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Boriani G, Guerra F, De Ponti R, D'Onofrio A, Accogli M, Bertini M, Bisignani G, Forleo GB, Landolina M, Lavalle C, Notarstefano P, Ricci RP, Zanotto G, Palmisano P, De Bonis S, Pangallo A, Talarico A, Maglia G, Aspromonte V, Nigro G, Bianchi V, Rapacciuolo A, Ammendola E, Solimene F, Stabile G, Biffi M, Ziacchi M, Malpighi PSO, Saporito D, Casali E, Turco V, Malavasi VL, Vitolo M, Imberti JF, Bertini M, Anna AS, Zardini M, Placci A, Quartieri F, Bottoni N, Carinci V, Barbato G, De Maria E, Borghi A, Ramazzini OB, Bronzetti G, Tomasi C, Boggian G, Virzì S, Sassone B, Corzani A, Sabbatani P, Pastori P, Ciccaglioni A, Adamo F, Scaccia A, Spampinato A, Patruno N, Biscione F, Cinti C, Pignalberi C, Calò L, Tancredi M, Di Belardino N, Ricciardi D, Cauti F, Rossi P, Cardinale M, Ansalone G, Narducci ML, Pelargonio G, Silvetti M, Drago F, Santini L, Pentimalli F, Pepi P, Caravati F, Taravelli E, Belotti G, Rordorf R, Mazzone P, Bella PD, Rossi S, Canevese LF, Cilloni S, Doni LA, Vergara P, Baroni M, Perna E, Gardini A, Negro R, Perego GB, Curnis A, Arabia G, Russo AD, Marchese P, Dell’Era G, Occhetta E, Pizzetti F, Amellone C, Giammaria M, Devecchi C, Coppolino A, Tommasi S, Anselmino M, Coluccia G, Guido A, Rillo M, Palamà Z, Luzzi G, Pellegrino PL, Grimaldi M, Grandinetti G, Vilei E, Potenza D, Scicchitano P, Favale S, Santobuono VE, Sai R, Melissano D, Candida TR, Bonfantino VM, Di Canda D, Gianfrancesco D, Carretta D, Pisanò ECL, Medico A, Giaccari R, Aste R, Murgia C, Nissardi V, Sanna GD, Firetto G, Crea P, Ciotta E, Sgarito G, Caramanno G, Ciaramitaro G, Faraci A, Fasheri A, Di Gregorio L, Campsi G, Muscio G, Giannola G, Padeletti M, Del Rosso A, Notarstefano P, Nesti M, Miracapillo G, Giovannini T, Pieragnoli P, Rauhe W, Marini M, Guarracini F, Ridarelli M, Fedeli F, Mazza A, Zingarini G, Andreoli C, Carreras G, Zorzi A, Zanotto G, Rossillo A, Ignatuk B, Zerbo F, Molon G, Fantinel M, Zanon F, Marcantoni L, Zadro M, Bevilacqua M. Five waves of COVID-19 pandemic in Italy: results of a national survey evaluating the impact on activities related to arrhythmias, pacing, and electrophysiology promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing). Intern Emerg Med 2023; 18:137-149. [PMID: 36352300 PMCID: PMC9646282 DOI: 10.1007/s11739-022-03140-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The subsequent waves of the COVID-19 pandemic in Italy had a major impact on cardiac care. METHODS A survey to evaluate the dynamic changes in arrhythmia care during the first five waves of COVID-19 in Italy (first: March-May 2020; second: October 2020-January 2021; third: February-May 2021; fourth: June-October 2021; fifth: November 2021-February 2022) was launched. RESULTS A total of 127 physicians from arrhythmia centers (34% of Italian centers) took part in the survey. As compared to 2019, a reduction in 40% of elective pacemaker (PM), defibrillators (ICD), and cardiac resynchronization devices (CRT) implantations, with a 70% reduction for ablations, was reported during the first wave, with a progressive and gradual return to pre-pandemic volumes, generally during the third-fourth waves, slower for ablations. For emergency procedures (PM, ICD, CRT, and ablations), recovery from the initial 10% decline occurred in most cases during the second wave, with some variability. However, acute care for atrial fibrillation, electrical cardioversions, and evaluations for syncope showed a prolonged reduction of activity. The number of patients with devices which started remote monitoring increased by 40% during the first wave, but then the adoption of remote monitoring declined. CONCLUSIONS The dramatic and profound derangement in arrhythmia management that characterized the first wave of the COVID-19 pandemic was followed by a progressive return to the volume of activities of the pre-pandemic periods, even if with different temporal dynamics and some heterogeneity. Remote monitoring was largely implemented during the first wave, but full implementation is needed.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41121, Modena, Italy.
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo-University of Insubria, Varese, Italy
| | - Antonio D'Onofrio
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, Naples, Italy
| | | | - Matteo Bertini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara "Arcispedale S. Anna", Cona, Ferrara, Italy
| | - Giovanni Bisignani
- Cardiology Division, Castrovillari Hospital, ASP Cosenza, Castrovillari, Italy
| | | | | | - Carlo Lavalle
- Department of Cardiology, Policlinico Universitario Umberto I, Rome, Italy
| | | | | | - Gabriele Zanotto
- Department of Cardiology, Mater Salutis Hospital, Legnago, Verona, Italy
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Segreti L, Maggio R, De Sanctis V, Stabile G, Battaglia A, Zingarini G, Mantica M, Agresta A, Mazza A, Pandozi C, Dello Russo A, Ottaviano L, Cavaiani M, Malacrida M, Solimene F. A novel local impedance algorithm to guide effective pulmonary vein isolation in AF patients: preliminary experience among different voltages of atrial substrate. Europace 2022. [DOI: 10.1093/europace/euac053.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Recently, a novel technology able to measure local tissue impedance (LI) and contact force (CF) aimed at validating ablation endpoints has become available for clinical use.
Purpose
This analysis explores the relationship between LI parameters, substrate characteristics and AF type during ablation in AF patients.
Methods
A novel ablation catheter with dedicated algorithm was used to measure LI at the distal electrode. Each ablation point was characterized in terms of RF delivery time, baseline LI and LI drop during ablation according to different voltages (above or below 0.5 mV) of the atrial substrate. Ablation endpoint was PVI as assessed by entrance and exit block with local capture. Data are reported as mean±SD.
Results
A total of 2032 RFC deliveries from 34 consecutive patients were analyzed (71% paroxysmal AF, 29% persistent AF). All PVs were successfully isolated with an overall procedure time of 128±33min (fluoroscopy time=15.6±9min, RF delivery time=9.6±4s, CF=11.1±7g). The baseline LI was 155±17Ω prior to ablation and 136±14Ω after ablation (p<0.0001, absolute LI drop of 21.0±8Ω) with a LI drop rate equal to 2.8±2Ω/s. Ablation spots were more frequently deployed in high-voltage areas (>0.5mv, n=1240, 61%). Baseline LI and LI drops were both higher when underlying atrial voltages were >0.5mV than when <0.5mV (156±18Ω vs 153.6±16Ω for starting LI, p=0.0032; 22.2±8Ω vs 19.1±8Ω for LI drop, p<0.0001, respectively). No differences were found in terms of both CF and LI after ablation between >0.5mV and <0.5mV (11.0±7g vs 11.2±7g for CF, p=0.3435; 136.4±13Ω vs 135.3±15Ω for ablated tissue LI, p=0.1521, respectively). Low-voltage areas were more frequently detected at ablated spots in persistent AF cases (n=288, 51.9%) than in paroxysmal AF cases (n=504, 35.1%, p<0.0001), however, no differences were found in terms of both baseline LI and LI drop between persistent and paroxysmal AF cases (156.3±17Ω vs 154.6±17Ω for starting LI, p=0.135; 20.7±8Ω vs 21.1±9Ω for LI drop, p=0.1722, respectively).
Conclusions
LI measurements well distinguished contact with high-voltage areas from low-voltage areas and were able to detect significant differences in LI drop during ablation according to the voltage level.
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Affiliation(s)
- L Segreti
- University Hospital of Pisa, Pisa, Italy
| | | | | | - G Stabile
- Montevergine Clinic, Mercogliano, Italy
| | | | - G Zingarini
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | - M Mantica
- Clinical Institute Saint Ambrogio, Milan, Italy
| | - A Agresta
- Montevergine Clinic, Mercogliano, Italy
| | - A Mazza
- Infermi Hospital, Rivoli, Italy
| | - C Pandozi
- San Filippo Neri Hospital, Rome, Italy
| | | | - L Ottaviano
- Clinical Institute Saint Ambrogio, Milan, Italy
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Barengo A, Parise A, Notaristefano F, Sforna S, Padoan L, Bernardini G, Notarianni G, D‘ammando M, Zingarini G, Cavallini C. P34 ASYMPTOMATIC VENTRICULAR PRE–EXCITATION WITH DISAPPEARANCE DURING EXERTION: ALWAYS AN INDEX OF BENIGNITY? Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
The disappearance of pre–excitation at high heart rates points to a low arrhythmic risk: why resort to electrophysiological studies anyway?
Clinical Case
L.S., a 12–year–old patient, performed an ECG for sports examination with evidence of ventricular pre–excitation from an asymptomatic left lateral accessory route (Fig. A). A 24 h ECG–Holter during training showed the disappearance of the pre–excitation at high frequencies (Fig. B) which is considered a low risk index. The patient underwent a transesophageal electrophysiological study (SETE) during which an effective refractory antegrade period of 228 ms of the pathway was objectified through atrial extrastimuli (*) (Fig. C: drive of atrial stimuli (*) followed by extrastimulus with conduction on an accessory route (E)). In addition, a 1: 1 conduction was observed on the atrial pathway up to at least 270 bpm (222 ms). The antegrade refractory period of the resting path was <250 ms and therefore identified a high–risk condition to be treated with ablation.
Discussion
The disappearance of pre–excitation at high heart rates is usually considered indicative of an accessory pathway with a long refractory period and therefore at low risk, however it must be sudden. According to European guidelines, the execution of invasive studies in asymptomatic patients who are employed in high–risk jobs or competitive sports has a class I B indication, but in the remaining asymptomatic cases the indication is IIa B. The Holter ECG alone or the stress test, with a careless evaluation of the disappearance of the pre–excitation (sudden vs progressive with minimal residual pre–excitation) would have erroneously led to labeling this accessory pathway at low risk. In the left lateral accessory pathways, with the increase of the HR, there can be a disappearance or pseudo–disappearance of the pre–excitation for anatomical reasons (being further away from the SA node) and for an increase in the AV conduction speed, not therefore for a long refractory period of the pathway. SETE is closer to the atrial side of the left accessory pathway and allows to correctly classify the risk.
Conclusion
SETE is a low–cost and minimally invasive method that should be considered as an integral part of the study of patients with asymptomatic ventricular pre–excitation even if non–invasive stratification indicates low risk.
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Affiliation(s)
- A Barengo
- OSPEDALE S. MARIA DELLA MISERICORDIA, PERUGIA; UNIVERSITÀ DEGLI STUDI, PERUGIA
| | - A Parise
- OSPEDALE S. MARIA DELLA MISERICORDIA, PERUGIA; UNIVERSITÀ DEGLI STUDI, PERUGIA
| | - F Notaristefano
- OSPEDALE S. MARIA DELLA MISERICORDIA, PERUGIA; UNIVERSITÀ DEGLI STUDI, PERUGIA
| | - S Sforna
- OSPEDALE S. MARIA DELLA MISERICORDIA, PERUGIA; UNIVERSITÀ DEGLI STUDI, PERUGIA
| | - L Padoan
- OSPEDALE S. MARIA DELLA MISERICORDIA, PERUGIA; UNIVERSITÀ DEGLI STUDI, PERUGIA
| | - G Bernardini
- OSPEDALE S. MARIA DELLA MISERICORDIA, PERUGIA; UNIVERSITÀ DEGLI STUDI, PERUGIA
| | - G Notarianni
- OSPEDALE S. MARIA DELLA MISERICORDIA, PERUGIA; UNIVERSITÀ DEGLI STUDI, PERUGIA
| | - M D‘ammando
- OSPEDALE S. MARIA DELLA MISERICORDIA, PERUGIA; UNIVERSITÀ DEGLI STUDI, PERUGIA
| | - G Zingarini
- OSPEDALE S. MARIA DELLA MISERICORDIA, PERUGIA; UNIVERSITÀ DEGLI STUDI, PERUGIA
| | - C Cavallini
- OSPEDALE S. MARIA DELLA MISERICORDIA, PERUGIA; UNIVERSITÀ DEGLI STUDI, PERUGIA
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Ducceschi V, Carbone A, Botto G, Nigro G, Lavalle C, Infusino T, Maglia G, Nicolis D, Zingarini G, Del Giorno G, Brasca F, Rago A, Auricchio C, Malacrida M, Sangiuolo R. Optimized radiofrequency lesions through local impedance guidance for effective cavo-tricuspid isthmus ablation in typical right atrial flutter: data from the CHARISMA registry. Europace 2021. [DOI: 10.1093/europace/euab116.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Radiofrequency (RF) catheter ablation of the cavo-tricuspid isthmus (CTI) is an established treatment for typical right atrial flutter (RAFL). However, whether local tissue impedance (LI) is able to predict effective CTI ablation and what LI drop values during ablation should be used to judge a lesion as effective remains to be established.
Purpose
We aimed to investigate the ability of LI to predict ablation efficacy in patients (pts) with RAFL and to characterize the CTI in terms of LI.
Methods
Consecutive pts undergoing RAFL ablation from the CHARISMA registry were enrolled at 9 centers. A novel RF ablation catheter with dedicated algorithm (DirectSense - DS -) was used to measure LI at the distal electrode of this catheter. RF applications (RFC) were targeted to a minimum LI drop of 10 Ω within 30 seconds and were stopped when a maximum cutoff LI drop of <40 Ω was observed. Successful single RFC was defined according with a split in two separate potentials (SPL), reduction of voltage (RedV) by at least 50% or changes at unipolar EGM (UPC). Agreement among criteria was evaluated. Ablation endpoint was the creation of bidirectional conduction block (BDB) across the isthmus.
Results
A total of 279 ablation spot lesions were delivered in 30 pts (mean RFC 9 ± 6 lesions per pt): 106 (38%) at anterior, 115 (41%) at mid and 58 (21%) at posterior portions of the CTI. BDB was obtained in all cases and no complications were observed. The median RFC delivery time was 30 [19–45] seconds per lesion. 132 (47%), 150 (54%) and 86 (31%) ablation spots were effective according with SPL, RedV and UPC, respectively. Complete agreement of all the criteria was reached in 70% of the cases. The mean LI was 104.4 ± 11Ω prior to ablation and 92.1 ± 11Ω after ablation (p < 0.0001, mean absolute LI drop 12.2 ± 7Ω, mean time to LI drop 13 ± 8 seconds). Effective ablation spots showed a higher LI drop compared with ineffective sites at each single criteria (16.6 ± 7Ω vs 8.3 ± 4Ω for SPL, p < 0.0001; 16.1 ± 6Ω vs 7.8 ± 5Ω at for RedV, p < 0.0001; 19 ± 6Ω vs 9.2 ± 4Ω for UPC, p < 0.0001) and LI drop values significantly increase according to the number of criteria satisfied (ranging from 7.5Ω % -no criteria- to 19.1 -all criteria-). A 15Ω cut-off value for LI (AUC 0.91, sensitivity = 67%, specificity = 92%, p < 0.0001) was associated with the achievement of all criteria with an OR of 21.9 (95%CI: 11.1 to 43.5, p < 0.0001) and a positive predictive value of 76%. Starting LI and LI drop seem to be higher at mid-septal areas.
Conclusion
In our preliminary experience, a LI-guided approach of CTI seems to be safe and effective in RAFL ablation. The magnitude of LI drop was associated with effective lesion formation and conduction block and could be used as a marker of ablation efficacy.
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Affiliation(s)
| | - A Carbone
- Maria SS Addolorata Hospital, Eboli, Italy
| | | | - G Nigro
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - C Lavalle
- Umberto I Polyclinic of Rome, Rome, Italy
| | | | - G Maglia
- Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | | | - G Zingarini
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | | | | | - A Rago
- AO dei Colli-Monaldi Hospital, Naples, Italy
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Annunziata R, Notaristefano F, Spighi L, Piraccini S, Giuffre' G, Deluca F, Bearzot L, D'Ammando M, Reccia M, Verdecchia P, Zingarini G, Cavallini C. Atrial fibrillation recurrence after transcatheter ablation worsens left atrial strain. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Left atrial strain (LAs) shows correlation with atrial fibrosis and is a predictor of atrial fibrillation (AF) recurrence after transcatheter ablation. Little is known about LAs evolution after ablation.
Purpose
We sought to evaluate the atrial function with echocardiographic strain before and 6 months after AF ablation.
Methods
65 consecutive patients undergoing radiofrequency or cryoballoon ablation for atrial fibrillation at our centre were enrolled. They underwent a transthoracic echocardiography before the procedure and at 6 months follow-up. 5 patients were excluded because of low quality images. Global left atrial strain during the reservoir phase (LASr) was calculated as a mean of the values obtained in 4 and 2 chamber apical view; the ventricular end-diastole was set as reference to allow the calculation both in patients in AF and sinus rhythm during the echocardiography. Recurrence was defined as any atrial arrhythmia episode lasting more than 30 seconds recorded on an EKG strip after the 3 months blanking period; all patients underwent a 24 hours EKG Holter after the blanking period to detect asymptomatic recurrence. Quality of life was assessed before the procedure and at follow-up with the EQ-5D-3L model.
Results
At 6 months 14 patients (13%) had AF recurrence. Patients with recurrence (AF-R) had similar baseline characteristics compared to those without recurrence (AF-NR) but the former had a longer history of AF (39±53 vs 85±94 months, p=0,018). LASr, LA volume and left ventricle ejection fraction (EF) were similar at baseline between groups. At follow-up LASr was significantly impaired in the AF-R group compared to AF-NR (14±6% vs 26±10% respectively, p<0,0001) whereas LA volume, LV end systolic volume and EF remained similar. Compared to baseline LASr worsened in patients experiencing AF recurrence (22±11% vs 14±6%, p=0.016) and this finding was consistent also in patients in sinus rhythm during both examinations (29±8 vs 17±7, p=0,005). Compared to baseline LASr (22±10% vs 26±10%, p=0.024), LV end-systolic volume (29±15 ml vs 22±6 ml, p=0,006) and EF (51±9% vs 58±18%, p=0,038) improved in the AF-NR group but the effect was driven mainly by patients restoring sinus rhythm. Both groups showed a significant improvement of the quality of life (55±23 vs 85±13, p<0,0001 AF-NR; 63±17 vs 80±12, p=0,012 AF-R).
Conclusions
Atrial fibrillation recurrence after transcatheter ablation is associated with significant left atrial strain worsening which indicates disease progression and may predispose to further long-term recurrences whereas a successful ablation has a protective effect on atrial function.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- R Annunziata
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | | | - L Spighi
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | - S Piraccini
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | - G Giuffre'
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | - F Deluca
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | - L Bearzot
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | - M D'Ammando
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | - M.R Reccia
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | - P Verdecchia
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | - G Zingarini
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | - C Cavallini
- Hospital Santa Maria Della Misericordia, Perugia, Italy
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Spighi L, Notaristefano F, Annunziata R, D"ammando M, Zingarini G, Verdecchia P, Cavallini C. P1187Pocket-Hematoma after cardiac implantable electronic devices surgery: a single centre study. Europace 2020. [DOI: 10.1093/europace/euaa162.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Intro
Pocket hematoma is a common complication after pacemaker (PMK) or implantable cardioverter defibrillator (ICD) surgery. In this clinical setting anticoagulant and antiplatelet therapy are associated with an increased risk of hemorrhagic complications, but data are sparse.
Purpose
We examined the impact of antiplatelet therapy and anticoagulation with vitamin K antagonists (VKA) or heparin on the risk of pocket hematoma. Materials and method: between august 2017 and june 2019, a total of 639 devices were implanted or replaced at our centre. Predictors of hematoma occurrence were determined by multivariate regression analysis. We used a specific definition of pocket hematoma: a) any palpable swelling in the pocket area requiring an unscheduled visit or prolonged hospitalization > 24 h or re-hospitalization for hematoma, b) interruption of antithrombotics, c) reoperation, d) hemoglobin drop > 2 g/dl or blood transfusion. The above criteria were assessed during hospitalization and up to 10 days after discharge. Results: the incidence of pocket hematoma was 7.5%. Among 639 patients (pts) including in the study 33.5% (214 pts) didn’ t take any antithrombotic therapy, 40.2 % (257 pts) were on single antiplatelet therapy (SAPT), 8.8 % (56 pts) were on dual antiplatelet therapy, 11.1 % (71 pts) were on uninterrupted VKA (mean INR 2). Heparin bridging was administered in 6.4% (41 pts). Ejection fraction (43 ±13 %) and hemoglobin value before implantation (12.3 ±2.6 g/dL) in patients who developed hematoma were significantly lower compared with whose without hematoma. Patients with hematoma had a higher prevalence of congestive heart failure, ischemic cardiomyopathy and intake antithrombotic therapy. After adjusting for confounding factors with multivariate logistic regression only the use of dual antiplatelet therapy (OR 5.9 95% CI 1.5-21 p = 0.008) and the bridging with enoxaparin (OR 5.6 95% CI 1.4-22 p = 0.013) increased the risk of pocket hematoma. Single antiplatelet therapy (OR 2.6 95% CI 0.8-8.4 p = ns) and uninterrupted VKA (OR 0.9 95% CI 0.7-11 p = ns) did not increased the risk of pocket hematoma compared to no antithrombotic therapy. Pulse generator change and new device implant/upgrading (OR 1.8 95% CI 0.6-5.2 p = ns) carried the same haemorrhagic risk.
Conclusion
the use of DAPT or bridging with enoxaparin are highly predictive for the occurrence of perioperative pocket hematoma in patients scheduled for pmk/icd surgery. In contrast, single antiplatelet therapy and uninterrupted VKA did not increase the risk of hematoma.
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Affiliation(s)
- L Spighi
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | | | - R Annunziata
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | - M D"ammando
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | - G Zingarini
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | - P Verdecchia
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | - C Cavallini
- Hospital Santa Maria Della Misericordia, Perugia, Italy
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Maglia G, Pentimalli F, Solimene F, Infusino T, Calo" L, Perego GB, Stabile G, Matta M, La Greca C, Rago A, Tomasi C, Zingarini G, Bottoni G, Malacrida M, Verlato R. P1448Ablation of cti-dependent flutter using a novel advanced mini-electrodes technology: preliminary results from Leonardo registry. Europace 2020. [DOI: 10.1093/europace/euaa162.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
NO FUNDING
OnBehalf
LEONARDO study group
Background
Ablation of cavotricuspid isthmus (CTI) represents the standard therapeutic approach for the creation of bidirectional conduction block (BDB) across the isthmus and the prevention of recurrences, yet recurrence of arrhythmia is common.
Objective
To evaluate the acute and long-term outcome of CTI ablation through a novel ablation catheter equipped with three radially distributed mini-electrodes (ME) compared with standard ablation catheter technology (ST).
Methods
Atrial Flutter Ablation in a Real World Population (LEONARDO) is a prospective, multicenter cohort study aimed at providing an estimate of acute to long-term outcome in a large population of pts indicated for AFL ablation from 2015 to 2017. The procedural endpoint was the creation of a BDB. Presence of widely split double potentials (DP) along the ablation line and assessment of the atrial activation sequence (AAS) were used as criteria for complete BDB. Recurrence of AFL and complications were assessed at 12-month follow-up.
Results
205 consecutive pts undergoing typical AFL ablation were included (74% male, 50.6% with history of AF, median of 7[4–11] ablation lesions, median ablation time of 20[10-30] min). Complete BDB was achieved in 175 (85.4%) pts (10 pts had DP only criterion, 19 pts had AAS only criterion whereas in 1 pt we failed to reach a BDB). 15 (7.3%) pts experienced AFL recurrence during follow-up. 102 pts (49.8%) underwent ablation procedure with ME catheters whereas 103 (50.2%) pts were treated by ST catheters. The median number of lesions/pt was significantly lower in the ME group compared to the ST one (4[3-6] vs 8.5[6-12], p < 0.0001), whereas no differences were found in terms of fluoroscopy time (10.5[7-15] min vs 10[5.8 ± 15] min, p = NS) or ablation time (22.5[10-30.5] min vs 18[10-26] min, p = NS). No complications were reported. The acute procedural success was comparable between groups (81.4% vs 89.2%, p = NS) whereas the time to AFL recurrence was significantly longer among pts targeted with ME catheters (HR = 0.343; 0.12 to 0.97; log-rank p = 0.044).
Conclusions
In our preliminary experience, the use of the ME technology seemed safe and effective. It resulted in fewer lesions/pt and a lower AFL recurrence rate at 1-year follow-up compared with ST ablation catheters.
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Affiliation(s)
- G Maglia
- Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | | | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - T Infusino
- S.Anna Hospital, Cardiovascular Surgery, Catanzaro, Italy
| | - L Calo"
- Polyclinic Casilino of Rome, Rome, Italy
| | - G B Perego
- Italian Institute for Auxology IRCCS, Milan, Italy
| | - G Stabile
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - M Matta
- Sant"Andrea Hospital, Vercelli, Italy
| | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - A Rago
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - C Tomasi
- Santa Maria delle Croci Hospital, Ravenna, Italy
| | - G Zingarini
- Hospital Santa Maria della Misericordia in Perugia, Perugia, Italy
| | | | | | - R Verlato
- Hospital of Camposampiero, Camposampiero, Italy
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8
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Segreti L, Lavalle C, Galeazzi M, Zingarini G, Bongiorni MG, Del Giorno G, Narducci ML, Russo M, Piro A, Pelargonio G, Carbone A, Piccolo F, Malacrida M, Pandozi C, Colivicchi F. P1005Origin, distribution and timing of the slow pathway potentials recorded inside the Kock's triangle in Avnrt patients through High-density Mapping. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial activation during typical atrioventricular nodal reentrant tachycardia (AVNRT) exhibits anatomic variability and spatially heterogeneous propagation inside the Kock's Triangle (KT). The mechanism of the reentrant circuit has not been elucidated yet.
Purpose
To evaluate signal characteristics and find out the origin, distribution, and timing of the slow pathway (SP) potentials recorded in the KT.
Methods
The 3-D KT geometry was created during both sinus rhythm (SR) and tachycardia (TR) from the basket mapping catheter IntellaMap Orion and the Rhythmia Mapping System (Boston Scientific). The KT was divided into 8 regions moving from an antero-septal to postero-septal areas and bounded by tricuspid annulus (TA) anteriorly and tendon of Todaro (TT) posteriorly. Each area was characterized in terms of distribution and timing of Jackman (JP) and Haissaguerre (HP) potentials and signal amplitude.
Results
20 consecutive successful SP ablation cases of AVNRT were included (mean RA acquired points = 6000±1100, 275±63 inside the KT; mean KT area=29±3mm2; mean mapping time=12±5 minutes). During SR, the site of earliest atrial activation within the KT was anterior in 80% of patients whereas a midseptal activation occurred less frequently (20%). The mid-septal regions bounded by TA anteriorly and TT posteriorly showed higher prevalence of JP as compared to antero-/mid-septal regions across TT both in SR and TR (77.4% vs 4.8% during SR, p<0.0001; 84.1% vs 0% during TR, p<0.0001, respectively). HPs seemed to have variable distribution across KT (50% of these potentials recorded in antero- to mid-septal regions across TT for SR, 52.3% for TR). The median signal voltage was 0.44 [0.2–0.9] mV during SR and 0.5 [0.22–0.895] mV during TR. The mid-septal region was the area of lowest voltage compared to other regions (0.2 [0.1–0.7] mV vs 0.5 [0.4–1.5] mV for SR, p<0.0001; 0.2 [0.15–0.6] mV vs 0.6 [0.4–1.5] mV for TR, p<0.0001, respectively).
Conclusion
JPs seem to be associated with low signal-amplitude areas whereas HPs seem to have variable distribution across KT. Although not perfectly known, the typical low-high-type double potential of JP might be therefore explained by wavefront collision in the lowest area of the KT.
Acknowledgement/Funding
None
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Affiliation(s)
- L Segreti
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - C Lavalle
- Umberto I Polyclinic of Rome, Rome, Italy
| | | | - G Zingarini
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | - M G Bongiorni
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | | | - M Russo
- San Filippo Neri Hospital, Rome, Italy
| | - A Piro
- Umberto I Polyclinic of Rome, Rome, Italy
| | | | | | - F Piccolo
- Boston Scientific Italy, Milan, Italy
| | | | - C Pandozi
- San Filippo Neri Hospital, Rome, Italy
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9
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Zanon F, Menardi E, Ammendola E, De Filippo P, Manzo M, Stabile G, Potenza DR, Zaca' V, Bertini M, Lissoni F, Bandini A, Calzolari V, Zingarini G, Malacrida M, Biffi M. P2871Attenuated clinical benefit after ICD replacement over long term follow-up in a contemporary large world population: insight to the DECODE registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac Implantable Electronic Device (CIED) surgery is threatened by serious complications both during the procedure and during follow-up. The factors associated to attenuated clinical benefit over long term follow-up are poorly understood.
Purpose
To evaluate type and extent of Adverse Events (AEs) and potential predictors of major AEs over 12 months after ICD/CRT-D replacement/upgrade in a contemporary Italian population.
Methods
Detect long-term complications after ICD replacement (DECODE) was a prospective, single-arm, multicenter cohort study aimed at estimating medium- to long-term complications in a large population of patients (pts) who underwent ICD/CRT-D replacement/upgrade from 2013 to 2015. The endpoint for this analysis is death from any cause, procedure-related infection, and surgical actions/hospitalizations necessary to treat the AEs.
Results
We included 983 consecutive pts (median age 71 years, 76% male, 55% ischemic, 47% CRT-D). During a mean follow-up duration of 353±49 days, 7% of the pts died. A total of 104 AEs occurred in 70 (7.1%) pts. 43 (4.4%) pts needed at least one surgical action to treat the AEs. A total of 23 (2.3%) pts had infective AEs (CIED related in 12 pts, due to other causes in 11). Mortality was unrelated to the occurrence of overall AEs, or of CIED-related AEs, or of surgical actions/hospitalizations needed to correct AEs. The endpoint was reached by 109 (11%) pts over 12-month follow-up (97 pts had a single event, and 12 pts had two events). The median time to the endpoint was 137 [50 - 254] days. On multivariate Cox regression analysis adjusted for baseline confounders, ischemic cardiomyopathy (HR = 1.86, 95% CI: 1.18 to 2.91; p=0.0076), hospitalization prior to the procedure (2.34, 1.35 to 4.05; 0.0025) and anticoagulation (1.91, 1.25 to 2.92; 0.0032) were associated with the endpoint during follow-up.
Conclusion
Evaluation of the patient's profile may assist in predicting vulnerability and should prompt reconsideration of the procedure by deferring at a more stable clinical status, and carefully individualized in the setting of upgrades and anticoagulation management
Acknowledgement/Funding
None
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Affiliation(s)
- F Zanon
- General Hospital, Rovigo, Italy
| | - E Menardi
- Santa Croce E Carle Hospital, Cuneo, Italy
| | | | | | - M Manzo
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | | | - D R Potenza
- Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - V Zaca'
- Polyclinic Santa Maria alle Scotte, Siena, Italy
| | - M Bertini
- University Hospital of Ferrara, Ferrara, Italy
| | - F Lissoni
- Presidio Ospedaliero di Lodi, Lodi, Italy
| | - A Bandini
- Morgagni-Pierantoni Hospital, Forli, Italy
| | - V Calzolari
- Hospital Santa Maria di Ca Foncello, Treviso, Italy
| | - G Zingarini
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | | | - M Biffi
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
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10
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Maglia G, Calo' L, Pentimalli F, Solimene F, Infusino T, Perego GB, Stabile G, Rago A, Tomasi C, Zingarini G, Devecchi C, La Greca C, Scaglione M, Malacrida M, Verlato R. P1009Procedural success and long-term outcome of CTI ablation targeted with maximum voltage-guided approach: preliminary results from an Italian multicenter registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Ablation technique targeting high-amplitude signals (maximum voltage guided - MVG -) on the cavotricuspid isthmus (CTI) has emerged as viable alternative option compared to standard anatomical approach (ST) for the creation of bidirectional conduction block (BDB) across the isthmus but limited data are available to date.
Purpose
To evaluate the effectiveness of acute and long-term outcome of CTI ablation through MVG technique for AFL compared to standard linear (SL) lesion ablation.
Methods
Atrial Flutter Ablation in a Real World Population (LEONARDO) is a prospective, multicenter cohort study aimed at providing an estimate of acute to long-term outcome in a large population of patients (pts) indicated for AFL ablation. Recurrence of AFL were retrieved at 12-month follow-up. Complete BDB was defined by agreement with the presence of widely split double potentials (DP) along the ablation line and assessment of the atrial activation sequence (AAS). For MVG technique the ablation catheter was positioned at the site of maximum local electrogram voltage.
Results
Two-hundred fifteen consecutive pts were included (mean age 68 years, 73% male). A median of 4 [2–6] ablation lesions were required. Median follow up was 359 [192–443] days. Complete BDB was achieved in 175 (81.4%) pts (9 pts had DP only criterion, 30 pts had AAS only criterion whereas in 1 pt we failed to reach a BDB). In the 106 pts with complete data at 1-year follow-up, 10 (9.4%) had a recurrence of AFL. 171 pts (79%) underwent a SL ablation whereas 44 pts (21%) were treated by MVG approach. The median number of lesions/pt was significantly lower in the group of pts targeted with MVG compared to the SL approach (3 [2–4] vs 4 [2–8], p<0.01), whereas no differences were found in terms of fluoroscopy time (16 [12–18] min vs 12 [7–22] min, p=NS) or proportion of pts with BDB achievement (86.4% of the cases for MVG vs 80.1% of the cases for ST, p=NS). No complications were reported. AFL recurrence was comparable during follow-up between groups (8.3% for MVG vs 9.8% for SL ablation; p=NS).
Conclusion
Ablation of a targeted site through MGV approach seems to be safe and effective as standard anatomical ablation technique. This strategy may avoid unnecessary ablation of the entire anatomic isthmus.
Acknowledgement/Funding
None
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Affiliation(s)
- G Maglia
- Civil Hospital of Pugliese, Catanzaro, Italy
| | - L Calo'
- Polyclinic Casilino of Rome, Rome, Italy
| | | | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | | | - G B Perego
- Italian Institute for Auxology IRCCS, Milan, Italy
| | | | - A Rago
- Second University of Naples, Naples, Italy
| | - C Tomasi
- Santa Maria delle Croci Hospital, Ravenna, Italy
| | - G Zingarini
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | | | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | | | | | - R Verlato
- Hospital of Camposampiero, Camposampiero, Italy
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11
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Zaca' V, Menardi E, Zanon F, Ammendola E, Narducci ML, Giofre' F, Zoni Berisso M, Bertini M, Tomasi C, Lissoni F, Pierantozzi A, Zingarini G, Carinci V, Malacrida M, Biffi M. P3158Health care consumption after ICD/CRT-D replacement: preliminary results from the DECODE registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- V Zaca'
- Division of Cardiology, Cardiovascular and Thoracic Department, Santa Maria alle Scotte Hospital, Siena, Italy, Italy
| | - E Menardi
- Santa Croce E Carle Hospital, Cuneo, Italy
| | - F Zanon
- General Hospital of Rovigo, Rovigo, Italy
| | | | - M L Narducci
- Catholic University of the Sacred Heart, Rome, Italy
| | - F Giofre'
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - M Zoni Berisso
- Padre A Micone Hospital ASL3, Genoa-Sestri Ponente, Italy
| | - M Bertini
- University Hospital of Ferrara, Ferrara, Italy
| | - C Tomasi
- Santa Maria delle Croci Hospital, Ravenna, Italy
| | | | | | - G Zingarini
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | | | | | - M Biffi
- University of Bologna, Bologna, Italy
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12
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Zaca' V, Zanon F, Ammendola E, Menardi E, Parisi Q, Narducci ML, De Filippo P, Manzo M, Stabile G, Potenza D, Iori M, Zingarini G, Saporito D, Malacrida M, Biffi M. P3216Management of complications following ICD replacement/upgrade: preliminary results of the health care resource utilization analysis from the DECODE registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V Zaca'
- Division of Cardiology, Cardiovascular and Thoracic Department, Santa Maria alle Scotte Hospital, Siena, Italy, Italy
| | - F Zanon
- General Hospital of Rovigo, Rovigo, Italy
| | | | - E Menardi
- Santa Croce E Carle Hospital, Cuneo, Italy
| | - Q Parisi
- Centro di Ricerca e Formazione ad Alta Tecnologia nelle Scienze Biomediche - “Giovanni Paolo II”, Campobasso, Italy
| | - M L Narducci
- Catholic University of the Sacred Heart, Rome, Italy
| | | | - M Manzo
- AOU S. Giovanni e Ruggi, Salerno, Italy
| | | | - D Potenza
- Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - M Iori
- Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - G Zingarini
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | - D Saporito
- Infermi Hospital of Rimini, Rimini, Italy
| | | | - M Biffi
- University of Bologna, Policlinico S. Orsola-Malpighi, Institute of Cardiology, Bologna, Italy
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13
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Menardi E, Zanon F, Ammendola E, Narducci ML, Giofre' F, Zoni Berisso M, Bertini M, Tomasi C, Lissoni F, Pierantozzi A, Zingarini G, Carinci V, Merlotti G, Malacrida M, Biffi M. P914Health Care Consumption after ICD/CRT-D replacement: preliminary results from the DECODE registry. Europace 2018. [DOI: 10.1093/europace/euy015.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Menardi
- Santa Croce E Carle Hospital, Cuneo, Italy
| | - F Zanon
- S. Maria della Misericordia Hospital, Rovigo, Italy
| | - E Ammendola
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - M L Narducci
- Catholic University of the Sacred Heart, Rome, Italy
| | - F Giofre'
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - M Zoni Berisso
- Padre A Micone Hospital ASL3, Genoa-Sestri Ponente, Italy
| | - M Bertini
- Arcispedale Sant'Anna, Ferrara, Italy
| | - C Tomasi
- Santa Maria delle Croci Hospital, Ravenna, Italy
| | | | | | - G Zingarini
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | | | | | | | - M Biffi
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
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14
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Biffi M, Vado A, Nigro G, Narducci M, Ammendola E, Zingarini G, Calzolari V, Calo' L, Tomasi C, Ciaramitaro G, Boggian G, Zennaro M, Sassone B, Malacrida M, Zanon F. P6425Performance of sudden cardiac death risk score at the time of device replacement for patients with hypertrophic cardiomyopathy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Mengoni A, Carluccio E, Biagioli P, Cerasa M, D'Antonio A, Coiro S, Oliva V, Zingarini G, Ambrosio G. P2449Mechanical LBBB contraction pattern by speckle tracking echocardiography and left ventricular remodeling after CRT. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Biffi M, Vado A, Nigro G, Narducci ML, Ammendola E, Zingarini G, Calzolari V, Calo' L, Tomasi C, Ciaramitaro G, Boggian G, Zennaro M, Sassone B, Malacrida M, Zanon F. P1476Performance of sudden cardiac death risk score at the time of device replacement for patients with hypertrophic cardiomyopathy. Europace 2017. [DOI: 10.1093/ehjci/eux158.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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17
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Zucchelli G, Sirico G, Rebellato L, Marini M, Del Greco M, Stabile G, Castro A, De Ruvo E, Soldati E, Zingarini G, Ocello S, Daleffe E, Mantica M, Pandozi C, Bongiorni MG. P900Impact of a novel technology for automatic point annotation during paroxysmal atrial fibrillation ablation with strict criteria of catheter stability. Europace 2017. [DOI: 10.1093/ehjci/eux151.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Andreoli C, Carluccio E, Biagioli P, D'Addario S, Zingarini G, Lauciello R, Zuchi C, Alunni G, Cavallini C, Ambrosio G. Clinical and echocardiographic predictors of super-responders to CRT and its related longterm follow-up. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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