Giuseppe Boriani

Policlinico S.Orsola-Malpighi, Bolonia, Emilia-Romagna, Italy

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Publications (496)2073.51 Total impact

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    ABSTRACT: The number of cardiac implantable electronic devices (CIEDs) has greatly increased in the last 10 years. Many electronic devices used in daily activities generate electromagnetic interferences (EMIs) that can interact with CIEDs. In clinical practice, it is very important to know the potential sources of EMIs and their effect on CIEDs in order to understand how to manage or mitigate them. A very important source of EMI is magnetic resonance (MR), which is considered nowadays the diagnostic gold standard for different anatomical districts. In this review, we focused on the effects of EMI on CIEDs and on the clinical management. Moreover, we made a clarification about MR and CIEDs.In patients with CIEDs, EMIs may cause potentially serious and even life-threatening complications (inappropriate shocks, device malfunctions, inhibition of pacing in pacemaker-dependent patients) and may rarely dictate device replacement. The association of inappropriate shocks with increased mortality highlights the importance of minimizing the occurrence of EMI. Adequate advice and recommendations about the correct management of EMIs in patients with CIEDs are required to avoid all complications during hospitalization and in daily life. Furthermore, the article focused on actual management about MR and CIEDs.
    Journal of Cardiovascular Medicine 10/2015; 16(10):704. DOI:10.2459/JCM.0000000000000301 · 1.51 Impact Factor
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    ABSTRACT: Guideline-adherent therapy for stroke prevention in atrial fibrillation has been associated with better outcomes, in terms of thromboembolism (TE) and bleeding. In this report from the EuroObservational Research Programme-Atrial Fibrillation (EORP-AF) Pilot General Registry, we describe the associated baseline features of 'high risk' AF patients in relation to guideline-adherent antithrombotic treatment, i.e. whether they were adherent, over-treated, or under-treated based on the 2012 European Society of Cardiology (ESC) guidelines. Secondly, we assessed the predictors of guideline-adherent antithrombotic treatment. Thirdly, we evaluated outcomes for all-cause mortality, TE, bleeding, and the composite endpoint of 'any TE, cardiovascular death or bleeding' in relation to whether they were ESC guideline-adherent treatment. From the EORP-AF cohort, the follow-up dataset of 2634 subjects was used to assess the impact of guideline adherence or non-adherence. Of these, 1602 (60.6%) were guideline adherent, whilst 458 (17.3%) were under-treated, and 574 (21.7%) were over-treated. Non-guideline-adherent treatment can be related to region of Europe as well as associated clinical features, but not age, AF type, symptoms, or echocardiography indices. Over-treatment per se was associated with symptoms, using the EHRA score, as well as other comorbidities. Guideline-adherent antithrombotic management based on the ESC guidelines is associated with significantly better outcomes. Specifically, the endpoint of 'all cause death and any TE' is increased by >60% by undertreatment [hazard ratio (HR) 1.679 (95% confidence interval (CI) 1.202-2.347)] or over-treatment [HR 1.622 (95% CI 1.173-2.23)]. For the composite endpoint of 'cardiovascular death, any TE or bleeding', over-treatment increased risk by >70% [HR 1.722 (95% CI 1.200-2.470)]. Even in this cohort with high overall rates of oral anticoagulation use, ESC guideline-adherent antithrombotic management is associated with significantly better outcomes, including those related to mortality and TE, as well as the composite endpoint of 'cardiovascular death, any TE or bleeding'. These contemporary observations emphasize the importance of guideline implementation, and adherence to the 2012 ESC guidelines for stroke prevention in AF. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email:
    Europace 08/2015; DOI:10.1093/europace/euv269 · 3.67 Impact Factor
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    ABSTRACT: The replacement of implantable cardioverter-defibrillators (ICDs) may give rise to considerable clinical consequences, the importance of which is underrated by the medical community. Replacement-related adverse events are difficult to identify and require monitoring of both short-term complications and long-term patient outcome. The aim of this study is to perform a structured evaluation of both short- and long-term adverse events and a cost analysis of consecutive ICD replacement procedures. Detect Long-term Complications After ICD Replacement (DECODE) is a prospective, single-arm, multicenter cohort study designed to estimate long-term complication rates (at 12 months and 5 years) in patients undergoing ICD generator replacement. The study will also evaluate predictors of complications, patient management before and during the replacement procedure in clinical practice, and the costs related to use of health care resources. About 800 consecutive patients with standard indications for ICD generator replacement will be enrolled in this study. The decision to undertake generator replacement/upgrade will be made according to the investigators' own judgment (which will be recorded). Patients will be followed for 60 months through periodic in-hospital examinations or remote monitoring. Detailed data on complications related to ICD replacement in current clinical practice are still lacking. The analysis of adverse events will reveal the value of new preventive strategies, thereby yielding both clinical and economic benefits. Moreover, assessment of complication rates after ICD replacement in a real-life setting will help estimate the actual long-term cost of ICD therapy and assess the real impact of increasing ICD longevity on cost-effectiveness. © 2015 Wiley Periodicals, Inc.
    Clinical Cardiology 08/2015; DOI:10.1002/clc.22440 · 2.59 Impact Factor
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    ABSTRACT: Cardiac resynchronization therapy (CRT) is an accepted treatment in patients with end-stage heart failure. PET permits the absolute quantification of global and regional homogeneity in cardiac sympathetic innervation. We evaluated the variation of cardiac adrenergic activity in patients with idiopathic heart failure (IHF) disease (NYHA III-IV) after CRT using (11)C-hydroxyephedrine (HED) PET/CT. Ten IHF patients (mean age=68; range=55-81; average left ventricular ejection fraction 26±4%) implanted with a resynchronization device underwent three HED PET/CT studies: PET 1 one week after inactive device implantation; PET 2, one week after PET 1 under stimulated rhythm; PET 3, at 3 months under active CRT. A dedicated software (PMOD 3.4 version) was used to estimate global and regional cardiac uptake of HED through 17 segment polar maps. At baseline, HED uptake was heterogeneously distributed throughout the left ventricle with a variation coefficient of 18±5%. This variable markedly decreased after three months CRT (12±5%, p<0.01). Interestingly, subdividing the 170 myocardial segments (17 segments of each patient multiplied by the number of patients) into two groups, according to the median value of tracer uptake expressed as % of maximal myocardial uptake (76%), we observed a different behaviour depending on baseline innervation: HED uptake significantly increased only in segments with "impaired innervation" (SUV 2.61±0.92 at PET1 and 3.05±1.67 at three months, p<0.01). As shown by HED PET/CT uptake and distribution, improvement in homogeneity of myocardial neuronal function reflected a selective improvement of tracer uptake in regions with more severe neuronal damage. These finding supported the presence of a myocardial regional variability in response of cardiac sympathetic system to CRT and a systemic response involving remote tissues with rich adrenergic innervation. This work might contribute to identify imaging parameters that could predict the response to CRT therapy. Copyright © 2015. Published by Elsevier Inc.
    Nuclear Medicine and Biology 07/2015; DOI:10.1016/j.nucmedbio.2015.07.002 · 2.41 Impact Factor
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    ABSTRACT: Since August 2012, Italian general practitioners are required to prescribe the generic name of medicines, except for refill of chronic therapy. We evaluated the extent of switching among equivalents in chronic cardiovascular therapies, the influence of the 2012 regulatory intervention and of patient-related or drug-related factors.Prescription of off-patent antiarrhythmics, oral antidiabetics and ACE-inhibitors dispensed from August 2011 to August 2013 within the Bologna Local Health Authority (870,000 inhabitants) were collected. The rate of actual switching among equivalents was evaluated monthly. The effect of the regulatory intervention was estimated by interrupted time series analysis. Adjusted odds ratios (aORs) of switching were calculated for: age, gender, number of different equivalents available for each drug, change in dispensing pharmacy between subsequent refills.The average monthly rates of switches were 9.6%, 16.3% and 16.3% for antiarrhythmics, antidiabetics and ACE inhibitors, respectively. Values significantly increased soon after the regulatory intervention for ACE inhibitors (+1.81%, p<0.01), antiarrhythmics (+1.46%, p=0.01) and antidiabetics (+1.09%, p=0.01), and no significant decreasing trends were observed in the following 12 months. For all drug classes, odd of switching was higher in case of change in dispensing pharmacy (up to aOR=4.31, 95CI=4.26-4.35 for ACE inhibitors) and availability of ≥5 different equivalents (up to aOR=7.82, 95CI=7.39-8.28 for antidiabetics). Switching was lower for age ≥65 for antidiabetics and ACE inhibitors (aOR=0.92, 95CI=0.90-0.93; 0.87, 0.86-0.88, respectively).The Italian regulatory intervention generated an immediate increase, not sustained in time, in switching among equivalents of cardiovascular therapies. Young age, high number of available equivalents and changes in dispensing pharmacy between subsequent refills were associated with switching.This article is protected by copyright. All rights reserved.
    Basic & Clinical Pharmacology & Toxicology 07/2015; DOI:10.1111/bcpt.12442 · 2.38 Impact Factor
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    Europace 06/2015; DOI:10.1093/europace/euv202 · 3.67 Impact Factor
  • Europace 06/2015; DOI:10.1093/europace/euv233 · 3.67 Impact Factor
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    Europace 06/2015; DOI:10.1093/europace/euv190 · 3.67 Impact Factor
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    ABSTRACT: Oncological patients are at increasing risk of QT prolongation, a risk factor for ventricular arrhythmia. We assessed impact and risk factors for corrected QT (QTc) prolongation during multiple-cycle chemotherapy. We enrolled 100 outpatients initiating chemotherapy in a university center specializing in female cancer. Clinical, drug, laboratory, and 12-lead ECG data collection at baseline and at each chemotherapy cycle was performed. Enrolled patients were followed for 992 chemotherapy cycles (median 7; interquartile range 6-13); 2438 ECGs were recorded (20; 18-31) 36.8 % pre-therapy, 36.8 % following chemotherapy, and 22.5 % 7-10 days after chemotherapy. Maximum QTc (Max-QTc) was recorded after 4 chemotherapy administrations in >50 % of the entire cohort and also within every subset of patients with prolonged QTc (57 % 471-480 ms; 54 % 481-500 ms; 66 % >500 ms). No cumulative effect on QTc was shown. QTc prolongation was comparable among the various protocols. Prophylactic/supportive drugs were not associated with additional QTc prolongation. Variables independently associated with QTc prolongation >470 ms were age (OR 1.056 95 % CI 1.006-1.108, p = 0.028) and the baseline-first chemotherapy averaged QTc (BC-QTc) (OR 1.092 95 % CI 1.051-1.136), a novel parameter devised for this study. Only BC-QTc maintained significance for QTc >480 ms. BC-QTc >435 ms identified 100 % of patients with Max-QTc >500 ms, 96 % with Max-QTc 481-500 ms, and 66 % with Max-QTc 471-480 ms. Only 29 % of patients with Max-QTc ≤470 ms presented a BC-QTc >435 ms. Our results confirm the high prevalence of QTc prolongation after chemotherapy. Most of the patients reached Max-QTc after several cycles. BC-QTc may help in stratifying arrhythmic risk in real-world clinical practice.
    European Journal of Clinical Pharmacology 06/2015; 71(8). DOI:10.1007/s00228-015-1874-3 · 2.97 Impact Factor
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    ABSTRACT: Background Cardiac resynchronization therapy is an established therapy for advanced congestive heart failure, improving both survival and hospitalization. The mechanism beneath these improvements still needs to be defined since about one third of the patients do not benefit from resynchronization. Restoration of sympatho-vagal function can play a significant role in the process but available data are limited. In this scenario, Positron-Emission-Tomography scans with 11C-hydroxyephedrine, a noradrenaline analogous, has the potential to characterize the modifications of the sympathetic nervous system induced by cardiac resynchronization therapy in decompensated patients.Materials and methodsTen patients (six males, age 68±10 years) with primary dilated cardiomyopathy were studied before and after resynchronization (acutely and after 3 months), from a clinical and echocardiographic point of view. Their cardiac sympathetic nerve activity was evaluated by 11C-hydroxyephedrine-Positron-Emission-Tomography before resynchronization, at short and medium term after resynchronization.ResultsResponders to cardiac resynchronization therapy (patients showing ≥15% decrease in left ventricular end-systolic volume) showed a higher level of left ventricular radiotracer uptake both at baseline and after resynchronization with respect to non-responders. This was coupled with a progressive improvement in homogeneity in left ventricular tracer uptake mainly in responders.Conclusions Cardiac resynchronization therapy improves cardiac sympathetic nerve activity in responders since its activation, while non-responders do not show any significant change at any time of evaluation. Cardiac resynchronization therapy seems to be more effective in those patients with a still structurally preserved, yet functionally impaired, neuroautonomic system.This article is protected by copyright. All rights reserved.
    European Journal of Clinical Investigation 06/2015; 45(8). DOI:10.1111/eci.12471 · 2.73 Impact Factor
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    ABSTRACT: Nowadays several diagnostic tools are available to investigate cardiovascular symptoms like palpitations, dizziness and syncope: ECG Holter (or ambulatory ECG, AECG), external and implantable event/loop recorders. Despite this technological burden, many diagnoses are still missed. In the meantime, we are facing an increasing use of implantable devices for cardiac pacing/defibrillation (CIED), which have rapidly evolved from simple pacing/shock boxes to devices including several diagnostic features. However, these functions are not adequately exploited in current clinical practice and several redundant diagnostic tests, like AECG, are still prescribed to CIED carriers, leading to an increase of costs and a delay in final diagnosis. This review is aimed at identifying the current role of AECG in CIED carriers in view of this technological improvement. First, we will briefly present the indications for AECG according to current guidelines. We will then provide a direct comparison of the different diagnostic features provided by AECG (and event/loop recorders) versus automatic diagnostic CIED to highlight the respective pros and cons. This will serve to carefully discuss these indications in view of the results of recent studies on CIED carriers, highlighting the need for proper implantation and follow-up. Eventually, we will provide useful hints to properly analyse AECG in CIED carriers, considering the different behaviours according to the implemented algorithms. We will conclude by suggesting updated indications for AECG. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    Heart (British Cardiac Society) 05/2015; 101(16). DOI:10.1136/heartjnl-2015-307614 · 5.60 Impact Factor
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    ABSTRACT: Mortality after cardiac resynchronization therapy (CRT) is difficult to predict. We sought to design and validate a simple prognostic score for patients implanted with CRT, based on readily available clinical variables, including age, gender, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class, presence/absence of atrial fibrillation, presence/absence of atrioventricular junction ablation, coronary heart disease, diabetes, and implantation of a CRT device with defibrillation. For predictive modelling, 5153 consecutive patients enrolled in 72 European centres (79% male; LVEF 25.9 ± 6.85%; NYHA class III-IV 77.5%; QRS 158.4 ± 32.3 ms) were randomly split into derivation (70%) and validation (30%) samples. The primary endpoint was total mortality and the secondary endpoint was cardiovascular mortality. The final predictive model fit was assessed by plotting observed vs. predicted survival. In the entire cohort, 1004 deaths occurred over a follow-up of 14 409 person years. Total mortality ranged from 3.1% to 28.2% at 2 years in the first and fifth quintile of the risk score, respectively. At 5 years, total mortality was 10.3%, 18.6%, 27.6%, 36.1%, and 58.8%, from the first to the fifth quintile. Compared with the lowest quintile (Q), total mortality was significantly higher in the other four quintiles [Q2 hazard ratio (HR) = 1.71; Q3 HR = 2.20; Q4 HR = 4.03; Q5 HR = 8.03; all P < 0.001). The final model, which was based on the entire cohort using the above variables, showed a good discrimination (Harrell's c = 0.70) and high explained variation (0.26). The mean predicted survival fitted well with the observed survival for up to 6 years of follow-up. The VALID-CRT risk score, which is based on routine, readily available clinical variables, reliably predicted the long-term total and cardiovascular mortality in patients undergoing CRT. While this score cannot be used to predict the benefit of CRT, it may be useful for predicting survival after CRT. This may have useful implications for follow-up. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.
    European Journal of Heart Failure 04/2015; 17(7). DOI:10.1002/ejhf.269 · 6.53 Impact Factor
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    ABSTRACT: Atrial fibrillation (AF) is a frequent comorbidity in pacemaker patients and is recognized cause of mortality, morbidity and quality of life impairment. The international MINERVA trial established that atrial preventive pacing and atrial antitachycardia pacing (DDDRP) in combination with Managed Ventricular Pacing (MVP) reduce permanent AF occurrence in comparison with standard dual-chamber pacing (DDDR). We aimed to determine the role of the new-generation of antitachycardia pacing (Reactive ATP) in preventing AF disease progression. Dual-chamber pacemaker patients with previous atrial tachyarrhythmias were randomly assigned to DDDR (n=385), MVP (n=398), or DDDRP+MVP (n=383). The incidence of permanent AF, as defined by the study investigator, or persistent AF, defined as ≥7 consecutive days with AF, was estimated through the Kaplan-Meier method, while its association with patients' characteristics was evaluated via multivariable Cox regression. At 2 years, the incidence of permanent or persistent AF was 26% (95% confidence interval (95%CI)=22-31%) in DDDR patients, 25% (95%CI=21-30%) in MVP and 15% (95%CI=12-20%) in DDDRP+MVP (p<0.001 vs. DDDR, p=0.002 vs. MVP). GEE-adjusted Reactive ATP efficacy was 44.4% (95%CI=41.3-47.6%). Multivariate modelling identified high Reactive ATP efficacy (>44.4%) as a significant predictor of reduced permanent or persistent AF risk (hazard ratio (HR)=0.32 (95%CI=0.13-0.781), p=0.012) and episodes' characteristics, such as long atrial arrhythmia cycle length, regularity and the number of rhythm transitions, as predictors of high ATP efficacy. In bradycardia patients, DDDRP+MVP pacing delays AF disease progression, with Reactive ATP efficacy being an independent predictor of permanent or persistent AF reduction. Copyright © 2015. Published by Elsevier Inc.
    Heart rhythm: the official journal of the Heart Rhythm Society 04/2015; 12(8). DOI:10.1016/j.hrthm.2015.04.015 · 5.08 Impact Factor
  • Giuseppe Boriani
    Europace 03/2015; 17(5). DOI:10.1093/europace/euv031 · 3.67 Impact Factor
  • Giuseppe Boriani · Luigi Padeletti
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    ABSTRACT: Sinus node disease (SND), a common indication to implant a pacemaker, is frequently associated with atrial fibrillation (AF), either at implantation (paroxysmal AF) or during follow-up, which often evolves to persistent or permanent AF. Pacemakers with an atrial lead allow continuous monitoring of the atrial rhythm and enable detection of the burden of AF. Asymptomatic atrial tachyarrhythmias, being associated with increased risk of stroke, have important prognostic implications, and their detection could guide decision-making about antithrombotic prophylaxis. Pacing mode and pacing algorithms can influence the occurrence of AF and atrial tachyarrhythmias. In DDD/DDDR pacing mode, reduction of unnecessary right ventricular pacing positively affects the occurrence and evolution of AF, but patients with a history of atrial tachyarrhythmias maintain an increased risk of arrhythmic events. In the MINERVA study, the use of algorithms that act in the atrium for preventive pacing and atrial antitachycardia pacing while minimizing right ventricular pacing was beneficial in patients with SND and previous atrial tachyarrhythmias, and was associated with a significant reduction in evolution to permanent AF. New information available on therapies delivered at the atrial level by implanted devices suggests clinical advantages that could improve current guidelines for the management of AF and atrial tachyarrhythmias.
    Nature Reviews Cardiology 03/2015; 12(6). DOI:10.1038/nrcardio.2015.30 · 9.18 Impact Factor
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    ABSTRACT: Scopo dello studio è stato capire il vantaggio di un catetere quadripolare con dipolo stretto nella gestione della stimolazione diaframmatica (SNV), delle alte soglie miocardiche (SM) e nella risposta alla terapia di resincronizzazione cardiaca (CRT) a 6 mesi di follow-up (6 M FUP). Metodi 158 pazienti (pz) portatori di una CRT-D impiantati con un catetere ventricolare sinistro (VSn) quadripolare Medtronic- Performa (P) sono stati rivalutati a 6 M FUP come classe NYHA, rimodellamento ventricolare inverso, presenza di SNV o alte SM in tutte le configurazione di stimolazione. Risultati. A 6 M FUP 99 (66%) pz avevano un rimodellamento ventricolare inverso (inteso come riduzione > 15% del volume ventricolare sinistro telesistolico). 101 (67%) pz avevano una riduzione della classe NYHA di almeno 1 punto e 8 (5%) sono morti. Nessuno dei pz è stato trapiantato e 13 (9%) sono stati ospedalizzati per una qualsiasi causa. All’ impianto, la SNV era presente in almeno 1/16 configurazioni in 65 (41%) pz, mentre al FUP in 78 (52%). Sia in acuto che in cronico, tutti i pz avevano almeno 4 configurazioni di stimolazione per la gestione della SNV, e più di 9 configurazione di stimolazione con la SM sotto 2.5V@0.5 ms. Al FUP 4 (3%) pz hanno avuto una dislocazione del catetere ventricolare sinistro, nella metà dei casi è stato risolto con il riposizionamento elettronico mentre negli altri 2 casi (2%) è stato necessario un reintervento. 83 (65%) pz avevano una configurazione di stimolazione non presente in un catetere bipolare standard. Il dipolo stretto è stato utilizzato in 31 (20%) pz perché considerato il migliore in termini di SNV , longevità o resincronizzazione cardiaca. Al FUP 36 (24%) pz hanno modificato la configurazione di stimolazione per SNV, aumento della SM o assenza di rimodellamento ventricolare inverso: 11 (7%) pz sono passati da una configurazione standard ad una presente solo nel catetere quadripolare e solo 3 (2%) pz hanno fatto il contrario. Conclusioni. 66% dei pz con P hanno avuto un rimodellamento ventricolare inverso e solo il 2% ha avuto una dislocazione con necessità di reintervento. Il catetere ventricolare sinistro P permette una facile gestione della SNV e delle alte SM sia all’impianto che durante il FUP. Le configurazioni di stimolazione non disponibili in un elettrocatetere bipolare sono state utilizzate nella maggior parte dei pazienti e tra queste, le configurazioni con dipolo stretto sono risultate le più utilizzate.
    12 Congresso Nazionale AIAC, Bologna, Italy; 03/2015
  • 12° Congresso Nazionale AIAC 2015, Bologna; 03/2015
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    ABSTRACT: The purpose of this study was too describe the associated baseline features of AF patients with heart failure (HF) with reduced and preserved ejection fraction (HFrEF and HFpEF). Secondly, we assessed symptomatic status and their clinical correlates. Finally, we examined independent predictors for 'heart failure' at the 1-year follow-up period. A survey of European cardiologists from nine countries, participating in the EURObservational Research Programme Pilot survey on Atrial Fibrillation (EORP-AF Pilot), was carried out. Of the whole cohort of 2972 patients, 1411 (47.5%) had a diagnosis of HF. Of the AF patients with HF, oral anticoagulants were prescribed to 82.1% and antiarrhythmic drugs in 36.7%. Independent predictors of HFpEF were high body mass index, high heart rate, high systolic blood pressure, low diastolic blood pressure, high CHA2 DS2 -VASc score, and absence of chronic kidney disease, sleep apnoea, or ischaemic cardiomyopathy. On multivariate stepwise regression analysis, independent predictors of the development of HF were mode of AF presentation, diuretic use, prior HF, COPD, and valvular disease. At 1 year, HF was associated with a greater risk of all-cause mortality (log-rank test, P < 0.001). When HFrEF was compared with HFpEF at 1 year, crude rates were significant for the composite endpoint of 'stroke/thrombo-embolism/transient ischaemic attack and death' (15.9% vs. 11.1%, P = 0.043). We provide insights into the clinical characteristics and outcomes in AF patients with HF, who were managed by European cardiologists. Despite a high prevalence of oral anticoagulant use, 1-year mortality and morbidity remained high in AF patients with HF, whether HFrEF or HFpEF. Such patients require a holistic approach to cardiovascular risk management. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.
    European Journal of Heart Failure 03/2015; 17(6). DOI:10.1002/ejhf.254 · 6.53 Impact Factor
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    ABSTRACT: Many patients who suffer from bradycardia and need cardiac pacing also have atrial fibrillation (AF). New pacemaker algorithms, such as atrial preventive pacing and atrial antitachycardia pacing (DDDRP), and Managed Ventricular Pacing (MVP), have been specifically designed to reduce AF occurrence and duration, and to minimize right ventricular pacing detrimental effects. The randomized MINERVA trial established that DDDRP+MVP pacing modality reduced permanent AF in bradycardia patients compared to standard dual-chamber pacing (DDDR). Quantify the cost savings due to lower AF-related healthcare utilizations based on health care costs from the United States and the European Union. Dual-chamber pacemaker patients with history of paroxysmal or persistent AF were randomly assigned to receive DDDR (n=385) or the advanced features (DDDRP+MVP; n=383). We used published healthcare cost from the United States and the European Union (Italy, Spain, UK) to estimate the costs associated with AF-related hospitalisations and emergency visits. The rate of AF-related hospitalizations was significantly lower in the DDDRP+MVP group compared with the conventional pacemaker group DDDR (42% reduction; Incidence Rate Ratios (IRR): 0.58). Similarly a significant 68% reduction for AF-related ER visits (IRR: 0.32, p<0.001) was observed. As a consequence, DDDRP+MVP could potentially reduce healthcare costs by 40-44%. Over a ten year period, the cost savings per 100 patients ranged from $35,702 in the UK to $121,831 in the US. New pacing algorithms such as DDDRP+MVP used in the MINERVA trial successfully reduced AF-related healthcare utilization resulting in significant cost savings to payers. Copyright © 2015. Published by Elsevier Inc.
    Heart rhythm: the official journal of the Heart Rhythm Society 02/2015; 12(6). DOI:10.1016/j.hrthm.2015.02.017 · 5.08 Impact Factor
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    ABSTRACT: Inappropriate ICD shocks are common adverse events; they are mainly due to supraventricular arrhythmias and secondly are related to noise, undersensing, oversensing, device malfunctions. We present a case of inappropriate device therapy due to myopotential oversensing in a patient with a subcutaneous ICD (s-ICD). A 58 years old male with an s-ICD during the device interrogation showed a previous episode of suspected sustained ventricular tachycardia at 210 bpm, which was effectively treated with ICD shock. The patient experienced the electrical shock while holding a big gas-cylinder in his arms. The EGM analysis revealed many irregular ventricular signals of low amplitude lasting for 24 s and interrupted by the shock. The device showed no malfunctions. This is the first case report of inappropriate S-ICD shock related to myopotential over-sensing. By recording intracardiac EGM, we demonstrated that the noise was created by the activity of the pectorals muscles. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.
    Indian Heart Journal 02/2015; 67(1). DOI:10.1016/j.ihj.2015.01.001 · 0.17 Impact Factor

Publication Stats

7k Citations
2,073.51 Total Impact Points


  • 2007–2015
    • Policlinico S.Orsola-Malpighi
      Bolonia, Emilia-Romagna, Italy
  • 1990–2015
    • University of Bologna
      • Institute of Cardiology
      Bolonia, Emilia-Romagna, Italy
  • 2012
    • University of Bonn
      Bonn, North Rhine-Westphalia, Germany
    • Hospital Civile Ramazzini
      Carpi, Emilia-Romagna, Italy
  • 2010
    • Italian National Institute of Statistics
      Roma, Latium, Italy
    • Galliera Hospital
      Genova, Liguria, Italy
    • Civil Hospital, Raikot
      Rāikot, Punjab, India
  • 2009
    • Bologna Center
      Bolonia, Emilia-Romagna, Italy
  • 1992–2009
    • Università degli Studi di Siena
      Siena, Tuscany, Italy
  • 2003
    • St. Jude Medical
      Little Canada, Minnesota, United States
  • 2001
    • Ospedale Maggiore Carlo Alberto Pizzardi di Bologna
      Bolonia, Emilia-Romagna, Italy
  • 1989–1990
    • Università Politecnica delle Marche
      Ancona, The Marches, Italy