-
Irma Battipaglia,
Giancarla Scalone,
Andrea Macchione,
Gaetano Pinnacchio,
Marianna Laurito,
Maria Milo,
Gemma Pelargonio, Gianluigi Bencardino,
Fulvio Bellocci,
Maurizio Pieroni,
Gaetano A Lanza,
Filippo Crea
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is associated with an increased risk of sudden cardiac death (SCD). Risk stratification of ARVC/D patients, however, remains an unresolved issue. In this study we investigated whether heart rate variability (HRV) can be helpful in identifying ARVC/D patients with increased risk of arrhythmic events. METHODS AND RESULts: We studied 30 consecutive patients (17 males; 45.4 ± 18 years) with ARVC/D, diagnosed according to guideline criteria; 15 patients (50%) had received an implantable cardioverter defibrillator (ICD) for primary SCD prevention. HRV was assessed on 24-h ECG Holter monitoring. The primary endpoint was the occurrence of major arrhythmic events (SCD, sustained ventricular tachycardia (VT), ICD therapy for sustained VT or ventricular fibrillation (VF)). During the follow-up period (19 ± 7 months), no deaths occurred, but 5 patients (17%) experienced arrhythmic events (4 VTs and 1 VF, all in the ICD group). All HRV parameters were significantly lower in patients with, compared with those without, arrhythmic events. Low-frequency amplitude was the most significant HRV variable associated with arrhythmic events in univariate Cox regression analysis (P=0.017), and was the only significant predictor of arrhythmic events in multivariable regression analysis (hazard ratio 0.88, P=0.047), together with unexplained syncope (hazard ratio 16.1, P=0.039). CONCLUSIONS: Our data show that among ARVC/D patients HRV analysis might be helpful in identifying those with increased risk of major arrhythmic events.
Circulation Journal 02/2012; 76(3):618-23. · 3.77 Impact Factor
-
Moussa Mansour,
Giovanni B Forleo,
Augusto Pappalardo,
Conor Barrett,
E Kevin Heist,
Andrea Avella, Gianluigi Bencardino,
Antonio Dello Russo,
Michela Casella,
Jeremy N Ruskin,
Claudio Tondo
[show abstract]
[hide abstract]
ABSTRACT: Pulmonary vein isolation (PVI) achieved using a cryoballoon has been shown to be safe and effective. This treatment modality has limited effectiveness for treatment of persistent atrial fibrillation (AF).
The purpose of this study was to evaluate a combined approach using a cryoballoon for treatment of PVI and focal radiofrequency (RF) left atrial substrate ablation for treatment of persistent AF.
Twenty-two consecutive patients with persistent AF were included in the study. PVI initially was performed with a cryoballoon. Left atrial complex fractionated atrial electrograms (CFAEs) then were ablated using an RF catheter. Finally, linear ablations using the RF catheter were performed.
Eighty-three PVs, including five with left common ostia, were targeted and isolated (100%). Seventy-seven (94%) of 82 PVs targeted with the cryoballoon were isolated, and 5 (6%) required use of RF energy to complete isolation. A mean of 9.7 +/- 2.6 cryoablation applications per patient was needed to achieve PVI. Median time required for cryoablation per vein was 600 seconds, and mean number of balloon applications per vein was 2.5 +/- 1.0. In 19 (86%) patients in whom AF persisted after PVI, CFAE areas were ablated using the RF catheter. Two cases of transient phrenic nerve paralysis occurred. After a single procedure and mean follow-up of 6.0 +/- 2.9 months, 86.4% of patients were AF-free without antiarrhythmic drugs.
A combined approach of cryoablation and RF ablation for treatment of persistent AF is feasible and is associated with a favorable short-term outcome.
Heart rhythm: the official journal of the Heart Rhythm Society 12/2009; 7(4):452-8. · 4.56 Impact Factor
-
Moussa Mansour,
Giovanni B Forleo,
Augusto Pappalardo,
E Kevin Heist,
Andrea Avella,
Francesco Laurenzi,
Piergiuseppe De Girolamo, Gianluigi Bencardino,
Antonio Dello Russo,
Massimo Mantica,
Jeremy N Ruskin,
Claudio Tondo
[show abstract]
[hide abstract]
ABSTRACT: A novel catheter design (HD Mesh ablator, Bard) combining high-density circumferential mapping and direct radiofrequency (RF) energy delivery has been developed to map and isolate the pulmonary veins (PVs).
The purpose of this study was to assess the feasibility of the Mesh catheter for PV isolation in patients with paroxysmal atrial fibrillation (AF).
Twenty consecutive patients (mean age 56.4 +/- 12.2 years; 16 men) with paroxysmal drug-refractory AF were referred for ablation. The procedure was performed in a stepwise manner: PV isolation was initially attempted with the Mesh ablator, and if that was not successful, a conventional ablation approach was then used.
A total of 73 PVs including seven veins with left common ostium were targeted. Successful deployment of the Mesh was achieved in all but four veins (94.5%). Using the Mesh catheter for ablation, PV isolation was achieved in 46 (63%) of the 73 PVs. The mean (RF) ablation time required to achieve complete isolation was 12.4 +/- 6.1 minutes per PV. The Mesh-only approach allowed isolation of all veins in eight (40%) patients. In combination with conventional ablation, successful PV isolation was achieved in 71 (97%) of 73 PVs. No complications attributable to the Mesh ablator occurred in this series.
PV isolation using the Mesh catheter is feasible and may simplify the current PV isolation procedures. With the current catheter design, PV isolation could be achieved in 63% of PVs. A larger Mesh diameter with an over-the-wire design may help improve the acute success rate.
Heart rhythm: the official journal of the Heart Rhythm Society 12/2008; 5(11):1510-6. · 4.56 Impact Factor
-
Michela Casella,
Antonio Dello Russo,
Manuela Pace,
Gemma Pelargonio,
Carolina Ierardi,
Tommaso Sanna,
Loredana Messano, Gianluigi Bencardino,
Sergio Valsecchi,
Fortunato Mangiola,
Gaetano A Lanza,
Paolo Zecchi,
Filippo Crea,
Fulvio Bellocci
[show abstract]
[hide abstract]
ABSTRACT: Myotonic dystrophy type 1 (MD1) is the most common muscular dystrophy of adult life. Cardiac involvement is characterized by disorders of atrioventricular conduction, ventricular arrhythmias, and sudden death. Heart rate turbulence (HRT) is a noninvasive risk predictor in patients affected by ischemic heart disease. The aim of our study is to assess the prognostic value of HRT in MD1 patients.
We performed HRT analysis by 24-hour Holter recording to calculate turbulence onset (TO) and turbulence slope (TS) in 29 MD1 patients (mean age 52 +/- 10 years), and in 30 patients (mean age 52 +/- 13 years) with frequent ventricular arrhythmias and structurally normal heart (VANH). An electrophysiological study (EPS) tested ventricular arrhythmias inducibility in 22 MD1 patients. TO was significantly different between MD1 and VANH patients (-1.66 +/- 2.04 and -2.98 +/- 1.79%, respectively, P 0.01), while no difference was observed in TS between MD1 and VANH patients (11.12 +/- 6.46 and 9.12 +/- 6 msec/beat, respectively). On EPS, sustained ventricular arrhythmias (SVA) were induced in six MD1 patients. TO was significantly different in inducible MD1 patients (0.88 +/- 1.95%), as compared with both noninducible (-2.49 +/- 1.43%, P < 0.001) or no eligible to EPS (-1.93 +/- 1.63%, P < 0.005) MD1 patients and to VANH patients (-2.98 +/- 1.79%, P < 0.001).
An impairment of TO, a measure of HRT, suggesting impaired cardiac parasympathetic activity, may be a useful, noninvasive predictor of arrhythmic risk in MD1 patients.
Journal of Cardiovascular Electrophysiology 08/2006; 17(8):871-6. · 3.06 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In this study we assessed whether serum endothelin-1 levels were associated with indexes of disease severity in unstable angina, including troponin I, C-reactive protein, and transient myocardial ischemia. Endothelin-1 levels were higher in patients who had transient myocardial ischemia and in those who had 3-vessel disease on angiography but were not significantly correlated with levels of C-reactive protein and troponin I.
The American Journal of Cardiology 03/2005; 95(4):492-4. · 3.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The case of a 72-year-old patient affected by myasthenia gravis under pyridostigmine therapy, admitted to the hospital for the onset of oppressive thoracic pain associated with mild enzyme increase, electrocardiographic and echocardiographic disorders, is discussed. Dypiridamole/gated SPECT perfusion scintigraphy at rest evidenced reduced coronary reserve at the level of the lateral wall with apical akinesia and normokinesia of mediobasal left ventricle. On coronarography, coronary arteries were free of significant stenoses and left ventricular apical akinesia. The diagnostic approach to ischemic cardiomyopathy with the correct sequence of performed diagnostic imaging led to the presumptive identification of a rare syndrome.
Rays 30(3):227-32.
