François Regoli

Cardiocentro Ticino · Cardiology

Background Leadless pacing has been established as an alternative approach to transvenous devices for selected patients. Often, leadless pacemaker (LP) implantation is a de novo procedure, but in an increasing number of patients, an LP is used after previous implantation of a conventional pacing system (CPS). Methods A retrospective analysis was c...

Background Impairment of the conduction system is a common complication of transcatheter aortic valve replacement (TAVR), which is typically performed in elderly patients. A leadless pacemaker (LP) may be a suitable option in this frail population, but the available scientific data concerning the efficacy and safety of leadless pacing after TAVR ar...

Background: Device patients may require upgrade interventions from simpler to more complex cardiac implantable electronic devices. Prior to upgrading interventions, clinicians need to balance the risks and benefits of transvenous lead extraction (TLE), additional lead implantation or lead abandonment. However, evidence on procedural outcomes of TL...

Aims of the study: Long-term complication rates in standard transvenous pacemakers are reported around 4-12% with a higher incidence in the elderly population. We report our experience in octogenarians undergoing leadless pacemaker implantation in two large-volume centres in Switzerland. Methods: Consecutive patients undergoing leadless pacemake...

Introduction: Data on peri-operative management of direct-acting oral anticoagulants (DOACs) during transcatheter pacing leadless system (TPS) implantations remain limited. This study aimed to evaluate a standardized DOAC management regime consisting of interruption of a single dose prior to implantation and reinitiation within 6-24 h; also, patie...

Introduction: Data on peri-operative management of direct-acting oral anticoagulants (DOACs) during transcatheter pacing leadless system (TPS) implantation remain limited. This study aimed to evaluate a standardized DOAC management regime consisting in interruption of a single dose prior to implantation and reinitiation within 6-24 hours; also, pat...

Unlabelled: Management of hemodynamically stable, incessant wide QRS complex tachycardia (WCT) in patients who already have an implantable cardioverter defibrillator (ICD) is challenging. First-line treatment is performed by medical staff who have no knowledge on programmed ICD therapy settings and there is always some concern for unexpected ICD s...

Aims To investigate the role of genetic testing in patients with idiopathic atrioventricular conduction disease requiring pacemaker (PM) implantation before the age of 50 years. Methods and results All consecutive PM implantations in Southern Switzerland between 2010 and 2019 were evaluated. Inclusion criteria were: (i) age at the time of PM impla...

Background Cardiac resynchronization therapy (CRT) is clinically proven in patients with heart failure (HF) and left bundle branch block (LBBB). However, approximately 30% of CRT individuals are non responsive to the therapy while factors affecting electromechanical coupling remain not fully understood. Objective To determine the optimal combinati...

Aims Electromechanical coupling in patients receiving cardiac resynchronization therapy (CRT) is not fully understood. Our aim was to determine the best combination of electrical and mechanical substrates associated with effective CRT. Methods and results Sixty-two patients were prospectively enrolled from two centres. Patients underwent 12-lead e...

In recent years, the rate of pacemaker implantations has continued to rise throughout Europe [...]

Purpose The miniaturized transcatheter pacing system (TPS) implant is performed using a 27 Fr sheath. Achieving femoral vein access hemostasis after sheath removal is of utmost importance. Feasibility and clinical effectiveness of double device-based suture-mediated closure technique (DualPerclose) were evaluated. Methods Patients undergoing TPS p...

Funding Acknowledgements Type of funding sources: None. Background Impairment of the conduction system may occur in 9-30 % of patients undergoing transcatheter aortic valve replacement (TAVR). Since this is typically an elderly and frail patient population, leadless pacing potentially offers benefits over conventional transvenous pacemaker devices...

Funding Acknowledgements Type of funding sources: None. Background Leadless pacing has been established as an alternative approach to transvenous devices for selected patients suffering from bradycardias. While in the majority of cases leadless pacemaker implantation represents a de novo procedure, in an increasing number of patients such a device...

Sustained forms of atrial fibrillation (AF) may be associated with a higher risk of adverse outcomes, but few if any long-term studies took into account changes of AF type and co-morbidities over time. We prospectively followed 3843 AF patients and collected information on AF type and co-morbidities during yearly follow-ups. The primary outcome was...

Electrophysiology procedures have evolved to be among the most utilized for a variety of cardiac rhythm disorders over the last three decades. A part of this success is because of improvements in signal processing, catheter design, and three-dimensional mapping technology. However, present ablation procedures for the most common arrhythmias like at...

Aims Data regarding the efficacy of catheter ablation in heart failure patients with severely dilated left atrium and reduced left ventricular ejection fraction (LVEF) are scanty. We sought to assess the efficacy of catheter ablation in patients with reduced LVEF and severe left atrial (LA) enlargement, and to compare it to those patients with pres...

Background. Short ECG P‐wave duration has recently been demonstrated to be associated with higher risk of atrial fibrillation (AF). The aim of this study was to assess the rate of AF recurrence after pulmonary vein isolation in patients with a short P wave, and to mechanistically elucidate the observation by computer modeling. Methods and Results....

The association of blood pressure (BP) and hypertension with the presence of different types of brain lesions in patients with atrial fibrillation is unclear. BP values were obtained in a multicenter cohort of patients with atrial fibrillation. Systolic and diastolic BP was categorized in predefined groups. All patients underwent brain magnetic res...

Background Remote monitoring (RM) technology embedded in cardiac rhythm devices permits continuous monitoring of device function, and recording of selected cardiac physiological parameters and cardiac arrhythmias and may be of utmost utility during Coronavirus (COVID-19) pandemic, when in-person office visit for regular follow-up were postponed. Ho...

Aims. Non-invasive imaging of electrical activation requires high-density body surface potential mapping. The 9 electrodes of the 12-lead ECG are insufficient for a reliable reconstruction with standard inverse methods. Patient-specific modeling may offer an alternative route to physiologically constraint the reconstruction. The aim of the study wa...

Background: Leadless pacemakers are an established treatment option for bradyarrhythmias. Similar to conventional transvenous pacemakers, satisfying pacing values during implantation are targeted for optimal long-term device function. The objective is to investigate the role of a local injury current (IC) in leadless pacemaker implantations. Meth...

Aims: To assess the value of high-density mapping (HDM) in revealing undetected incomplete pulmonary vein isolation (PVI) after the fourth-generation cryoballoon (CB4G) ablation compared to the previous cryoballoon's versions. Methods and results: Consecutive patients with paroxysmal or early-persistent atrial fibrillation (AF) undergoing CB abl...

Aims: The aim of this study was to determine the relationship between electrical and mechanical activation in heart failure (HF) patients and whether electromechanical coupling is affected by scar. Methods and results: Seventy HF patients referred for cardiac resynchronization therapy or biological therapy underwent endocardial anatomo-electrome...

Introduction The complexity of candidates for transvenous lead extraction (TLE) has shown a parallel increase, both in terms of comorbidities, and of concomitant therapy, including antithrombotic therapy (AT). The management of candidates for TLE receiving concomitant AT is a debated issue, and only marginally the object of evidence-based recommend...

Background Pulmonary vein isolation (PVI) is becoming the therapy of choice for symptomatic paroxysmal drug-refractory atrial fibrillation (AF). The most frequently reported complications are vascular complications (1.4%). Bleeding complications of the central nervous system have rarely been described. We report a case of spontaneous spinal bleed a...

Aims: To define the clinical characteristics and long-term clinical outcomes of a large cohort of patients with idiopathic ventricular fibrillation (IVF) and normal 12-lead electrocardiograms (ECGs). Methods and results: Patients with ventricular fibrillation as the presenting rhythm, normal baseline, and follow-up ECGs with no signs of cardiac...

Background: Little is known about the ICD performance using enhanced detection algorithms in unselected, non-trial patients. Performance of recent generation ICD equipped with SmartShock™ technology (SST) for detection and conversion of ventricular tachyarrhythmias (VTA) was investigated. Methods: 4P was a prospective, multicenter, observational st...

Aims: A sub-analysis of the ESC-EHRA European Lead Extraction ConTRolled (ELECTRa) Registry to evaluate the clinical impact of antithrombotic (AT) on transvenous lead extraction (TLE) safety and efficacy. Methods and results: ELECTRa outcomes were compared between patients without AT therapy (No AT Group) and with different pre-operative AT regi...

Background: Modern ECG imaging (ECGi) tools enable accurate, non-invasive evaluation of epicardial potential and activation from high-density body surface potential maps and patient-specific anatomy. Current ECGi tools, however, 1) are limited to the epicardium, with no septal and transmural information, 2) do not use prior knowledge on conduction...

Introduction Little data are available on anticoagulation (AC) management in patients with cardiac resynchronization (CRT) devices who undergo lead extraction procedure (TLE). We investigated the impact of AC on peri‐procedural complications in CRT patients undergoing TLE, enrolled in the ESC‐EHRA European Lead Extraction ConTrolled (ELECTRa) regis...

Background: Patients with atrial fibrillation (AF) have an increased risk of cognitive decline, potentially resulting from clinically unrecognized vascular brain lesions. Objectives: This study sought to assess the relationships between cognitive function and vascular brain lesions in patients with AF. Methods: Patients with known AF were enro...

Aims: We aimed at describing outcomes and predictors of cardiac avulsion or tear (CA/T) with tamponade and vascular avulsion or tear (VA/T) after transvenous lead extraction (TLE) in the ESC-EHRA European Lead Extraction ConTRolled (ELECTRa) registry. Methods and results: A total of 3555 consecutive patients of whom 3510 underwent TLE at 73 cent...

Aims: P-wave beat-to-beat morphological variability can identify patients prone to paroxysmal atrial fibrillation (AF). To date, no computational study has been carried out to mechanistically explain such finding. The aim of this study was to provide a pathophysiological explanation, by using a computer model of the human atria, of the correlation...

Aims: The aim of this study was to investigate the influence of the activation sequence on voltage amplitudes by evaluating regional voltage differences during a left bundle branch block (LBBB) activation sequence vs. a normal synchronous activation sequence and by evaluating pacing-induced voltage differences. Methods and results: Twenty-one pa...

Background: CRT has been proven to achieve most benefit in patients with left bundle branch block morphology (LBBB). However, ECG criteria to define LBBB significantly differ from each other. Objective of the study was to evaluate the impact of different ECG criteria for LBBB definition on survival, hospitalization for heart failure and reverse re...

Background: Unrecognized incomplete pulmonary vein isolation (PVI), as opposed to post-PVI pulmonary vein reconnection, may be responsible for clinical recurrences of atrial fibrillation (AF). To date, no data are available on the use of high-resolution mapping (HRM) during cryoballoon (CB) ablation for AF as the index procedure. The aims of this...

Aims Phrenic nerve palsy (PNP) after mechanical transvenous lead extraction (TLE) was recently described for the first time. We aimed to analyse our TLE database for the presence of PNP. Methods and results All consecutive patients referred to our institution were included in this study. Every available post-procedural chest X-ray was compared to...

Purpose: Pericardial effusion (PE) may occur during the lead extraction procedure (TLE). Little is known about the incidence, causes, and predictors of this complication. Methods: From January 2009 to October 2016, TLE was attempted for 297 leads in 212 patients (age 69.3 ± 12.9 years, 169 male, BMI 27.2 ± 9.9 m²/kg, LVEF 43.4 ± 24.6%) for lead...

Objectives: The electrocardiogram (ECG) of patients with BrS in sinus rhythm might reflect intrinsic atrial electrical abnormalities independent from any previous atrial fibrillation (AF). Aim of this study is to investigate the presence of P-wave abnormalities in patients with BrS and no history of AF, and to compare them with those displayed by...

Objectives This study sought to test the accuracy of strain measurements based on anatomo-electromechanical mapping (AEMM) measurements compared with magnetic resonance imaging (MRI) tagging, to evaluate the diagnostic value of AEMM-based strain measurements in the assessment of myocardial viability, and the additional value of AEMM over peak-to-pe...

The implantation rate of cardiac electronic devices has grown over the past decades. The number of treated patients has increased in parallel with the complexity of the patient population treated, being older, frailer, having more complex devices (in particular, cardiac resynchronisation therapy) and presenting with a greater comorbidity burden. As...

Background: Validation of voltage-based scar delineation has been limited to small populations using mainly endocardial measurements. The aim of this study is to compare unipolar voltage amplitudes (UnipV) with scar on delayed enhancement cardiac magnetic resonance imaging (DE-CMR). Methods: Heart failure patients who underwent DE-CMR and electr...

Introduction: Lead extraction procedure (TLE) may determine tricuspid valve regurgitation (TR) or worsen pre-existing TR. This study evaluated entity of TR before and after TLE. Methods: From January 2009 to December 2016, TLE of 295 leads in 214 patients(pts)(mean age 70+-13 years, 156 male, mean BMI 27+-11 m2/kg, LVEF 436 27%) was performed. Indi...

This study assessed the clinical utility and feasibility of concomitant of combined left atrial appendage (LAA) closure and positioning of miniaturized pace-maker (Micra TPS). All consecutive patients undergoing VVI-PM implant from November 2015 to October 2016 were considered. VVI-PM implant was conducted either using transvenous approach or by po...

Aims Subcutaneous implantable cardioverter-defibrillator (S-ICD) can avoid important complications associated with transvenous leads in patients with inherited primary arrhythmia syndromes, who do not need pacing therapy. Few data are available on the percentage of patients with inherited arrhythmia syndromes eligible for S-ICD implantation. Aim of...

Aim: We compared the time to initiation of cardiopulmonary resuscitation (CPR) by lay responders and/or first responders alerted either via Short Message Service (SMS) or by using a mobile application-based alert system (APP). Methods: The Ticino Registry of Cardiac Arrest collects all data about out-of-hospital cardiac arrests (OHCAs) occurring...

Aims: Radiofrequency ablation (RFA) is the treatment of choice of cavotricuspid isthmus (CTI)-dependent atrial flutter. Procedural time is highly variable due to anatomical structures. This study aimed to characterize CTI anatomy by transesophageal 3D echocardiography imaging (3D-TEE) to identify anatomic structures related to longer ablation time...

Background: Both duration and morphology of the T-wave are regarded important parameters describing repolarization of the ventricles. Conventionally, T-wave concordance is explained by an inverse relation between the time of depolarization (TD) and repolarization (TR). Little is known about T-wave morphology and TD-TR relations in patients with he...

Aims: Apparently conflicting clinical measurements of P-wave duration (PWD) pre- vs. post-ablation have been reported. To assist the interpretation of these clinical data, we used a computer model of the atria and torso to simulate P waves before and after pulmonary vein (PV) isolation. Methods and results: Twenty ablation patterns were designed (...

AIMS: Apparently conflicting clinical measurements of P-wave duration (PWD) pre- vs. post-ablation have been reported. To assist the interpretation of these clinical data, we used a computer model of the atria and torso to simulate P waves before and after pulmonary vein (PV) isolation. METHODS AND RESULTS: Twenty ablation patterns were designed (s...

Background: The aim of this study was to determine overall and aetiology-related incidence of secondary prevention ICD implantation over the last 15years in Canton Ticino and to assess clinical outcome according to time period of implantation. Methods and results: Consecutive patients treated by implantation of an ICD for secondary prevention fr...

Few data are available on the assessment of P-wave beat-to-beat morphology variability and its ability to identify patients prone to paroxysmal atrial fibrillation (AF) occurrence. Aim of this study was to determine whether electrocardiographic (ECG) parameters resulting from the beat-to-beat analysis of P-wave in ECG recorded during sinus rhythm c...

Purpose: Early and good quality cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AEDs) improve cardiac arrest patients' survival. However, AED peri- and post-shock/analysis pauses may reduce CPR effectiveness. Methods: The time performance of 12 different commercially available AEDs was tested in a manikin ba...

Brugada and early repolarisation (ER) syndromes are currently considered two distinct inherited electrical disorders with overlapping clinical and electrocardiographic features. A considerable number of patients diagnosed with ER syndrome have a genetic mutation related to Brugada syndrome (BrS). Due to the high variable phenotypic manifestation, p...

Left atrial appendage (LAA) closure is indicated in patients with atrial fibrillation (AF) and high bleeding as well as thromboembolic risks. A subgroup of these patients may also present an indication for a single-chamber permanent pacemaker due to symptomatic low-rate AF or when "ablate and pace" strategy is indicated for rate control. A miniatur...

Purpose: Left-bundle-branch block (LBBB) is a heterogeneous ventricular electrical disorder. Patient-specific models were created to characterize myocardial electrical properties in heart failure patients with LBBB. Methods: The database consisted of 10 patients diagnosed with LBBB with no scars as detected by cardiac magnetic resonance imaging (CM...

Purpose: Heart failure patients are often affected by a ventricular conduction disorder. Accurate characterization of the tridimensional (3D) activation sequence of the ventricles is fundamental for an effective personalized therapy. Electroanatomical mapping provides the activation times at the endocardium, with limited coverage due to anatomical...

Purpose: Pericardial effusion (PE) may be a life-threatening complication of lead extraction procedure (TLE). We evaluated causative mechanism of PE formation during TLE and subsequent patient management. Method: From January 2009 to June 2015, TLE of 264 leads in 184 patients(pts)(mean age 69 ± 14 years, 131 male, mean BMI 27 ± 11m²/kg, LVEF 43± 2...

Background: There are sparse data on the percentage of patients with Brugada syndrome (BrS) eligible for a subcutaneous implantable-defibrillator (S-ICD) implantation. Aim of this study was to analyze eligibility for S-ICD in a series of patients with BrS, and to compare with age- and gender-matched patients with structural heart disease. Methods:...

Purpose: Measurements of left ventricular (LV) systolic function, in particular strain, are gaining popularity as predictor of CRT effectiveness. Also, spatially accurate strain mapping, may help guiding intramyocardial biological therapy delivery and assessment. We recently developed a method for the simultaneous assessment of the LV electrical an...

Introduction: Little is known about the clinical outcome and recurring system-related adverse events (SAE) in cardiac resynchronization therapy (CRT) patients after transvenous lead extraction (TLE). Methods and results: From January 2009 to June 2014, 256 consecutive CRT patients (mean age 68.3 ± 11.6 years, 216 male, 88% in New York Heart Asso...

Left atrial appendage closure is indicated in patients with atrial fibrillation (AF) and high bleeding as well as thromboembolic risks. A subgroup of these patients may also present an indication for a single-chamber permanent pacemaker due to symptomatic low-rate AF or when "ablate and pace" strategy is indicated for rate control. A miniaturized w...

Aims Out-of-hospital cardiac arrest (OHCA) in the absence of evident structural heart disease is rare and can be due to subclinical cardiomyopathy and primary electrical disorders, including idiopathic ventricular fibrillation (IVF) with early repolarization (ER) pattern. Aim of this study was to investigate prevalence, clinical features, and long-...

Purpose: The electrocardiogram (ECG) is sensitive to geometrical factors such as heart­torso geometry and respiration. Moreover, ventricular enlargement, as noted in heart failure (HF) patients, may rotate the heart to a more horizontal orientation. The purpose of this study was to investigate the effect of heart position and orientation on the 12­...

Background: Combined measurement of electrical activation and mechanical dyssynchrony in heart failure (HF) patients is scarce but may contain important mechanistic and diagnostic clues. Objective: The purpose of this study was to characterize the electromechanical (EM) coupling in HF patients with prolonged QRS duration. Methods: Ten patients...

Aims Left-ventricular (LV) conduction disturbances are common in heart-failure patients and a left bundle-branch block (LBBB) electrocardiogram (ECG) type is often seen. The precise cause of this pattern is uncertain and is probably variable between patients, ranging from proximal interruption of the left bundle branch to diffuse distal conduction...

BACKGROUND: Data on the use of transesophageal echocardiography (TEE) during transvenous lead extraction (TLE) procedures are scarce. OBJECTIVE: The purpose of this study was to assess the routine use of TEE during transvenous lead extraction. METHODS: From January 2009 to January 2014, TLE of 241 leads in 168 patients (mean age 70 ± 13 years, 129...

Real-time 3-dimensional transesophageal echocardiography (RT3DTEE) has the potential of giving fluoroless real-time images during electrophysiological procedures [(1)][1]. We sought to prospectively evaluate the ability of RT3DTEE to visualize the pulmonary vein (PV) ostia and to compare RT3DTEE

Aims: Left ventricular (LV) endocardial pacing may address the limitations in the selection of an LV pacing site and provide improvements in cardiac resynchronization therapy (CRT) effectiveness. We report on the feasibility, the safety, and the short-term outcome of a leadless ultrasound-based technology for LV endocardial resynchronization in he...

Because of their rapid onset of action and short therapeutic half-life, new oral anticoagulants (NOACs) may significantly simplify peri-procedural oral anti-coagulation management during cardiac implantable electronic device implant and trancatheter ablation procedures. The pharmacological properties of NOACs are reviewed to better comprehend how t...

Background: In experimental models, ranolazine exerts a synergistic effect which enhances amiodarone's potential to suppress atrial fibrillation (AF). The clinical effect of ranolazine added to amiodarone for AF conversion has only undergone minimal investigation. Purpose: This study compared the safety and effectiveness of ranolazine in combinatio...

Introduction: Cardiac resynchronization therapy (CRT) with single site left ventricular (LV) pacing improves acute cardiac hemodynamics. We hypothesized that CRT with multisite LV pacing in a single coronary sinus branch can offer further acute hemodynamic benefits to patients. Methods: Forty-four patients receiving a CRT implant (Unify Quadra MP™...

AIMS: Several factors can influence the extent of left ventricular (LV) reverse remodelling after cardiac resynchronization therapy (CRT) in patients with heart failure (HF). Polymorphism in genes involved in cardiac remodelling, namely beta-adrenergic receptors (ARs), may have a role. We studied the influence of beta-1 Arg389Gly, beta-2 Arg16Gly,...

AimsThe importance of specific-site pacing is increasingly recognized in cardiac resynchronization therapy (CRT). Using current pacing technology, site selection is still largely limited by coronary vein anatomy, whereas left ventricular (LV) endocardial pacing using current lead technology is risky and challenging. To overcome limitations and comp...