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1. P101 HIGH–DENSITY MAPPING OF KOCH‘S TRIANGLE DURING SINUS RHYTHM AND TYPICAL AV NODAL REENTRANT TACHYCARDIA INTEGRATED WITH THE DIRECT RECORDING OF ATRIOVENTRICULAR NODE STRUCTURES POTENTIAL: A MULTICENTER NON–RANDOMIZED STUDY

Author

A Matteucci, M Russo, M Galeazzi, G Botto, A Castro, G Zingarini, G Del Giorno, A Papa, N Di Belardino, L Segreti, P Pepi, M Casale, S Treglia, D Nicolis, A Carbone, C Lavalle, M Malacrida, C Pandozi, and F Colivicchi

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background Atrioventricular nodal re–entrant tachycardia (AVNRT) is humans‘ most frequent regular tachycardia. Nevertheless, understanding the exact mechanism and pathways involved in the circuit that sustains the arrhythmia is still incomplete. Also, the recording of nodal potential was performed previously in animals with relative success, but not in humans. The aim of our study is to identify the potential of the compact atrioventricular node (AVN) and inferior extensions by using an electroanatomic mapping of the right atrium and the Koch‘s triangle in sinus rhythm and during AVNRT. Methods From March 2021 to July 2022, 79 patients with AVNRT underwent high–resolution mapping and complete ablation in 12 Italian Hospitals. No patients with atrial fibrillation or sustained ventricular tachycardia were included. The diagnosis of AVNRT was established according to standard criteria and diagnostic pacing manoeuvres. The presence and location of SP potentials, i.e., Jackman potential (JP) and Haïssaguerre potential (HP) were evaluated in each patient. The electroanatomic mapping obtained were merged with cardiac computerized tomography (CT) scan. Results Forty–five cases of successful AVNRT ablation were included in the analysis. The AVN potential has been demonstrated to be a very low frequency signal distinct from atrial, His bundle or ventricular activations, that can be recorded from electrodes overlying the region of the compact AVN by using a non–conventional bipolar electrogram filtering both during sinus rhythm and slow fast AVNRT. AVN potential was identified in all cases in the mid–septal region (#5) in both sinus rhythm and tachycardia. The mid–septal region and the postero–septal regions (#7) bounded anteriorly by the tricuspid annulus and posteriorly by the lateral wall toward the crista terminalis showed a higher prevalence of HP than other regions (46.7% in region #5 and 51.1% in region #7, p Conclusion The exact anatomical site and pathways involved in AVNRT are still unclear as well as the analysis and characterisation of the AVN potential. Our results represent the first evidence of the recording of AVN potential. Further studies and technological improvements are needed to confirm our results.

Published
2023

2. P102 DIFFERENCES IN HIGH–DENSITY MAPPING OF KOCH‘S TRIANGLE DURING TYPICAL AV NODAL REENTRANT TACHYCARDIA INTEGRATED AND NOT INTEGRATED WITH DIRECT RECORDING OF ATRIOVENTRICULAR NODE STRUCTURES POTENTIAL: A MULTICENTER NON–RANDOMIZED STUDY

Author

A Matteucci, M Galeazzi, M Russo, G Botto, A Castro, G Zingarini, G Del Giorno, A Papa, N Di Belardino, L Segreti, P Pepi, D Nicolis, A Carbone, C Lavalle, M Casale, S Treglia, M Malacrida, C Pandozi, and F Colivicchi

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background Despite the sustained efforts and advances in the fields of anatomy, histology, immunohistochemistry and cardiac mapping, the definition of the AVNRT circuit in humans is still incomplete. This discouraging result can be explained by many reasons, but the most important one has been the impossibility to map the AVNRT circuit without recording the electrical activity of the AVN and its extensions, which represent the diastolic interval in the tachycardia cycle. The aim of this study was to compare high density activation mapping integrated and not integrated with AV node potential recordings to establish the importance of annotation of AV nodal structure electrical activity in defining Koch’s triangle activation during AVNRT. Methods Electroanatomic 3–D reconstruction and propagation automated mapping of atrial activation during both sinus rhythm and tachycardia was performed using a basket catheter (64 electrodes of 0.4–mm2 area; 2.5–mm spacing, Orion, Boston Scientific, Natick, MA) and the Rhythmia electroanatomic mapping system in group 1 patients (X). In group 2 patients (45) the AV node potential (a very low frequency signal distinct from atrial, His bundle or ventricular activations, recorded from electrodes overlying the region of the compact AV node and its extensions by using a non–conventional bipolar electrogram filtering of [0.05/1 – 250] Hz) were also recorded both during slow fast AVNRT. Results The integrated map showed that during AVNRT, the activation wavefront descends from the Tendon of Todaro region (fast pathway area) and rises along the septal leaflet of the tricuspid valve through the RINE and reaches the AV bundle probably via the LNB bypassing the compact AV node almost completely. This kind of activation of the Koch’s triangle was not reconstructed by the non–integrated map. Moreover, the recording of the potentials of the AV node structures makes it possible to obtain a 100% coverage of the tachycardia cycle which was only 32% in the non–integrated maps (p < 0.0001). Conclusion The recording of the electrical activity of AV nodal structures allows a better definition of the circuit of typical slow–fast AVNRT which, in the majority of the cases, is completely localised in the right atrium.

Published
2023

3. High-definition electro-anatomical mapping of Koch’s Triangle including AV node potentials recordings in consecutive AVNRT patients

Author

C Pandozi, GL Botto, G Del Giorno, AA Papa, A Castro, N Di Belardino, S Viani, M Russo, F Brasca, A Carbone, M Galeazzi, MC Casale, S Treglia, M Malacrida, and F Colivicchi

Subjects
Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract

Funding Acknowledgements Type of funding sources: None. Background Activation mapping of Koch’s Triangle, even when coupled with high density mapping, is incomplete without recordings of AV nodal electrical activity. Purpose To identify, through a highly specific methodology and high-density electro-anatomical mapping (HDM), the slow AVN potential (AVNP) and the precise activation modality of Koch’s Triangle in SR in atrio-ventricular nodal reentrant tachycardia (AVNRT) patients. Method The 3D KT geometry was created from the Orion mapping and the Rhythmia Mapping System. KT was divided into 8 distinct regions moving from an antero-septal to postero-septal areas and bounded by tricuspid annulus (TA) anteriorly and tendon of Todaro posteriorly. AV nodal potential activity was recorded by non-standard bipolar electrogram filtering at 0.50–300 Hz. The AVNP was defined as a slow frequency potential between atrial and ventricular EGM similar to that reported by Scherlag and Jackman, and it was confirmed by high frequency atrial pacing. The AVNP was annotated at the end of electrogram when it was followed in the same recording by a sharp potential; otherwise it was annotated at the center. Data are reported as mean±SD. Results Twenty successful SP ablation cases of typical AVNRT from 7 centers were included. RA acquired points during SR were 2512±1400 (123±67 acquired inside the KT, KT area of 41±64 mm2). The time of a complete RA mapping was 19.2±8 min. The AVNP was detected in all cases (n=20, 100%). At the mid-region of the KT, AVNP was identified in 20 (100%) cases; at postero-septal regions bounded anteriorly by the TA and posteriorly by the lateral wall toward the crista terminalis AVN was present in 17 (85%) cases; at mid-postero-septal regions AVN was detected in 15 (75%) cases. In all patients, the first activation in the KT was recorded in the antero-septal region at the expected site of the fast pathway; then the wavefront spread in two directions: anteriorly toward the His-bundle and posteriorly toward the base of KT colliding with the wavefront coming from the opposite direction through the slow pathway. In all patients, abolition of the SP and acute procedural success was achieved in the first procedure with 5.4±3 RF ablations. In 30 out 35 (86%) ablation sites, ablations were done at sites with concurrent detectable AVNP. No complications occurred. Conclusions High-density mapping using a non-standard bipolar electrograms filtering at 0.50–300 Hz showed multiple electrograms in SR including low frequency potential that may represent the electrical activity of compact node and inferior extensions.

Published
2022

4. Minimal fluoroscopic approaches and factors associated with radiation dose when high-definition mapping is used for supraventricular tachycardia ablation: insight from the CHARISMA registry

Author

N Di Belardino, Domenico Pecora, Francesco Solimene, Agostino Piro, A Di Cori, Stefano Pedretti, C La Greca, Luca Rossi, Roberto Mantovan, Marco Scaglione, P. Rossi, Filippo Maria Cauti, G Tola, Stefano Bianchi, and Marco Anselmino

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Radiation dose, Cardiac arrhythmia, medicine.disease, Ablation, Recurrence risk, Physiology (medical), High definition, Medicine, Fluoroscopy, Supraventricular tachycardia, Radiology, Cardiology and Cardiovascular Medicine, business, Adverse effect
Abstract

Funding Acknowledgements Type of funding sources: None. Background Limited data exist on factors associated with radiation exposure during ablation procedures when a high definition mapping technology is used. Purpose To report factors associated with radiation exposure and data on feasibility and safety of a minimal fluoroscopic approach using the Rhythmia mapping system in supraventricular tachycardia (SVT) ablation procedures. Methods Consecutive patients indicated for arrhythmia ablation were enrolled in the CHARISMA study at 12 centers. We included in this analysis consecutive right-side procedures performed through a minimal fluoroscopy approach with the Rhythmia mapping system were analyzed. A 3D geometry of chambers of interest was reconstructed on the basis of the electroanatomic information taken from the mapping system. Fluoroscopy was used only if deemed necessary. The effective dose (ED) was calculated using accepted formula. For our purpose high dose exposure was defined as an ED greater than the median value of ED of the population exposed to radiation. Results This analysis included 325 patients (mean age = 56 ± 17 years, 57% male) undergoing SVT procedures (152 AVNRT, 116 AFL, 41 AP and 16 AT). During the study, 27481 seconds of fluoroscopy was used (84.6 ± 224 seconds per procedure), resulting in a mean equivalent ED of 1.1 ± 3.7 mSv per patient. The mean reconstructed RA volume was 99 ± 54 ml in a mean mapping time of 12.2 ± 7 min. The mean number of radiofrequency ablations (RFC) to terminate each arrhythmia was 9.4 ± 9 (mean RFC delivery time equal to 6.7 ± 6 min). 192 procedures (59.1%) were completed without any use of fluoroscopy; during the remaining 133 procedures (39.9%), 206.6 ± 313.4 seconds of fluoroscopy was used (median ED = 1.2 mSv). In a minority of the cases (n = 25, 7.7%) the fluoroscopy time was higher than 5 minutes (median ED = 6.5 mSv), whereas radiologic exposure time greater than 1 minute occurred in ninety cases (27.7%, median ED = 2.1 mSv). On multivariate logistic analysis adjusted for baseline confounders the RFC application time (OR = 1.0014, 95%CI: 1.0007 to 1.0022; p = 0.0001) was independently associated to an ED greater than 1.2 mSv, whereas female gender had an inverse association (0.54, 0.29 to 0.98; p = 0.0435). Acute success was reached in 97.8% of the cases. During a mean of 290.7 ± 169.6 days follow-up, no major adverse events related to the procedure were reported. Overall, the recurrence rate of the primary arrhythmia during follow-up was 2.5%. Conclusions In our experience, arrhythmias ablation through minimal fluoroscopy approach with the use of a novel ablation technology is safe, feasible, and effective in common right atrial arrhythmias. High-dose exposure occurred in a very limited number of cases, without any reduction of the safety and acute and long-term effectiveness profile.

Published
2021

5. Minimal fluoroscopy approach in current clinical practice with a novel ablation technology for supraventricular tachycardia: a large multicenter experience from an Italian registry

Author

Stefano Pedretti, G Tola, Luigi Iaia, Domenico Pecora, Marco Scaglione, Agostino Piro, N Di Belardino, Francesco Solimene, Roberto Mantovan, Stefano Bianchi, A Di Cori, Filippo Maria Cauti, Luca Rossi, Pietro Rossi, and Marco Anselmino

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Cardiac arrhythmia, medicine.disease, Ablation, Clinical Practice, Medicine, Fluoroscopy, Supraventricular tachycardia, Radiology, Cardiology and Cardiovascular Medicine, business
Abstract

Background Electrophysiological studies and ablation procedures expose both physicians and patients to a large amount of radiation. Most of 3-D mapping systems provide improved tracking of catheters, possibly allowing relevant reductions in radiation exposure. No data exists on the ability of the Rhythmia mapping system to minimize fluoroscopy time and dose. Purpose To report preliminary data on feasibility and safety of a minimal fluoroscopic approach using the Rhythmia mapping system in supraventricular tachycardia (SVT) procedures. Methods Consecutive patients indicated for arrhythmia ablation were enrolled in the CHARISMA study at 12 centers. For our purpose consecutive right-side procedures performed through a minimal fluoroscopy approach with the Rhythmia mapping system were analyzed. A 3D geometry of chambers of interest was reconstructed on the basis of the electroanatomic information taken from the mapping system. Fluoroscopy was used only if deemed necessary. Results This analysis included 266 patients (mean age = 57±17 years, 57% male) undergoing SVT procedures (120 AVNRT, 91 AFL, 32 AP, 11 AT and 12 other right atrial procedures). In all cases, diagnostic EP and ablation catheters were positioned using a low fluoroscopic electroanatomic guided approach. The mean fluoroscopy time needed for each procedure was 55±128 s. The median reconstructed RA volume was 92 [63–131] ml in a median mapping time of 11 [7–17] min. The median number of radiofrequency ablations to terminate each arrhythmia was 6 [3–12] (total RF delivery time of 291 [180–505] s). Sixty-five percent of the procedures (n=174) were completed with less than 10 s of fluoroscopy. Low fluoroscopy approach with less than 10 s (minimal fluoroscopy approach) was most frequently obtained in case of AVNRT (91, 76%) compared to other arrhythmias' ablation (83, 57%, p=0.001) Achievement of a minimal fluoroscopic approach was not affected by operator's experience (65% vs 66%, p=1.00, respectively within physician with more or less of 10 years of active practice), whereas it was affected by presence of a fellow in training during the procedure (72% without fellow vs 26% with fellow, p Conclusions In our preliminary experience, arrhythmias' ablation through minimal fluoroscopy approach with the use of a novel ablation technology seems to be safe, feasible, and effective in common right atrial arrhythmias. Use of fluoroscopy can be dramatically reduced in most cases, without any reduction of the safety and acute effectiveness profile. Funding Acknowledgement Type of funding source: None

Published
2020

6. P1452Low fluoroscopy approach with a novel ablation technology in right side procedures: a large multicenter experience from the CHARISMA registry

Author

Stefano Bianchi, Roberto Mantovan, Stefano Pedretti, Marco Scaglione, Francesco Solimene, A Di Cori, Luca Rossi, Pietro Rossi, Luigi Iaia, Domenico Pecora, G Tola, Marco Anselmino, Agostino Piro, Filippo Maria Cauti, and N Di Belardino

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Cardiac arrhythmia, Ablation, medicine.disease, Radiation exposure, medicine.anatomical_structure, Physiology (medical), medicine, Fluoroscopy, Radiology, Supraventricular tachycardia, Atrium (heart), Cardiology and Cardiovascular Medicine, business
Abstract

Funding Acknowledgements NO FUNDING Background Electrophysiological studies and ablation procedures expose both physicians and patients to a significant amount of radiation. Nowadays, most of 3-D mapping systems allow for improved tracking of catheters with possible reduction in radiation exposure. No data exists on the ability to minimize fluoroscopy time and dose while using the Rhythmia mapping system. Purpose To report preliminary data on feasibility and safety of a low fluoroscopic approach using the Rhythmia mapping system in SVT procedures. Methods The CHARISMA study is a non-randomized, multicenter, prospective study in which consecutive patients indicated for arrhythmia were enrolled. For our purpose consecutive right-side procedures performed through a low fluoroscopy approach with the Rhythmia mapping system were analyzed. The mapping system was used to create the 3D geometry of chambers of interest and anatomic reference points and to visualize the catheters from the beginning to the end of the procedure. Fluoroscopy was used only if deemed necessary. Results 204 unselected consecutive cases of SVT from 11 centers were included in the study (mean age = 55 ± 18 years, 53% male, 85 AVNRT, 75 AFL, 28 AP, 9 AT and 7 other right atrial procedures). In all the cases, diagnostic EP and ablation catheters were positioned using only the low fluoroscopic guided mapping approach. During the study, a total of 7157 s of fluoroscopy was needed in 204 patients (51 ± 137 s per procedure). One hundred fourty-one procedures (69%) were completed with less than 10 seconds of fluoroscopy, whereas in 169 (83%) of the cases the fluoroscopy time was lower than 60 seconds. Low fluoroscopy approach with less than 10 seconds was less frequently obtained in case of AFL (46, 61.3%) compared to AVNRT ablation (65, 76.5%, p = 0.041) whereas no differences were found comparing with AP (21, 75%, p = 0.248). The median reconstructed RA volume was 94[65-133] ml in a median mapping time of 11 [6-16] min. The median number of radiofrequency ablations to terminate each arrhythmia was 5 [3-12] (total RF delivery time of 293 [180-505] sec). A 100% rate of acute success was observed in our case series. No complications occurred. Conclusions In our preliminary experience, arrhythmias ablation through low fluoroscopy approach and the use of a novel ablation technology seems to be safe, feasible, and effective in common right atrial arrhythmias. Use of fluoroscopy can be nearly avoided in most cases, without any reduction of the safety and effectiveness profile.

Published
2020

7. P529Efficacy and safety of S-ICD implantation without use of defibrillation threshold testing: a retrospective multicentric observational study

Author

Giovanni B. Forleo, Francesco Picarelli, S Picarelli, Luca Santini, Antonio Creta, L Aurino, Carlo Lavalle, F A Gioia, Vito Calabrese, Danilo Ricciardi, Francesco Grigioni, Antonio Bisignani, Giovanni Bisignani, Carlo Pignalberi, and N Di Belardino

Subjects
inorganic chemicals, Defibrillation threshold, medicine.medical_specialty, business.industry, Physiology (medical), Emergency medicine, medicine, Observational study, Cardiology and Cardiovascular Medicine, business, Icd implantation
Abstract

Introduction The subcutaneous ICD (S-ICD) is a valid alternative to transvenous systems (TV-ICD) for the treatment of life-threatening arrhythmias, and the extravascular position of the lead allows a significant reduction of the risk of infection. Current guidelines recommend defibrillation threshold testing (DFT) at the time of S-ICD implantation (class I). Although randomised trials have proven the safety of TV-ICD implantation with no DFT, it is unclear whether such an approach could be adopted for S-ICD as well. The PRAETORIAN score, based on post-implantation chest X-ray, can accurately predict a high defibrillation threshold after S-ICD implantation. The aim of this retrospective multicentre study was to evaluate the efficacy and safety of S-ICD implantation with no DFT. Methods We enrolled 203 consecutive patients undergoing S-ICD implantation in six different centres between October 2012 and January 2019. It was left at discretion of the operator whether performing or not DFT at the time of the procedure. Baseline device settings were collected, and the PRAETORIAN score was retrospectively calculated whenever chest X-ray was available. Both remote or in-clinic device interrogation reports were systemically analysed, and all the shocks and arrhythmia episodes identified. All the patients provided consent form and ethical approval was obtained. Results The population (mean age 57.6 ± 14.2) was divided in two groups, based on whether DFT was performed at the time of the S-ICD implantation: 72 patients (35.4%) underwent DFT (DFT+ group), while 131 patients (64.5%) did not (DFT- group). In the DFT- group, mean LVEF was lower (32 ± 8% vs 42 ± 17%, p Conclusions This study suggests that implantation of S-ICD with no DFT might be reasonable. These results should be confirmed in prospective randomised trials.

Published
2020

8. P454Validation of a new LVH ECG criterion in a single center wide population

Author

Antonio Nenna, A Venditti, G Migliaro, Giampaolo Vetta, Fabio Mangiacapra, N Di Belardino, Laura Ragni, Danilo Ricciardi, M Urbano, Vito Calabrese, G. Di Sciascio, Rosetta Melfi, F Vetta, and Francesco Picarelli

Subjects
education.field_of_study, medicine.medical_specialty, business.industry, Population, Single Center, Left ventricular hypertrophy, medicine.disease, Physiology (medical), Internal medicine, Cardiology, Medicine, Cardiology and Cardiovascular Medicine, business, education
Published
2018

9. A38-1 Far field R wave oversensing in dual chamber pacemakers designed for atrial arrhythmia management: Effect of pacing site and lead tip to ring distance

Author

Alessandro Capucci, Stefano Favale, G.M. Campoleoni, Giuseppe Vergara, Massimo Santini, Gaetano Senatore, Michele Massimo Gulizia, Andrea Grammatico, N Di Belardino, and Luigi Padeletti

Subjects
business.industry, Near and far field, Ring (chemistry), Dual (category theory), law.invention, QRS complex, Optics, law, Physiology (medical), Artificial cardiac pacemaker, Medicine, Cardiology and Cardiovascular Medicine, business, Lead (electronics)
Published
2003

10. A31-1 Analysis of atrial tachyarrhythmia organization patterns and implications for the efficacy of a DDDRP pacemaker

Author

G.L. Botto, G Boriani, Marco Vimercati, Marcello Disertori, Massimo Santini, L. Zamparelli, T. De Santo, Luigi Padeletti, N Di Belardino, and Francesco Solimene

Subjects
medicine.medical_specialty, law, business.industry, Physiology (medical), Internal medicine, Cardiology, medicine, Artificial cardiac pacemaker, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Atrial tachycardia, law.invention
Published
2003

11. Novel cryoballoon technology for atrial fibrillation ablation: Impact of pulmonary vein variant anatomy, cooling characteristics, and 1-year outcome from the CHARISMA registry.

Author

Schiavone M, Bianchi S, Malacrida M, Fassini G, Ricciolino R, Pecora D, Pelargonio G, Iacopino S, Ducceschi V, Maggio R, Bianchini L, La Greca C, Rossi P, Bencardino G, Moltrasio M, Di Belardino N, Pepi P, Rossi L, Santagostino M, Tondo C, and De Simone A

Abstract

Background: No data have been reported on cooling characteristics and the impact of variant pulmonary vein (PV) anatomy on atrial fibrillation (AF) recurrences after POLARx cryoballoon (CB) ablation., Objective: The purpose of this study was to analyze the impact of PV anatomy variants and cooling characteristics after CB ablation from a large multicenter prospective registry., Methods: The primary end point was defined as 1-year absence of any atrial tachyarrhythmias (ATAs: AF/atrial flutter/atrial tachycardia). Correlation between ATA recurrences and anatomy variants/cooling characteristics were evaluated. The secondary outcome was the rate of major periprocedural complications., Results: A total of 429 consecutive patients diagnosed with paroxysmal AF (83.4%) or persistent AF (peAF; 16.6%) were enrolled. Twenty-eight patients (6.6%) exhibited an anatomical variant (common ostium: 4.0%; adjunctive PV: 2.6%). Nadir temperature, thaw time, and total deflation time were different between standard PVs and PV variants. After the blanking period, over a mean of 431 ± 99 days of follow-up, 63 patients (14.7%) suffered an ATA recurrence. Patients with recurrences had both a shorter thaw time (18.5 ± 7 seconds vs 19.8 ± 7 seconds; P = .0012) and a shorter total deflation time, whereas time to isolation was longer (57.4 ± 42 seconds vs 49.1 ± 33 seconds; P = .04). Patients with anatomy variants showed a similar ATA recurrence rate (5 of 28 [17.9%]) to the standard PV anatomy group (58 of 401 [14.5%]) (P = .584), with a hazard ratio (HR) of 1.43 (95% confidence interval [CI] 0.49-4.13; log-rank, P = .4384). After adjusting for confounders, heart failure (HR 4.12; 95% CI 1.75-9.73; P = .0013) and peAF (HR 1.81; 95% CI 1.03-3.18; P = .0433) remained associated with ATA recurrence during follow-up., Conclusion: The POLARx CB system demonstrated long-term efficacy, along with a safe profile, in both patients with paroxysmal AF and those with peAF, regardless of the presence PV variants. Time to isolation was longer in patients with ATA recurrences during follow-up., Clinical Trial Registration: Catheter Ablation of Arrhythmias with a High-Density Mapping System in Real-World Practice (CHARISMA)., Clinicaltrials: gov identifier: NCT03793998. Registration date: January 4, 2019., Competing Interests: Disclosures Mr Malacrida is a salaried employee of Boston Scientific. Dr Tondo is a member of the Boston Scientific advisory board. The other authors have no conflicts of interest to declare., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Published
2024
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12. [New Treatment Strategies in Patients with Heart Failure with Reduced Ejection Fraction: Beyond Neurohormonal Inhibition].

Author

Di Lullo L, Galderisi C, Lavalle C, Palombi M, De Pascalis A, Di Belardino N, Iannotti S, Barbera V, and Bellasi A

Subjects
Humans, Disease Progression, Practice Guidelines as Topic, Neurotransmitter Agents therapeutic use, Heart Failure drug therapy, Heart Failure physiopathology, Stroke Volume
Abstract

Patients affected by heart failure (HF) with reduced ejection fraction (HFrEF) are prone to experience episodes of worsening symptoms and signs despite continued therapy, termed "worsening heart failure" (WHF). Although guideline-directed medical therapy is well established, worsening of chronic heart failure accounts for almost 50% of all hospital admissions for HF with consequent higher risk of death and hospitalization than patients with "stable" HF. New drugs are emerging as cornerstones to reduce residual risk of both cardiovascular mortality and readmission for heart failure. The following review will debate about emerging definition of WHF in light of the recent clinical consensus released by the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) and the new therapeutic strategies in cardiorenal patients., (Copyright by Società Italiana di Nefrologia SIN, Rome,Italy.)

Published
2024

13. 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.

Author

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

Subjects
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.)

Published
2024
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14. Minimal fluoroscopy approach for right-sided supraventricular tachycardia ablation with a novel ablation technology: Insights from the multicenter CHARISMA clinical registry.

Author

Cauti FM, Rossi P, La Greca C, Piro A, Di Belardino N, Battaglia A, Ferraris F, Pecora D, Lavalle C, Scalone A, Rossi L, Di Cori A, Solimene F, Mantovan R, Pedretti S, Iaia L, Bianchi S, and Anselmino M

Subjects
Adult, Aged, Female, Fluoroscopy, Humans, Male, Middle Aged, Registries, Treatment Outcome, Catheter Ablation adverse effects, Tachycardia, Supraventricular diagnostic imaging, Tachycardia, Supraventricular surgery
Abstract

Background: No data exist on the ability of the novel Rhythmia 3-D mapping system to minimize fluoroscopy exposure during transcatheter ablation of arrhythmias. We report data on the feasibility and safety of a minimal fluoroscopic approach using this system in supraventricular tachycardia (SVT) procedures., Methods: Consecutive patients were enrolled in the CHARISMA registry at 12 centers. All right-sided procedures performed with the Rhythmia mapping system were analyzed. The acquired electroanatomic information was used to reconstruct 3-D cardiac geometry; fluoroscopic confirmation was used whenever deemed necessary., Results: Three hundred twenty-five patients (mean age = 56 ± 17 years, 57% male) were included: 152 atrioventricular nodal reentrant tachycardia, 116 atrial flutter, 41 and 16 right-sided accessory pathway and atrial tachycardia, respectively. Overall, 27 481 s of fluoroscopy were used (84.6 ± 224 s per procedure, equivalent effective dose = 1.1 ± 3.7 mSv per patient). One hundred ninety-two procedures (59.1%) were completed without the use of fluoroscopy (zero fluoroscopy, ZF). In multivariate analysis, the presence of a fellow in training (OR = 0.15, 95% CI: 0.05-0.46; p = .0008), radiofrequency application (0.99, 0.99-1.00; p = .0002), and mapping times (0.99, 0.99-1.00; p = .042) were all inversely associated with ZF approach. Acute procedural success was achieved in 97.8% of the cases (98.4 vs. 97% in the ZF vs. non-ZF group; p = .4503). During a mean of 290.7 ± 169.6 days follow-up, no major adverse events were reported, and recurrence of the primary arrhythmia was 2.5% (2.1 vs. 3% in the ZF vs. non-ZF group; p = .7206)., Conclusions: The Rhythmia mapping system permits transcatheter ablation of right-sided SVT with minimal fluoroscopy exposure. Even more, in most cases, the system enables a ZF approach, without affecting safety and efficacy., (© 2021 Wiley Periodicals LLC.)

Published
2021
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15. Noninvasive cardiovascular imaging for myocardial necrosis, viability, stunning and hibernation: evidence from an umbrella review encompassing 12 systematic reviews, 286 studies, and 201,680 patients.

Author

Nudi F, Iskandrian AE, Schillaci O, Nudi A, DI Belardino N, Frati G, and Biondi Zoccai G

Subjects
Diagnostic Tests, Routine, Humans, Systematic Reviews as Topic, Tomography, X-Ray Computed, Myocardial Infarction diagnostic imaging, Myocardial Infarction therapy, Myocardial Stunning
Abstract

Introduction: The concomitant presence of myocardial necrosis with myocardial ischemia, stunning or hibernation may complicates appraisal of left ventricular (LV) function and patient management. Several imaging modalities have been proposed for the accurate assessment of myocardial necrosis, viability, stunning and hibernation, with mixed results. We aimed to review the evidence base on myocardial necrosis, stunning and hibernation by conducting an umbrella review (i.e. overview of systematic reviews)., Evidence Acquisition: We searched PubMed and The Cochrane Library for meta-analyses focusing on the diagnostic, prognostic, or management appraisal of myocardial necrosis, viability, stunning and hibernation. Diagnostic test accuracy, prognostic yield, and clinical outcomes were systematically abstracted from shortlisted reviews., Evidence Synthesis: From an initial set of 6069 citations, 12 systematic reviews were finally included, encompassing 286 studies and 201,680 patients. Cardiac magnetic resonance imaging (CMR) had favorable results in 4 reviews that focused on the diagnosis of myocardial stunning or hibernation in patients followed for 6±4 months after coronary revascularization (sensitivity 96% and specificity 91%). Positron emission tomography (PET), single photon emission tomography (SPECT) and CMR in 6 meta-analyses had each a significant and independent prognostic role for the prediction of fatal and non-fatal cardiovascular events in patients with follow-up of 2.8±1.7 years. Finally, 2 reviews with 2.3±1.1 years of follow-up showed moderate quality evidence in favor of coronary revascularization in patients with objective signs of myocardial viability., Conclusions: The appraisal of myocardial necrosis and residual viability remains a cornerstone of the modern management of patients with CAD. Current imaging modalities (echocardiography, PET, SPECT and CMR) are widely used. Further trials using contemporary methods are warranted to further clarify the impact of viability assessment on patient management, and the cumulative risk of morbidity and mortality.

Published
2021
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16. Clinical impact of defibrillation testing in a real-world S-ICD population: Data from the ELISIR registry.

Author

Ricciardi D, Ziacchi M, Gasperetti A, Schiavone M, Picarelli F, Diemberger I, Bontempi L, Di Belardino N, Bisignani G, De Bonis S, Mitacchione G, Calabrese V, Lavalle C, Piro A, Pignalberi C, Santini L, Grigioni F, Tondo C, Biffi M, and Forleo GB

Subjects
Adult, Aged, Electric Countershock, Female, Humans, Male, Middle Aged, Registries, Treatment Outcome, Defibrillators, Implantable
Abstract

Background: Current guidelines recommend defibrillation testing (DT) performance in patients with a subcutaneous implantable cardioverter defibrillator (S-ICD), theoretically to reduce the amount of ineffective shocks. DT, however, has been proven unnecessary in transvenous ICD and real-world data show a growing trend in avoidance of DT after S-ICD implantation., Methods: All patients undergoing S-ICD implant at nine associated Italian centers joining in the ELISIR registry (ClinicalTrials.gov Identifier: NCT04373876) were enrolled and classified upon DT performance. Long-term follow-up events were recorded and compared to report the long-term efficacy and safety of S-ICD implantations without DT in a real-world setting., Results: A total of 420 patients (54.0 ± 15.5 years, 80.0% male) were enrolled in the study. A DT was performed in 254 (60.5%) patients (DT+ group), while in 166 (39.5%) was avoided (DT- group). Over a median follow-up of 19 (11-31) months, a very low rate (0.7%) of ineffective shocks was observed, and no significant differences in the primary combined arrhythmic outcome were observed between the two groups (p = .656). At regression analysis, the only clinical predictor associated with the primary combined outcome was S-ICD placement for primary prevention (odds ratio: 0.42; p = .013); DT performance instead was not associated with a reduction in primary outcome (p = .375)., Conclusion: Implanting an S-ICD without DT does not appear to impact the safety of defibrillation therapy and overall patients' survival., (© 2020 Wiley Periodicals LLC.)

Published
2021
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18. Current diagnostic ECG criteria for left ventricular hypertrophy: is it time to change paradigm in the analysis of data?

Author

Ricciardi D, Vetta G, Nenna A, Picarelli F, Creta A, Segreti A, Cavallaro C, Carpenito M, Gioia F, Di Belardino N, Lusini M, Chello M, Calabrese V, and Grigioni F

Subjects
Aged, Aged, 80 and over, Female, Humans, Hypertrophy, Left Ventricular epidemiology, Hypertrophy, Left Ventricular physiopathology, Male, Middle Aged, Predictive Value of Tests, Prevalence, Reproducibility of Results, Retrospective Studies, Rome epidemiology, Electrocardiography, Hypertrophy, Left Ventricular diagnosis, Ventricular Function, Left, Ventricular Remodeling
Abstract

Background: Twelve-lead ECG represents the most common diagnostic tool in clinical cardiology and allows an immediate screening of left ventricular hypertrophy (LVH), but current criteria might have poor clinical usefulness in everyday clinical practice due to lack of sensitivity., Methods: The current study aims to review and compare the clinical performance of known ECG criteria of LVH in a real-life setting; 2134 patients had ECG and echocardiographic exams performed during the same hospitalization. All traces were retrospectively analysed, and the amplitudes of the waves were manually measured. Transthoracic echocardiography was considered as the gold standard to assess LVH., Results: LVH had a prevalence of 58%. Considering the diagnostic performance of ECG criteria for LVH, the Cornell voltage carried the best area under the receiver operating characteristic curve (0.678), while RaVF (R wave in aVF lead) had the poorer result (0.440). The R5/R6 criterion had the best sensitivity (60%), but with the worst specificity (37.4%). The 'Q or S aVR' had the best specificity (99.9%) but lacks sensitivity (0.80%). The Peguero Lo Presti criterion had a sensitivity of 42.3% and a specificity of 75.8%. The Cornell voltage and the Cornell product had similar area under the receiver operating characteristic curve values which were found to be significantly greater compared with other criteria., Conclusion: Current ECG criteria of LVH have low sensitivity despite an acceptable specificity. Among these, Cornell voltage and Cornell product criteria were equally found to have a more accurate diagnostic performance compared with other criteria. To overcome the intrinsic limitations of the current ECG LVH criteria, a new paradigm in the analysis of electrocardiographic data might be necessary.

Published
2020
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19. Prognostic accuracy of myocardial perfusion imaging in octogenarians.

Author

Nudi F, Biondi-Zoccai G, Schillaci O, di Belardino N, Versaci F, Nudi A, Pinto A, Neri G, Procaccini E, Frati G, and Iskandrian AE

Subjects
Age Factors, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Prognosis, Coronary Artery Disease diagnostic imaging, Myocardial Perfusion Imaging methods
Abstract

Background: Myocardial perfusion imaging (MPI) has an established role in the work-up of coronary artery disease (CAD), but its comparative accuracy is debated in elderly patients. We examined a large administrative database to appraise the performance of MPI in octogenarians., Methods: Our institutional database was queried for patients undergoing MPI without recent coronary revascularization or myocardial infarction (MI). We compared baseline, procedural, diagnostic, and prognostic features in patients aged < 80 vs ≥ 80 years with bivariate and propensity-adjusted analyses., Results: From 13,254 patients, 12,737 (96.1%) were < 80 years old and 517 (3.9%) ≥ 80 years. Octogenarians were less likely to undergo exercise testing, had more severe and extensive myocardial ischemia (all P < 0.001), whereas CAD was more prevalent and diffuse in them (P = 0.012), and major adverse cardiac events more common during follow-up (P = 0.009). Diagnostic accuracy of MPI was similar or higher in octogenarians than in younger patients (e.g., sensitivity for three-vessel disease 92% in octogenarians vs 91% in younger patients), as was prognostic accuracy. Using propensity-matched analyses, MPI again yielded satisfactory prognostic accuracy in octogenarians., Conclusions: Use of MPI in octogenarians is associated with similar or better prognostic accuracy than in younger subjects.

Published
2018
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20. Assessment of the fate of myocardial necrosis by serial myocardial perfusion imaging.

Author

Nudi F, Di Belardino N, Pinto A, Procaccini E, Neri G, Schillaci O, Tomai F, Frati G, and Biondi-Zoccai G

Subjects
Acute Coronary Syndrome diagnostic imaging, Aged, Electrocardiography, Female, Humans, Male, Middle Aged, Myocardial Infarction diagnostic imaging, Myocardial Ischemia diagnostic imaging, Myocardial Revascularization, Retrospective Studies, Myocardial Perfusion Imaging, Myocardium pathology, Necrosis diagnostic imaging
Abstract

Background: Myocardial necrosis after myocardial infarction (MI) is common; extent and severity are however variable. The pattern is recognized by myocardial perfusion imaging (MPI) as fixed perfusion defects (FPD). The fate of such FPD is not well appraised. This study addressed this important issue in a large number of patients undergoing serial MPI in relation to type of intervening therapy., Methods: Patients with prior MI or MPI-evidence of myocardial necrosis undergoing serial MPI without intervening acute coronary syndromes were included. The fate of necrosis by MPI on per-patient and per-region analysis was analyzed, factoring also the impact of intervening coronary revascularization (CR)., Results: A total of 3691 patients with 25,837 regions were identified, including 1413 (38.3%) subjects with 3358 (13.0%) regions exhibiting necrosis. Serial MPI after 29±21 months confirmed the persistent presence of myocardial necrosis FPD in the vast majority of patients and regions (86%); the consistency was even higher in the presence of moderate or severe necrosis (99%). Neither type nor site of CR significantly impacted on the presence and extent of myocardial necrosis at multivariable analysis., Conclusions: The finding of myocardial necrosis by MPI remains highly consistent over time, and is not significantly altered by CR.

Published
2018
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21. Temporal Trends in the Prevalence, Severity, and Localization of Myocardial Ischemia and Necrosis at Myocardial Perfusion Imaging After Myocardial Infarction.

Author

Nudi F, Schillaci O, Di Belardino N, Versaci F, Tomai F, Pinto A, Neri G, Procaccini E, Nudi A, Frati G, and Biondi-Zoccai G

Subjects
Aged, Electrocardiography, Exercise Test, Female, Follow-Up Studies, Humans, Italy epidemiology, Male, Middle Aged, Myocardial Infarction diagnosis, Myocardial Infarction surgery, Myocardial Ischemia diagnosis, Myocardial Ischemia physiopathology, Myocardial Revascularization, Necrosis diagnosis, Necrosis epidemiology, Necrosis physiopathology, Predictive Value of Tests, Prevalence, Retrospective Studies, Risk Factors, Severity of Illness Index, Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography methods, Coronary Circulation physiology, Myocardial Ischemia epidemiology, Myocardial Perfusion Imaging methods, Risk Assessment methods
Abstract

The definition, presentation, and management of myocardial infarction (MI) have changed substantially in the last decade. Whether these changes have impacted on the presence, severity, and localization of necrosis at myocardial perfusion imaging (MPI) has not been appraised to date. Subjects undergoing MPI and reporting a history of clinical MI were shortlisted. We focused on the presence, severity, and localization of necrosis at MPI with a retrospective single-center analysis. A total of 10,476 patients were included, distinguishing 5 groups according to the period in which myocardial perfusion scintigraphy had been performed (2004 to 2005, 2006 to 2007, 2008 to 2009, 2010 to 2011, 2012 to 2013). Trend analysis showed over time a significant worsening in baseline features (e.g., age, diabetes mellitus, and Q waves at electrocardiogram), whereas medical therapy and revascularization were offered with increasing frequency. Over the years, there was also a lower prevalence of normal MPI (from 16.8% to 13.6%) and ischemic MPI (from 35.6% to 32.8%), and a higher prevalence of ischemic and necrotic MPI (from 12.0% to 12.7%) or solely necrotic MPI (from 35.7% to 40.9%, p <0.001). Yet the prevalence of severe ischemia decreased over time from 11.4% to 2.0%, with a similar trend for moderate ischemia (from 15.9% to 11.8%, p <0.001). Similarly sobering results were wound for the prevalence of severe necrosis (from 19.8% to 8.2%) and moderate necrosis (from 8.5% to 7.8%, p = 0.028). These trends were largely confirmed at regional level and after propensity score matching. In conclusion, the outlook of stable patients with previous MI has substantially improved in the last decade, with a decrease in the severity of residual myocardial ischemia and necrosis, despite an apparent worsening in baseline features., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Published
2017
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22. Impact of coronary revascularization vs medical therapy on ischemia among stable patients with or suspected coronary artery disease undergoing serial myocardial perfusion scintigraphy.

Author

Nudi F, Di Belardino N, Versaci F, Pinto A, Procaccini E, Neri G, Vetere M, Frati G, Peruzzi M, Schillaci O, Gaspardone A, Tomai F, and Biondi-Zoccai G

Subjects
Aged, Exercise Test, Female, Humans, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Prevalence, Retrospective Studies, Tomography, Emission-Computed, Single-Photon, Coronary Artery Disease diagnostic imaging, Myocardial Ischemia diagnostic imaging, Myocardial Perfusion Imaging, Myocardial Revascularization, Radionuclide Imaging
Abstract

Background: Randomized trials have challenged the role of revascularization in stable coronary artery disease. We aimed to appraise the impact of revascularization on ischemia in patients undergoing serial myocardial perfusion scintigraphy (MPS)., Methods: We queried our institutional database for stable subjects undergoing serial MPS and appraised the impact of revascularization on changes in ischemia., Results: A total of 3631 patients were included: 967 (27%) undergoing revascularization and 2664 (73%) receiving medical therapy only. Patients treated with revascularization had a significantly lower burden of myocardial ischemia at follow-up (odds ratio = 0.577 [95% confidence interval 0.483-0.689] vs medical therapy, P < .001). Among all those having moderate or severe ischemia at baseline, revascularization was associated with a follow-up prevalence of 80% for no, minimal, or mild ischemia and 20% for moderate or severe ischemia, vs 43% and 57% for medical therapy (P < .001). Even at multivariable analysis and propensity-adjusted, and propensity-matched analyses, revascularization was associated with a significantly lower prevalence of moderate or severe ischemia at follow-up (respectively P < .001, P = .001, and P = .042)., Conclusions: Revascularization appears superior to medical therapy in reducing ischemic burden and normalizing myocardial perfusion among subjects with moderate or severe ischemia at baseline.

Published
2017
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23. Impact of the high-frequency cutoff of bandpass filtering on ECG quality and clinical interpretation: A comparison between 40Hz and 150Hz cutoff in a surgical preoperative adult outpatient population.

Author

Ricciardi D, Cavallari I, Creta A, Di Giovanni G, Calabrese V, Di Belardino N, Mega S, Colaiori I, Ragni L, Proscia C, Nenna A, and Di Sciascio G

Subjects
Adult, Ambulatory Care statistics & numerical data, Diagnosis, Computer-Assisted, Female, Humans, Italy epidemiology, Male, Middle Aged, Observer Variation, Preoperative Period, Prevalence, Prospective Studies, Reproducibility of Results, Sensitivity and Specificity, Single-Blind Method, Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac epidemiology, Electrocardiography instrumentation, Electrocardiography statistics & numerical data, Signal Processing, Computer-Assisted
Abstract

Background: In 1990 the American Heart Association (AHA) established a standard 0.05 to 150Hz bandwidth for the routine recording of 12-lead electrocardiograms (ECGs). However, subsequent studies have indicated a very high prevalence of deviations from the recommended cutoffs., Objective: This prospective observational study investigates the impact of 40Hz compared to 150Hz high-frequency cutoffs on ECG quality and clinical interpretation in a single-center surgical outpatient population., Methods: 1582 consecutive adult patients underwent two standard 12-lead ECG tracings using different high-frequency cutoffs (40Hz and 150Hz). Two blinded cardiologists randomly reviewed and interpreted the recordings according to pre-defined parameters (PR and ST segment, Q and T wave abnormalities). An arbitrary score, ranging from 1 to 3, was established to evaluate the perceived quality of the recordings and the non-interpretable ECGs were noted. The tracings were then matched to compare interpretations between 40 and 150Hz filters., Results: A 40Hz high-frequency cutoff resulted in an increased rate of optimal quality ECGs compared to the 150Hz cutoff (93.4% vs 54.6%; p<0.001) and a lower rate of non-interpretable traces (0.25% vs 4.80%; p<0.001). Analyzing the morphologic parameters, no significant differences between the filter settings were found, except for a higher incidence of the J-point elevation in the 40Hz high-frequency cutoff (p=0.007) and a higher incidence of left ventricular hypertrophy in the 150Hz high-frequency cutoff (7.4% vs 5.4%, p<0.001). The latter was noted only in ECGs with borderline QRS amplitudes (between 3.3 and 3.7mV; p<0.001)., Conclusion: Despite current recommendations, the large deviation from standard high-frequency cutoff in clinical practice does not seem to significantly affect ECG clinical interpretation and a 40Hz high-frequency cutoff of the band-pass filtering may be acceptable in a low risk population, allowing for a better quality of tracings., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Published
2016
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24. Primary prevention implantation of cardioverter defibrillator without defibrillation threshold testing: 2-year follow-up.

Author

Bianchi S, Ricci RP, Biscione F, Sgreccia F, Di Belardino N, Rossi P, Giuli S, Grammatico A, De Santo T, Santi E, Merico M, Piccirillo G, Azzolini P, Santini M, and Puglisi A

Subjects
Aged, Differential Threshold, Female, Follow-Up Studies, Humans, Italy epidemiology, Male, Perioperative Care statistics & numerical data, Primary Prevention statistics & numerical data, Retrospective Studies, Risk Assessment, Risk Factors, Survival Analysis, Survival Rate, Death, Sudden, Cardiac epidemiology, Death, Sudden, Cardiac prevention & control, Defibrillators, Implantable statistics & numerical data, Electric Countershock instrumentation, Electric Countershock mortality, Equipment Failure Analysis statistics & numerical data, Prosthesis Implantation statistics & numerical data
Abstract

Background: Even though the intraoperative threshold testing of the implantable cardioverter defibrillator (ICD) may cause hemodynamic impairment or be unfeasible, it is still considered required standard practice at the time of implantation. We compared the outcome of ICD recipients who underwent defibrillation threshold testing (DFT) with that of patients in whom no testing was performed., Methods: A total of 291 subjects with ischemic dilated cardiomyopathy received transvenous ICDs between January 2000 and December 2004 in five Italian cardiology centers. In two centers, DFT was routinely performed in 137 patients (81% men; mean age 69+/-9 years; mean ejection fraction 26+/-4%) (DFT group), while three centers never performed DFT in 154 patients (90% men; mean age 69+/-9 years; mean ejection fraction 27+/-5%) (no-DFT group)., Results: We compared total mortality, total cardiovascular mortality, sudden cardiac death (SCD), and spontaneous episodes of ventricular arrhythmia (sustained ventricular tachycardia, VT, and ventricular fibrillation, VF) between these groups 2 years after implantation (median 23 months, 25th-75th percentile, 12-44 months). On comparing the DFT and no-DFT groups, we found an overall mortality rate of 20% versus 16%, cardiovascular mortality of 13% versus 10%, SCD of 3% versus 0.6%, VT incidence of 8% versus 10%, and VF incidence of 6% versus 4% (no significant difference in any comparison)., Conclusions: No significant differences in the incidence of clinical outcomes considered emerged between no-DFT and DFT groups. These results should be confirmed in larger prospective studies.

Published
2009
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25. Monitored atrial fibrillation duration predicts arterial embolic events in patients suffering from bradycardia and atrial fibrillation implanted with antitachycardia pacemakers.

Author

Capucci A, Santini M, Padeletti L, Gulizia M, Botto G, Boriani G, Ricci R, Favale S, Zolezzi F, Di Belardino N, Molon G, Drago F, Villani GQ, Mazzini E, Vimercati M, and Grammatico A

Subjects
Aged, Atrial Fibrillation diagnosis, Female, Follow-Up Studies, Humans, Male, Monitoring, Physiologic, Prospective Studies, Risk Factors, Time Factors, Atrial Fibrillation complications, Atrial Fibrillation therapy, Bradycardia complications, Bradycardia therapy, Embolism diagnosis, Embolism etiology, Pacemaker, Artificial
Abstract

Objectives: The aim of our study was to evaluate arterial embolism (AE) occurrence rates and predictors in patients suffering from bradycardia and wearing a pacemaker with antitachycardia pacing therapies., Background: Atrial fibrillation (AF) is associated with a high incidence of AE., Methods: A total of 725 patients (360 men, age 71 +/- 11 years) were implanted with a DDDRP pacemaker (Medtronic AT500, Medtronic Inc., Minneapolis, Minnesota). At baseline 225 (31.0%) patients received antiplatelet therapy and 264 (36.4%) patients received anticoagulation agents., Results: Over a median 22-month follow-up (25th to 75th interquartile range 16 to 30 months), AE occurred in 14 (1.9%) patients: 7 patients suffered a nonfatal ischemic stroke (0.6% per year), 4 patients had transient ischemic attack (0.34% per year), and 3 patients had embolic complications. Among baseline patients' characteristics, multivariate logistic analysis showed that embolic events are independently associated to ischemic heart disease (7.0 odds ratio [OR], 95% confidence interval [CI] 2.3 to 21.3, p = 0.001), prior embolic event (7.3 OR, 95% CI 1.2 to 43.9, p = 0.029), diabetes (5.0 OR, 95% CI 1.2 to 15.7, p = 0.032), and hypertension (4.1 OR, 95% CI 1.1 to 15.6, p = 0.036). The risk of embolism, adjusted for known risk factors, was 3.1 times increased (95% CI 1.1 to 10.5, p = 0.044) in patients with device-detected atrial fibrillation episodes longer than one day during follow-up., Conclusions: In a cohort of patients with bradycardia and AF, arterial embolism was common in patients with ischemic cardiopathy, hypertension, diabetes mellitus, and in patients with known stroke risk factors. Atrial fibrillation occurrences longer than one day were independently associated with embolic events.

Published
2005
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26. Dual site right atrial pacing in the prevention of symptomatic atrial fibrillation refractory to drug therapy and unrelated to sinus bradycardia.

Author

Boccadamo R, Di Belardino N, Mammucari A, and Boccadamo V

Subjects
Aged, Atrial Fibrillation etiology, Female, Humans, Male, Middle Aged, Prospective Studies, Atrial Fibrillation prevention & control, Bradycardia complications, Cardiac Pacing, Artificial methods
Abstract

Unlabelled: Dual-site right atrial pacing has been shown recently to prevent atrial fibrillation relapses in patients affected by drug-refractory, highly-recurring tachyarrhythmia, associated to sinus bradycardia. The aim of our study was to verify whether this stimulation modality could be useful in patients affected by refractory atrial fibrillation unassociated to sinus bradycardia., Methods and Results: Fifteen patients (6 males) affected by refractory, symptomatic atrial fibrillation, and potential candidates to AV node ablation, were prospectively enrolled. Mean age was 65 +/- 5 years (range 62-78). Associated pathology was arterial hypertension in 12, and dilated cardiomyopathy in 3. Eight patients were affected by persistent atrial fibrillation, and seven by paroxysmal atrial fibrillation. The duration of the arrhythmia was 61 +/- 63 months (range 3-216). Left atrial diameter was 39.4 +/- 4.2 mm (range 33-46), left ventricular end-diastolic diameter was 52.4 +/- 12.2 mm (range 41-90), and left ventricular ejection fraction was 55 +/- 16 (range 18-81). Single chamber atrial pacing was used in 10 patients, dual chamber in 5 patients. The mean duration of follow up was 24 +/- 12 months (range 3-41). During this period the number of episodes of atrial fibrillation decreased from a mean of 13 +/- 38 (range 1-150) to 0.4 +/- 0.7 (range 0-2.3) per month (p < 0.001). In the subgroup of patients with persistent atrial fibrillation the number of episodes decreased from a mean of 20.4 +/- 52.4 (range 1-150) to 0.6 +/- 0.9 (range 0-2.3) (p < 0.001). In patients with paroxysmal atrial fibrillation the number of episodes decreased from 4.6 +/- 3.5 (range 2-12) to 0.2 +/- 0.5 (range 0-1.4) (p < 0.001). One patient (6.7%) developed chronic atrial fibrillation 16 months after the implant, 2 remaining patients (13%) had their arrhythmia unaltered. After the implant the number of Class 1 antiarrhythmic drugs fell from 18 to 6 (p < 0.001) and that of Class 2 changed from 0 to 7 p < 0.001). The use of Class 3 and 4 did not change significantly. No complications related to implant were observed., Conclusions: Permanent dual-site right atrial pacing can prevent atrial fibrillation recurrences in patients affected by highly symptomatic episodes unassociated to sinus bradycardia.

Published
2002
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