P Zecchi's research while affiliated with Catholic University of the Sacred Heart and other places

Publications (115)

Article
Full-text available
Introduction: Radiofrequency catheter ablation is the mainstay of therapy for supraventricular tachyarrhythmias. Conventional radiofrequency catheter ablation requires the use of fluoroscopy, thus exposing patients to ionising radiation. The feasibility and safety of non-fluoroscopic radiofrequency catheter ablation has been recently reported in a...
Article
Contact point-to-point electroanatomic mapping (Pt-Map) is a validated tool to evaluate right ventricular (RV) substrate. When using the EnSite NavX system (St. Jude Medical, St Paul, Minnesota), geometry reconstruction by dragging the mapping catheter (Geo-Map) allows for quicker acquisition of a large number of points and better definition of ana...
Article
We report the case of a 50 year-old woman referred for extraction of an infected biventricular implantable cardioverter defibrillator (ICD) who underwent device and leads extraction. Due to adhesions at the level of the subclavian-innominate vein angle, manual traction with locking stylet was ineffective. A new mechanical sheath provided with a sta...
Article
Voltage Mapping-Guided Biopsy in ARVC/D. To improve the endomyocardial biopsy (EMB) diagnostic sensitivity for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D), we hypothesized a biopsy sampling focused on selected right ventricle (RV) low-voltage areas identified by electroanatomic voltage mapping. The study population (22 patien...
Article
A 65-year-old man was referred for atrial fibrillation ablation to our center. Routine pre-procedure transthoracic and transoesophageal echocardiography and cardiac computed tomography examinations showed a normal interatrial septum and fossa ovalis anatomy. Access to left atrium was initially planned using a conventional transseptal needle punctur...
Article
A positive endomyocardial biopsy (EMB) is a major diagnostic criterion for arrhythmogenic right ventricular cardiomyopathy (ARVC). Nevertheless, its sensitivity is low due to the focal nature of the disease. Moreover, myocardial samples are usually taken from the uncommonly involved interventricular septum to minimize the risk of perforation. In th...
Article
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 asses...
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Conduction disturbances and arrhythmias characterize the cardiac feature of myotonic dystrophy type 1 (MD1); a myocardial involvement has been suggested as part of the cardiac disease. The aim of our study was to investigate the underlying myocardial alterations using electroanatomic mapping (CARTO) and their possible correlation with genetic and n...
Article
transvenous positioning of the left ventricular (LV) lead in a branch of the coronary sinus (CS) is generally the preferred implantation technique in biventricular pacing. Very few data are reported about removal of LV pacing leads positioned in a CS branch. Aim of the study was to describe our experience with percutaneous extraction of LV pacing l...
Article
Full-text available
Biventricular implantation procedures require contrast venography of the coronary sinus. The aim of our study was to evaluate the efficacy and safety of contrast venography obtained by direct manual contrast injection into the guiding catheter, compared with venography obtained after occlusion of the coronary sinus by a Swan-Ganz catheter. Eighty-t...
Article
Biventricular pacing system implantation is a time-consuming and challenging procedure. A critical step in biventricular pacemaker implantation is coronary sinus (CS) cannulation. CS cannulation can be achieved either using dedicated guiding catheters (guiding catheter alone positioning strategy, GCA) or with the aid of an electrophysiology cathete...
Article
The term "heart rate turbulence" (HRT) indicates the physiologic changes in the sinus cycle that follow a ventricular premature complex; impaired HRT denotes abnormalities in cardiac autonomic function. To investigate whether HRT is impaired in patients with stable coronary artery disease (CAD), we studied 29 patients with documented CAD and freque...
Chapter
Biventricular stimulation is a new promising therapy for the treatment of moderate-to-severe heart failure in patients refractory to drug treatment and with contractile dyssynchrony due to conduction delay. The principle on which the resynchronization therapy is based is the reactivation of homogeneous and synchronized contraction by means of atria...
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The aims of this study were to compare the efficacy of a 2- versus a 3 RF lesions ablation procedure in the RA in patients with paroxysmal AF, and to map right atrial activation during AF. RF catheter-mediated ablation lines mimicking the Maze operation have been proposed as a novel curative approach for AF. The relationship between this type of ab...
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We performed a review of the current literature in order to evaluate clinical, electrocardiographic and electrophysiologic parameters predictive of atrial fibrillation development. Clinical parameters were obtained from two large observational studies (the Framingham heart study and the Cardiovascular health study). Different laboratoristic predict...
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The importance of genetics to the pathogenesis of myocardial infarction is suggested by the frequent familial clustering of premature disease. Yet, studies associating myocardial infarction with gene polymorphisms of vascular proteins (angiotensinogen, angiotensin converting enzyme, angiotensin II type 1 receptor, endothelial nitric oxide synthase)...
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Acute myocardial infarction, sudden cardiac death and ischemic stroke show a circadian periodicity, occurring more frequently in the morning. Because arterial thrombosis is common to these disorders, a circadianicity of prothrombotic and antithrombotic processes may contribute to explain the 24 h rhythms of these acute events. Available data indeed...
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Full-text available
Patients presenting with acute coronary syndromes disclose a number of gender-related differences. Women are more likely than men to have unstable angina and less likely to present with myocardial infarction. Women have a better prognosis than men among patients with unstable angina. Among patients with myocardial infarction without ST-segment elev...
Article
The present study examines the potential electromagnetic interference effects induced by cellular telephones on ICDs. We developed ad hoc protocols to conduct both in vitro and in vivo trials on most of the implantable cardioverter defibrillators available on the international market. Trials were conducted with three cellular telephones: two GSM (G...
Article
The aim of this study was to investigate the usefulness of heart rate variability (HRV) in predicting cardiac mortality in patients with a recent acute myocardial infarction at high risk of events. Time- and frequency-domain HRV was assessed on 24-hour pre-discharge Holter recording of 81 patients (mean age 65 +/- 10 years, 76.5% males) with 1) a r...
Chapter
Implantable cardioverter defibrillators (ICD) are automatic arrhythmia management devices designed to detect ventricular tachycardia (VT), fast ventricular tachycardia (FVT) or ventricular fibrillation (VF) and, upon detection, deliver the programmed pacing cardioversion or defibrillation therapies. In addition these devices provide bradycardia pac...
Chapter
The efficacy of implantable cardioverter-defibrillators (ICD) in preventing sudden death has been shown by several trials. Nonetheless two functions need to be improved: (1) the identification of arrhythmias other than VF (supraventricular or ventricular fibrillation) in order to reduce inappropiate shocks, (2) the quality of cardiac pacing. Dual-c...
Chapter
Although the benefits of dual (DDD) over single (VVI) chamber pacing have been demonstrated in hemodyamics, exercise capacity, quality of life and reduced complications in patients with atrioventricular block and sick sinus syndrome; a considerable number of such patients still receive single-chamber ventricular pacemakers, mostly because of the lo...
Article
Catheter ablation of accessory pathways using radiofrequency current has been shown to be effective in patients with Wolff-Parkinson-White syndrome, by using either the ventricular or atrial approach. However, the unipolar electrogram criteria for identifying a successful ablation at the atrial site are not well established. One hundred patients wi...
Chapter
The implantable cardioverter defibrillator (ICD) is an important and unique new method of potentially preventing recurrent sudden cardiac death (SCD) due to malignant ventricular arrhythmias (MVA).
Article
The purpose of this study was to evaluate the efficacy and safety of radiofrequency ablation of supraventricular tachycardias due to a reentry circuit in a group of closely followed-up pediatric patients. Forty-six pediatric patients (mean age 12.6 years, range 3-18) underwent a total of 48 radiofrequency ablation procedures for reciprocating supra...
Chapter
Supraventricular tachycardia (SVT) is the most common sustained cardiac arrhythmia in children and adolescents, approximately 85% being due to reentrant circuits (1). Pharmacologic treatment has been proposed as the first-line therapy for frequent, sustained episodes of SVT associated with significant symptoms. However, patients refractory to medic...
Article
In the past few years, there has been a relative explosion of activity in the realm of interventional cardiology. The high rate of success of radiofrequency energy ablation have transformed catheter ablation from an investigational procedure into the first-line therapy for symptomatic Wolff-Parkinson-White syndrome. Radiofrequency catheter ablation...
Article
The above study was aimed at testing the efficacy and tolerability of a pharmacological combination of the beta-blocking agent nadolol and the thiazide diuretic bendroflumethiazide. The trial was carried out in 20 patients (11 males, 9 females) aged 47 to 76 (average 59,9) with mild or moderate hypertension (WHO classes 1 and 2). Mean pressure valu...
Article
We evaluated the hemodynamic effects of nifedipine in 10 symptomatic patients with chronic refractory heart failure due to idiopathic cardiomyopathy. Nifedipine significantly increased cardiac index (from 1.80 +/- 0.4 to 3 +/- 0.6 L/min/m2), stroke volume index (from 21 +/- 6 to 33 +/- 8 ml/beat/m2), and stroke work index (from 17.9 +/- 7 to 25.5 +...
Article
The electrocardiographic and vectorcardiographic (Frank system) features of the first degree relatives of subjects with documented familial hypertrophic cardiomyopathy were analysed. A total of nine affected members and 29 relatives were examined in four families. THe subjects were considered to be affected when the septal to free posterior wall th...
Article
A case of progressive systemic sclerosis with syncopal symptoms is reported. The presenting ECG pattern was that of an anterior myocardial infarction. The clinical history and the coronary angiography excluded significant coronary atherosclerotic heart disease. The ECG pattern evolved from the infarctual pattern associated with right bundle branch...
Article
The acute cardiac effects of tolbutamide on myocardial contractility, evaluated with systolic time intervals (ST), and on the atrio-ventricular conduction system have been studied in a group of five volunteer normal subjects. The intravenous administration of 1 g of tolbutamide showed no considerable changes of STI and of electrophysiologic paramet...
Article
We describe a patient with complete intra-Hisian A-V block and narrow QRS who developed catheter-induced right bundle branch block during an electrophysiological study. Selective His bundle pacing was performed during complete intra-Hisian A-V block and right bundle branch block pattern; the distal His bundle pacing normalized the QRS complex, whil...
Article
We studied the antiarrhythmic effect of oral Mexiletine in 20 patients with stable high-frequency ventricular arrhythmias refractory to therapeutic doses of conventional antiarrhythmic therapy. Arrhythmias were classified according to modified grading system of Lown and Wolf. The efficacy of Mexiletine was assessed with use of both the arrhythmic m...
Article
In 92 patients affected from chronic obstructive pulmonary disease (C.O.P.) undergoing spirometric evaluation, the ability of the Pipberger computer program for electrocardiographic interpretation to predict the presence of pulmonary disease with or without right ventricular hipertrophy was compared with that of the manually measured conventional a...
Article
For clinical purpose, poligraphyc signals are analyzed: systolic time intervals (STI) and all other significative magnitudes are measured. A system of modular programs (ATS), in Assembler and Fortran IV languages, digitalizes, filters and analyzes three simultaneous analogical signals: ECG, PCK and CP. ATS, adapted polynomial and gonyometrics leats...
Article
A method is presented for the non-invasive recording of His bundle electrical activity from the body surface in man. Several bipolar ECG leads were employed: precordial, Frank "x" and Frank "z". Signals were filtered (30-300 Hz), highly amplified (5 x 104) and averaged. Digital averaging was performed on line by a microcomputer (OTE Biomedica Neuro...
Article
Systolic time intervals were measured in 21 endurance-athletes (middle and lung distance runners) with a computerized method. Data from athletes were compared with that obtained in 27 age-matched normal untrained subjects. Endurance athletes showed significantly inferior values than normal untrained subjects of heart rate, total ejection time (TET)...
Article
The HP-5 program for computer analysis of the ECG has been evaluated as far as sensibility and specificity in a multicenter study. A consistent number of tracings were sampled according to a statistical formula and all measurements and statements given by the computer were checked in a standardized manner. The collected data were classified and com...
Article
We present three cases of primary sclerodermic cardiopathy with an electrocardiographic picture of anterior myocardial infarction not preceded by chest pain. On one of the cases a coronary angiography was performed with negative results. The echocardiogram of case no 1 showed a pattern of congestive cardiomyopathy, while case no 2 showed a picture...
Article
A computer program for the on-line analysis of the carotid pulse (CP) and of the apexcardiogram (ACG) is described. The program measures the absolute and the heart rate-corrected time intervals, the time intervals ratios, the amplitude absolute values, the quantitative ACG (DA/Dt), the ejection fraction and the circumferential fiber shortening velo...
Article
Full-text available
Using a bipolar suction electrode technique, right atrial monophasic action potentials were recorded in 11 patients with recurrent attacks of paroxysmal atrial tachyarrhythmia. The right atrial monophasic action potential total duration, measured at 90 per cent level of repolarisation, in sinus rhythm, ranged between 217 and 394 ms. N(2-diethylamin...
Article
His Bundle Electrogram (HBE) was recorded in 20 patients with Mobitz type II block. All patients were clinically evaluated and a history of syncope was carefully investigated. These patients were prospectively followed (mean follow up: 20,4 months). ECG showed LBBB in 9 patients, RBBB + LAHI in 6, RBBB + LPH in 3, LAH in 1, left axis deviation in 1...