different AV delays, were compared with aVTI acquired at AV delays suggested by QuickOpt. The AV Pearson correlations were 0.96 at pre-discharge, 0.95 and 0,98 at 6- and 12- month follow-up respectively. After programming optimal AV, the same approach was used to compare echocardiographic aVTI with aVTI corresponding to the VV values provided by QuickOpt. The VV Pearson Correlation were 0,92 at pre-discharge, 0,88 and 0.90 at 6-month and 12- month follow-up respectively., Conclusions: IEGM-based optimization provides comparable results with echocardiographic method (maximum aVTI) used as reference with mid-septum RV lead location., (Copyright © 2016 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.)

Published
2016
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19. Head-up tilt testing potentiated with oral nitroglycerin: a randomized trial of the contribution of a drug-free phase and a nitroglycerin phase in the diagnosis of neurally mediated syncope.

Author

Bartoletti A, Gaggioli G, Menozzi C, Bottoni N, Del Rosso A, Mureddu R, Musso G, Foglia-Manzillo G, Bonfigli B, and Brignole M

Subjects
Administration, Oral, Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Nitroglycerin administration & dosage, Syncope, Vasovagal diagnosis, Tilt-Table Test
Abstract

Background: Since the pharmacological challenge with nitroglycerin (NTG) follows the initial drug-free phase in current tilt testing protocols, the effects of nitroglycerin alone and the appropriate duration of the basal phase are unknown., Methods: To optimize the test, a randomized intra-patient comparison of two protocols was undertaken: a conventional nitroglycerin test (cHUT) consisting of passive upright posture at 60 degrees for 45 min followed, if negative, by sublingual NTG 0.4 mg spray, with the test continued for 20 min; and, accelerated nitroglycerin test (aHUT) consisting of passive upright posture at 60 degrees for 5 min--to rule out orthostatic hypotension--followed by sublingual NTG 0.4 mg spray, with the test continued for 20 min. Eighty-four consecutive patients (33 males; mean age 55+/-22) with unexplained syncope underwent both cHUT and aHUT in a randomized sequence with a 24-72 h interval between them. Additionally, 25 age-matched control subjects underwent aHUT., Results: In the drug-free phase, cHUT was positive in 15/84 patients (18%) and aHUT in 1/84 patients (1%). After NTG, cHUT and aHUT showed the same positivity rate of 33% (28/84 patients). The overall positivity rate was therefore higher with cHUT than with aHUT (51% vs 35%, P=0.04). Times to syncope were 29+/-12 min, (range 2-44) for cHUT drug-free phase, 5+/-2 min (range 2-9) for cHUT NTG phase, and 5+/-2 min (range 2-9) for aHUT. Only one (4%) of the control subjects had a positive response to aHUT., Conclusions: The contribution of NTG to the diagnosis is independent of the presence of an unmedicated phase. The appropriate duration of the NTG phase is 10 min. aHUT has good specificity, but a positivity rate lower than cHUT; thus a drug-free phase is necessary to increase the sensitivity of the test.

Published
1999
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20. Assessment of atrioventricular junction ablation and VVIR pacemaker versus pharmacological treatment in patients with heart failure and chronic atrial fibrillation: a randomized, controlled study.

Author

Brignole M, Menozzi C, Gianfranchi L, Musso G, Mureddu R, Bottoni N, and Lolli G

Subjects
Aged, Anti-Arrhythmia Agents classification, Atrial Fibrillation complications, Atrial Fibrillation drug therapy, Atrial Fibrillation surgery, Chest Pain, Dyspnea prevention & control, Electrocardiography, Ambulatory, Exercise Tolerance, Female, Heart Failure complications, Heart Failure drug therapy, Heart Failure surgery, Heart Rate, Humans, Male, Patient Selection, Quality of Life, Anti-Arrhythmia Agents therapeutic use, Atrial Fibrillation therapy, Atrioventricular Node surgery, Catheter Ablation, Heart Failure therapy, Pacemaker, Artificial
Abstract

Background: Uncontrolled studies have suggested that atrioventricular junction ablation and pacemaker implantation have beneficial effects on quality of life in patients with chronic atrial fibrillation (AF)., Methods and Results: We performed a multicenter, controlled, randomized, 12-month evaluation of the clinical effects of atrioventricular junction ablation and VVIR pacemaker (Abl+Pm) versus pharmacological (drug) treatment in 66 patients with chronic (lasting >6 months) AF who had clinically manifest heart failure and heart rate >90 bpm on 3 standard ECGs recorded at rest during stable clinical conditions on different days. Before completion of the study, withdrawals occurred in 8 patients of the drug group and in 4 patients of the Abl+Pm group. At the end of the 12 months, the 28 Abl+Pm patients who completed the study showed lower scores in palpitations (-78%; P=0.000) and effort dyspnea (-22%; P=0.05) than the 26 of the drug group. Lower scores, although not significant, were also observed for exercise intolerance (-20%), easy fatigue (-17%), chest discomfort (-50%), Living with Heart Failure Questionnaire (-14%), New York Heart Association functional classification (-4%), and Activity scale (-12%). The intrapatient comparison between enrollment and month 12 showed that in the Abl+Pm group, all variables except easy fatigue improved significantly from 14% to 82%. However, because an improvement was also observed in the drug group, the difference between the 2 groups was significant only for palpitations (P=0.000), effort dyspnea (P=0.01), exercise intolerance (P=0.005), easy fatigue (P=0.02), and chest discomfort (P=0.02). Cardiac performance, evaluated by means of standard echocardiogram and exercise test, did not differ significantly between the 2 groups and remained stable over time., Conclusions: In patients with heart failure and chronic AF, Abl+Pm treatment is effective and superior to drug therapy in controlling symptoms, although its efficacy appears to be less than that observed in uncontrolled studies because some improvement can also be expected in medically treated patients. Cardiac performance is not modified by the treatment.

Published
1998
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21. Effects of long-term vasodilator therapy in patients with carotid sinus hypersensitivity.

Author

Brignole M, Menozzi C, Gaggioli G, Musso G, Foglia-Manzillo G, Mascioli G, Fradella G, Bottoni N, and Mureddu R

Subjects
Aged, Aged, 80 and over, Blood Pressure drug effects, Female, Heart Arrest chemically induced, Homeostasis drug effects, Humans, Long-Term Care, Male, Massage, Middle Aged, Reflex, Abnormal drug effects, Risk Factors, Syndrome, Vasodilator Agents administration & dosage, Venous Pressure drug effects, Carotid Sinus innervation, Pressoreceptors drug effects, Syncope chemically induced, Vasodilator Agents adverse effects
Abstract

Background: In patients affected by carotid sinus hypersensitivity, long-term vasodilator therapy might increase the risk of syncopal episodes by reducing systolic blood pressure and venous return to the heart., Methods and Results: Thirty-two patients (mean age 73 +/- 9 years; 20 men) who met all the following criteria were included: (1) one or more episodes of syncope occurring during long-term (>6 months) treatment with angiotensin-converting enzyme inhibitors, long-acting nitrates, calcium antagonists, or a combination of these; (2) a positive response to carotid sinus massage, defined as the reproduction of spontaneous syncope in the presence of ventricular asystole > or =3 seconds or a fall in systolic blood pressure > or =50 mm Hg; (3) negative workup for other causes of syncope. The patients were randomly assigned to continue or to discontinue use of vasodilators; carotid sinus massage was repeated 2 weeks after randomization. By the end of the study period, the baseline values of systolic blood pressure were significantly different between the 2 groups of patients both in supine (P=.01) and upright (P=.03) positions. Syncope had been induced by carotid sinus massage in 81% of patients in the "on-vasodilator" group and in 62% of patients in the "off-vasodilator" group (P=.21). The cardioinhibitory reflex was of similar magnitude in the 2 groups, being found in 50% of the patients in each group, with a maximum ventricular pause of 7.1 +/- 2.7 and 6.7 +/- 1.8 seconds, respectively. The percentage decrease of blood pressure did not differ between the 2 groups, even if, in absolute values, the baseline difference of blood pressure roughly persisted for the duration of the test. In consequence of that, the rise of blood pressure to similar values was delayed approximately 30 seconds in the "on-vasodilator" group and took more than 2 minutes to return to baseline values., Conclusions: In patients affected by carotid sinus hypersensitivity, chronic vasodilator therapy does not have a direct effect on carotid sinus reflexivity, although the delayed recovery of pretest blood pressure values could indirectly potentiate the severity of the clinical manifestations of the syndrome. The persistence of hypotension for a longer time after the end of the massage suggests that vasodilators cause an impairment of compensatory mechanisms.

Published
1998
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22. Value of head-up tilt testing potentiated with sublingual nitroglycerin to assess the origin of unexplained syncope.

Author

Raviele A, Menozzi C, Brignole M, Gasparini G, Alboni P, Musso G, Lolli G, Oddone D, Dinelli M, and Mureddu R

Subjects
Administration, Sublingual, Adolescent, Adult, Aged, Aged, 80 and over, Blood Pressure, Child, Evaluation Studies as Topic, Female, Heart Rate, Humans, Male, Middle Aged, Sensitivity and Specificity, Syncope physiopathology, Vagus Nerve physiopathology, Nitroglycerin, Syncope etiology, Tilt-Table Test methods
Abstract

This study was undertaken to assess the value of sublingual nitroglycerin administration during upright tilt as a simple practical test for the diagnosis of vasovagal syncope. To this purpose, 235 patients with syncope of unknown origin and no evidence of organic heart disease (110 men, mean age 52 +/- 20 years) and 35 asymptomatic control subjects underwent head-up tilt testing with nitroglycerin challenge. Patients and subjects were tilted at 60 degrees for 45 + 20 minutes; the initial 45 minutes were without medication and the final 20 minutes after 300 micrograms of sublingual nitroglycerin. During the drug-free phase of the test, 59 patients (25%) and no controls had a positive response. After drug administration, a positive response (syncope in association with sudden hypotension and bradycardia) occurred in 60 patients (26%) and in 2 controls (6%), whereas an exaggerated or false-positive response (minor or different symptoms in association with slowly increasing hypotension alone) was observed in 33 patients (14%) and in 5 controls (14%). We conclude that the sublingual nitroglycerin head-up tilt test is a useful tool to unmask the vasovagal origin of unexplained syncope in patients without organic heart disease. The addition of nitroglycerin to upright tilt allows the positive rate of passive tilting to be doubled (51% vs 25%) while maintaining a high specificity (94% vs 100%).

Published
1995
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23. [A case of leishmaniasis in intensive care].

Author

Pastorelli M, Salvi G, Vilianis G, Musso G, Mureddu R, and Verda F

Subjects
Aged, Critical Care, Humans, Male, Leishmaniasis diagnosis
Abstract

A case is presented of severe visceral leishmaniasis initially misdiagnosed owing to the old age of the patient and the contemporary presence of a carcinoma of the sigmoid. Admitted in ICU for severe post operative cardiorespiratory failure. During ICU stay the patients presented a bilateral pneumothorax and a long QT syndrome, presumably due to antimonials.

Published
1994

24. [Ventricular pre-excitation disclosed by an episode of high-frequency atrial fibrillation: the role of frequency-dependent variations in the bundle of Kent conduction].

Author

Paparella N, Mureddu R, Musso G, and De Thomatis M

Subjects
Atrial Fibrillation complications, Electrocardiography, Humans, Middle Aged, Pre-Excitation Syndromes complications, Atrial Fibrillation physiopathology, Heart Conduction System physiopathology, Pre-Excitation Syndromes physiopathology
Abstract

The presence of a ventricular pre-excitation, which becomes evident only during episodes of atrial fibrillation, is a very rare event. The authors report a case of ventricular pre-excitation revealed by an access of atrial fibrillation with high ventricular frequency and hemodynamic failure. The ventricular pre-excitation signs were not evident after the sinus rythm had been restored. The electrophysiological study has shown that such behaviour is not related to a different input of the stimulus in the bypass tract during the passage from the sinus rhythm to the atrial fibrillation, as other authors have recently suggested, but to rate-dependent variations of the conduction in the Kent bundle: in the bypass either a phase-4 block of the conduction is present, or a supernormal conduction.

Published
1991

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