Dionyssios Leftheriotis - Academia.edu (original) (raw)

Papers by Dionyssios Leftheriotis

Research paper thumbnail of Serum markers of deranged myocardial collagen turnover: Their relation to malignant ventricular arrhythmias in cardioverter-defibrillator recipients with heart failure

American Heart Journal, 2012

Research paper thumbnail of Selvester QRS score: an automated algorithm for the quantification of myocardial scar

European Heart Journal, 2013

Purpose: ST-segment deviation score (STDS), a summation of all ST-segment deviations from baselin... more Purpose: ST-segment deviation score (STDS), a summation of all ST-segment deviations from baseline in a standard 12-lead ECG, has shown to correlate with mortality in patients with acute coronary syndrome. However, it is unknown whether these findings can be generalized to the clinical important setting of unselected patients presenting with acute chest pain, in which the early and reliable detection of patients at higher risk still presents an unmet clinical need. Methods: In this prospective multicenter study STDS was determined in 1336 consecutive patients presenting to the emergency department (ED) with symptoms suggestive of acute myocardial infarction. Primary endpoint was the occurrence of death within 30 and 360 days. Patients with left ventricular hypertrophy or bundle branch block were excluded. The STDS was defined as the sum in millimeters (1mm = 1mV) of the absolute value of ST-segment deviations in all 12 leads of the first recorded ECG. Results: STDS at presentation in the highest tertile (≥4.8mm) compared to the intermediate or lowest tertile (<2.7mm) was associated with an increased risk for death in the ensuing 30 days (HR 5.5, p<0.001) and 360 days (HR 3.9, p<0.001). Multivariate analysis showed that initial STDS levels remained an independent predictor of death within 30 days after adjustment for high-sensitive cardiac troponin T levels at presentation (HR 5.2, p=0.002) or TIMI-risk score (HR 5.5, p<0.001).

Research paper thumbnail of Coronary and peripheral blood flow changes following biventricular pacing and their relation to heart failure improvement

Europace, 2006

To study the effect of cardiac resynchronization therapy (CRT) on coronary and peripheral arteria... more To study the effect of cardiac resynchronization therapy (CRT) on coronary and peripheral arterial circulation and to assess whether their changes are related to the improvement in patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; functional capacity and prognostically important biochemical markers. Twenty-five patients were studied (New York Heart Association classes III and IV, left ventricular ejection fraction &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;35%, QRS&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;120 ms, mean age 66 +/- 2.1 years). Coronary blood flow (CBF), forearm blood flow (FBF), and their reserve were measured by transoesophageal echocardiography (in cm/s) and venous occlusion plethysmography (in mL/100 mL/min) at baseline and following 3 months of CRT. N-terminal-pro-brain natriuretic peptide (Nt-pro-BNP) and serum adhesion molecules, sICAM-1 and sVCAM-1 levels were also assessed. CRT induced a non-significant increase in resting CBF (baseline vs. CRT: 52.1 +/- 5.5 vs. 58.2 +/- 3.6, P: NS), whereas hyperaemic CBF was increased by CRT (baseline vs. CRT: 67.8 +/- 6.8 vs. 79.8 +/- 6.2, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Significant increases were observed in resting FBF (baseline vs. CRT: 1.6 +/- 0.2 vs. 2.6 +/- 0.2, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and hyperaemic FBF (baseline vs. CRT: 2.1 +/- 0.2 vs. 3.2 +/- 0.3, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). The per cent difference in hyperaemic FBF was related to the per cent change in Nt-pro-BNP (r = -0.71, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and the per cent improvement in exercise duration (r = 0.80, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). CRT induces favourable changes in coronary and peripheral arterial function. Changes in peripheral blood flow are related to patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; improvement and may be prognostically significant.

Research paper thumbnail of Long-Term Nonoutflow Septal Versus Apical Right Ventricular Pacing: Relation to Left Ventricular Dyssynchrony

Pacing and Clinical Electrophysiology, 2009

Background: Right ventricular (RV) apical pacing deteriorates left ventricular (LV) function. RV ... more Background: Right ventricular (RV) apical pacing deteriorates left ventricular (LV) function. RV nonoutflow (low) septal pacing may better preserve ventricular performance, but this has not been systematically tested. Our aim was to assess (1) whether long-term RV lower septal pacing is superior to RV apical pacing regarding LV volumes and ejection fraction (EF), and (2) if the changes in LV dyssynchrony imposed by pacing are related to the long-term changes in LV volumes and EF.

Research paper thumbnail of Electrophysiologic Effects of Endothelin Receptor–A Blockade in Patients with Coronary Artery Disease

Journal of Interventional Cardiac Electrophysiology, 2003

Selective endothelin receptor-A antagonists are a promising new treatment in patients with heart ... more Selective endothelin receptor-A antagonists are a promising new treatment in patients with heart failure and/or pulmonary hypertension. Animal studies have suggested that these agents may have additional cardiac electrophysiologic actions, however, no data exist in man. We examined the effects of acute endothelin receptor-A blockade on the sinus node, the atrioventricular node and on the ventricular myocardium, in patients with single-vessel coronary artery disease and preserved left ventricular function. The selective endothelin receptor-A antagonist BQ-123 was administered by the intracoronary route, in order to achieve maximum local cardiac effects. After endothelin receptor-A blockade, QT interval increased from 373 ± 30 msec (mean ± SD) to 395 ± 20 msec (p < 0.01) and QTc interval increased from 394 ± 36 msec to 421 ± 28 msec (p < 0.01). QT-dispersion, calculated from 12-lead ECG, decreased from 40 ± 18 msec to 24 ± 8 msec (p < 0.01) and QTc-dispersion decreased from 44 ± 20 msec to 26 ± 9 msec (p < 0.05). These changes were evident only after infusion in the left, but not in the right coronary artery. No effect was found on the sinus node, the atrioventricular node, or the ventricular effective refractory periods. We conclude that selective endothelin receptor A blockade lengthens ventricular repolarization and decreases its inhomogeneity. Further studies are needed to evaluate possible antiarrhythmic actions of this class of agent.

Research paper thumbnail of P4-34

Results: Forty two consecutive pts were evaluated, of whom 31 completed both tests. AP was not po... more Results: Forty two consecutive pts were evaluated, of whom 31 completed both tests. AP was not possible in 10 pts (24%) due to atrioventricular block (7) or atrial fibrillation (3).VP was not possible in 2 (5%) with frequent ectopy. All pts were male, aged 66.7Ϯ10.8 years. Ejection fraction was 32.8 12.6 with coronary artery disease in 76%. Pts were on betablockers (76%), ACE-I (79%), digoxin (23%) and amiodarone (12%) at time of testing. AP was N in 17 pts (53%) and NN in 15 (47%), while VP was N in 16 (40%) and NN in 24 (60%). Twenty five (80%) of 31 paired tests were concordant indicating good agreement between both tests (kϭ0.62, pϽ0.001). VP had a better negative than positive predictive value (NPV 92% vs. PPV 72%) and was more sensitive (93%) than specific (71%) when referenced to AP. There were no differences in clinical variables between pts with concordant or noncordant tests other than amiodarone use which was more likely in nonconcordants (pϭ0.02). Mv from both tests had significant positive correlation (rϭ0.63, pϭ0.05) with a trend toward higher values of Mv by VP (10.7Ϯ5.3 vs. 7.8Ϯ3.9, pϭ0.058). VP noise was significantly higher (1.4Ϯ0.8 vs. 1Ϯ0.8, p Ͻ0.01). Conclusion: Despite overall agreement between results of VP and AP, VP appears to generate higher levels of Mv and noise with higher percentage of NN results. New cutoffs for positive VP may need to be established.

Research paper thumbnail of Vasodilation in Vasovagal Syncope and the Effect of Water Ingestion

with vasovagal syncope (VVS). The objective was to assess reactive vasodilation in supine patient... more with vasovagal syncope (VVS). The objective was to assess reactive vasodilation in supine patients with VVS and its relation to severity of the syndrome. Reactive vasodilation was also assessed after a simple therapeutic intervention (water drinking). Thirty-four patients were studied, all with recurrent VVS and a recent positive head-up tilt test result. Seventeen matched healthy subjects served as controls. Venous occlusion plethysmography was used to assess forearm blood flow (FBF) and forearm vascular resistance resistance (1) at rest and (2) during reactive hyperemia. Clinical severity of the syndrome was related to the intensity and duration of the vasodilative reflex. The same plethysmographic measurements were repeated 60 minutes after drinking 500 ml of water. Before water drinking, no difference was observed between groups in baseline measurements. However, duration of hyperemia was longer in patients (p <0.05) and was related to the duration of the previous positive tilt test (r ‫؍‬ ؊0.69, p <0.05) and total number of each patient's symptomatic vasovagal episodes (r ‫؍‬ 0.49, p <0.05). After water ingestion, baseline FBF decreased in patients (p <0.05) and remained stable in controls. In patients, duration of hyperemia decreased to normal values. Hyperemic FBF remained similar between groups. In conclusion, increased reactive vasodilative reflexes were observed in patients with VVS. They seemed to be of significant pathophysiologic significance. Water drinking can normalize them for >60 minutes.

Research paper thumbnail of Effect of Levosimendan on Ventricular Arrhythmias and Prognostic Autonomic Indexes in Patients With Decompensated Advanced Heart Failure Secondary to Ischemic or Dilated Cardiomyopathy

Positive inotropes used for the treatment of heart failure have been arrhythmogenic. Levosimendan... more Positive inotropes used for the treatment of heart failure have been arrhythmogenic. Levosimendan is a novel calcium sensitizer with vasodilating properties and a complex mechanism of action. Its effect on ventricular arrhythmias and 24-hour Holter electrocardiographically derived prognostic autonomic nervous system-related markers, because it occurs in parallel with changes in cardiac function and neurohormonal response, has not been systematically assessed. Forty-five patients (mean age 65 +/- 1.3 years) with heart failure refractory to conventional therapy and a mean ejection fraction of 23 +/- 1.2%, randomized to levosimendan or placebo, were studied. After Holter electrocardiographic recording, 1 drug was infused for 24 hours (levosimendan at a dose of 0.1 mug/kg/min). During this period, another Holter recording was performed to assess changes in ventricular arrhythmogenesis, 24-hour heart rate variability indexes, QTc, QT variability, and QT/RR slope. Clinical evaluation, echocardiography, and B-type natriuretic peptide measurements were performed at baseline and after treatment. After levosimendan, clinical and echocardiographic improvement was observed, associated with beneficial neurohormonal modulation (mean B-type natriuretic peptide level after levosimendan 668 +/- 108 vs 1,009 +/- 122 pg/ml at baseline, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Episodes of nonsustained ventricular tachycardia increased with levosimendan (21.9 +/- 9.6 vs 3.0 +/- 1.2, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Levosimendan and placebo exerted a neutral effect on all autonomic markers assessed. In conclusion, levosimendan at low doses increases nonsustained ventricular arrhythmias, without affecting Holter-derived, prognostically significant autonomic markers. At the same time, it is associated with improvements in cardiac function and neurohormonal response. These findings may have important clinical and prognostic implications.

Research paper thumbnail of Electrophysiologic effects of endothelin receptor-A blockade in patients with coronary artery disease

Selective endothelin receptor-A antagonists are a promising new treatment in patients with heart ... more Selective endothelin receptor-A antagonists are a promising new treatment in patients with heart failure and/or pulmonary hypertension. Animal studies have suggested that these agents may have additional cardiac electrophysiologic actions, however, no data exist in man. We examined the effects of acute endothelin receptor-A blockade on the sinus node, the atrioventricular node and on the ventricular myocardium, in patients with single-vessel coronary artery disease and preserved left ventricular function. The selective endothelin receptor-A antagonist BQ-123 was administered by the intracoronary route, in order to achieve maximum local cardiac effects.

Research paper thumbnail of Minor Psychiatric Disorders and Syncope: The Role of Psychopathology in the Expression of Vasovagal Reflex

Psychotherapy and Psychosomatics, 2008

A high prevalence of minor psychiatric disorders (MPDs) has been reported in patients with vasova... more A high prevalence of minor psychiatric disorders (MPDs) has been reported in patients with vasovagal syncope (VVS). However, the relationship between the psychiatric substrate and syncope remains unclear. In order to test the hypothesis that MPDs may predispose to VVS, we assessed the prevalence of syncope, the response to head-up tilt test (HUTT) and the efficacy of psychiatric drug treatment in reducing syncopal episodes, in patients with recently diagnosed MPDs. The response to HUTT was compared with that in an equal number of matched (a) patients with VVS and (b) healthy controls. A high rate of patients with MPDs (58%) had a positive HUTT. Additionally, 45% had a history of syncope; among them, the rate of positive HUTT was identical to that in the VVS group (83%). Following psychiatric drug treatment, the number of patients with syncope decreased in the MPD group (6/67 from 30/67, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Psychiatric symptoms and quality of life were also improved. The number of syncopal spells decreased equally in the MPD and VVS groups (0.6 +/- 0.5 from 2.5 +/- 1.4, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01, and 0.7 +/- 0.5 from 2.7 +/- 1.3, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01, respectively). A high proportion of patients with MPDs experience syncope, associated with a high rate of positive HUTT, comparable to that observed in VVS. Psychiatric treatment results in the improvement of syncopal and psychiatric symptoms. These findings suggest involvement of co-occurring MPDs in the pathogenesis of VVS. Therefore, the diagnosis and treatment of MPDs, when present, may be crucial for the effective therapy of vasovagal syndrome.

Research paper thumbnail of Sertindole and impaired atrioventricular function, in the absence of Q-T prolongation: A case report

Psychiatry and Clinical Neurosciences, 2010

Research paper thumbnail of Long-Term Nonoutflow Septal Versus Apical Right Ventricular Pacing: Relation to Left Ventricular Dyssynchrony

Pacing and Clinical Electrophysiology, 2009

Background: Right ventricular (RV) apical pacing deteriorates left ventricular (LV) function. RV ... more Background: Right ventricular (RV) apical pacing deteriorates left ventricular (LV) function. RV nonoutflow (low) septal pacing may better preserve ventricular performance, but this has not been systematically tested. Our aim was to assess (1) whether long-term RV lower septal pacing is superior to RV apical pacing regarding LV volumes and ejection fraction (EF), and (2) if the changes in LV dyssynchrony imposed by pacing are related to the long-term changes in LV volumes and EF.

Research paper thumbnail of Antiinflammatory Effects of Cardiac Resynchronization Therapy in Patients with Chronic Heart Failure

Pacing and Clinical Electrophysiology, 2006

Cardiac resynchronization therapy (CRT) pacing has been proposed as an additional treatment to me... more Cardiac resynchronization therapy (CRT) pacing has been proposed as an additional treatment to medical therapy to improve heart failure patients with left ventricular asynchrony. The aim of this study was to evaluate the influence of CRT treatment on proinflammatory cytokines in patients with heart failure. Twenty patients, with a mean age 64 +/- 2 years, with severe chronic heart failure NYHA class II-IV (mean ejection fraction 25 +/- 2%), were included in the study. Patients were treated with CRT pacing, after failure of optimal therapy. Blood samples were taken at baseline, 3 months after pacing therapy, and after a subsequent 3-month period of no pacing for the assessment of proinflammatory cytokines TNF-alpha and its receptors (sTNFR-I, sTNFR-II), IL-6, adhesion molecules sICAM-1 and sVCAM-1, and the apoptotic indices sFas and sFas-Ligand. Levels of TNF-alpha, sTNFR-I, and sTNFR-II were reduced at the end of 3 months of CRT therapy and further reduced at the end of the no pacing period (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05, compared to baseline). Levels of IL-6 also declined after 3 months of CRT pacing (from 8.9 +/- 2.5 pg/mL to 4.7 +/- 1.3 pg/mL, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and this was maintained during the no pacing period (3.9 +/- 1.1 pg/mL P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05 compared to baseline). The adhesion molecule sICAM-1 levels also reduced (from 265 +/- 17 ng/mL to 235 +/- 12, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) after 3 months of CRT pacing and remained unchanged at the end of the no pacing period (219 +/- 12 ng/mL, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05 compared to baseline values). Major proinflammatory cytokines and the adhesion molecule sICAM-1 are reduced with CRT therapy and this effect is maintained for at least 3 months after discontinuation of pacing.

Research paper thumbnail of The Role of the Selective Serotonin Re-Uptake Inhibitor Sertraline in Nondepressive Patients with Chronic Ischemic Heart Failure: A Preliminary Study

Pacing and Clinical Electrophysiology, 2010

Selective serotonin re-uptake inhibitors (SSRIs) have been associated with better psychiatric sta... more Selective serotonin re-uptake inhibitors (SSRIs) have been associated with better psychiatric status, functional capacity, and fewer arrhythmias in depressive patients with heart failure (HF). In this study, we tested the impact of sertraline (an SSRI) on patients with HF, but not clinical depression. We studied 62 clinically stable, nondepressive patients with ischemic HF (New York Heart Association class: I-II), and implantable cardioverter-defibrillator (ICD). Following psychiatric evaluation and quality of life (QoL) assessment, 24-hour electrocardiogram recordings including heart rate variability (HRV) and ICD interrogation were performed every 4 months for 1 year. Ventricular effective refractory period (ERP) at 600-, 500-, and 400-ms cycle length and the inducibility of ventricular tachycardia (VT) were assessed via the ICD. After that, sertraline 50 mg/day was administered for 12 months and the whole evaluation was repeated. Sertraline was associated with fewer ventricular extrasystoles per 24 hours and a significant change in HRV (increase in mean R-R, 5-minute standard deviation of RR intervals, and root mean-square difference of successive RR intervals, and reduction in ultra and very low frequency). It was also followed by an improvement in patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; QoL. A trend toward a decrease was observed in the number of recalled nonsustained VTs. The episodes of sustained VT were not significantly reduced. Ventricular ERPs and VT inducibility remained unaltered. In clinically stable, nondepressive patients with ischemic HF and ICD, sertraline is associated with reduced ventricular extrasystoles, better QoL, and a possible improvement in some HRV indexes. This suggests that SSRIs may have a favorable clinical impact on these patients, independent of the improvement in depressive symptoms.

Research paper thumbnail of Heart Rate Turbulence After Short Runs of Nonsustained Ventricular Tachycardia in Chronic Heart Failure

Pacing and Clinical Electrophysiology, 2007

Background: Heart rate turbulence (HRT) following isolated premature complexes is a baroreceptorm... more Background: Heart rate turbulence (HRT) following isolated premature complexes is a baroreceptormediated prognostic marker. Short runs of spontaneous, nonsustained ventricular tachycardia (nsVT) exert a greater hemodynamic effect than extrasystoles and may trigger a more potent turbulence-like response (HRT VT ), possibly related to other risk-related markers, such as heart rate variability (HRV)

Research paper thumbnail of Situational Syncope:. Response to Head-Up Tilt Testing and Follow-Up: Comparison with Vasovagal Syncope

Pacing and Clinical Electrophysiology, 2004

LIVANIS, E.G., ET AL.: Situational Syncope: Response to Head-Up Tilt Testing and Follow-Up: Compa... more LIVANIS, E.G., ET AL.: Situational Syncope: Response to Head-Up Tilt Testing and Follow-Up: Comparison with Vasovagal Syncope. Among sequential patients with neurally-mediated syncope, we studied the response to head-up tilt test (HUTT) in patients with situational syncope (SS) and their follow-up. Our findings were compared to those in patients with vasovagal syncope (VVS). The response to HUTT in patients with SS has not to date been fully investigated. Additionally, the prognosis of SS patients has not been systematically studied. We studied 162 consecutive patients with recurrent SS or VVS, all free of structural heart disease. Before study inclusion, they underwent an HUTT and were followed up for 12 months. Patients with SS were advised to avoid the trigger event. Patients with VVS were treated with propranolol or fluoxetine. For each patient we compared the number of syncopal spells during the last 12 months before study inclusion with that during follow-up. Among the 162 patients, 36 had SS and 126 had VVS. The response to HUTT and the number of syncopes before and during follow-up were similar in both groups. Among patients with SS, 10 (28%) had also experienced occasional episodes of VVS; however, they had a similar response to HUTT and prognosis to the remaining 26 SS patients without VVS attacks. Patients with SS have a similar response to HUTT and similarly benign clinical course to patients with VVS. The coexistence of occasional VVS episodes in patients with SS is not associated with a higher rate of positive HUTT or worse prognosis. (PACE 2004; 27:918-923) situational syncope, tilt test, follow-up

Research paper thumbnail of Assessment of therapeutic efficacy in neurocardiogenic syncope: clomipramine versus isoproterenol tilt test

Journal of the American College of Cardiology, 2002

= cD 114A ABSTRACTS -Cardiac Arrhythmlas greater amplitude of far field potentials when performin... more = cD 114A ABSTRACTS -Cardiac Arrhythmlas greater amplitude of far field potentials when performing catheter ablation in the left superior pulmonary vein. The results of this study also demonstrate that pulmonary vein anatomy is highly variable and that a different pattern of branching exists between the right and left pulmonary veins. 11:30 a.m.

Research paper thumbnail of Sustained improvement in peripheral immune response by biventricular pacing and its association with exercise tolerance and quality of life

Journal of the American College of Cardiology, 2003

Research paper thumbnail of Instantaneous electrocardiographic changes and transient sinus rhythm restoration in severe hyperkalaemia

International Journal of Cardiology, 2011

Severe hyperkalaemia is a life threatening electrolyte abnormality that if not treated urgently, ... more Severe hyperkalaemia is a life threatening electrolyte abnormality that if not treated urgently, might cause electric death. Hyperkalaemia induced electrocardiogram (ECG) alterations vary according to the levels and rate of increase of potassium concentration ([K + ]) in the extracellular milieu but the paradox is that not all these cases provide ECG changes. We describe the first case in the literature of transient sinus rhythm (SR) recovery despite severe hyperkalaemia in a 57-year-old (yo) male patient with impressive ECG changes considering the heart rhythm and QRS morphology. We also review the literature for the mechanism of ECG alterations induced by hyperkalaemia.

Research paper thumbnail of The predictive value of inflammatory and oxidative markers following the successful cardioversion of persistent lone atrial fibrillation

International Journal of Cardiology, 2009

Background: Although there is evidence that inflammation and oxidative stress might contribute to... more Background: Although there is evidence that inflammation and oxidative stress might contribute to the pathogenesis of atrial fibrillation (AF), the predictive value of inflammatory and oxidative stress markers in patients with AF has not been fully assessed. The aim of this study is to evaluate these markers as predictors of sinus rhythm (SR) maintenance, in patients with persistent lone AF. Methods: Among 268 patients with symptomatic AF, we studied 46 patients with a first episode of recently established persistent lone AF. We measured the circulating levels of hs-CRP, TNF-α, IL-6, IL-10, sICAM-1, sVCAM-1, malondialdehyde (MDA) and nitrotyrosine (NT) before, 1 h, 24 h, 1, 2, 4 and 6 weeks after cardioversion. During a 12-month follow-up period, AF recurrence was evaluated by Holter ECG recordings every month and when symptoms were reported. Results: Baseline levels of CRP, TNF-α, sICAM-1, MDA, and NT were elevated in patients with AF compared to controls, and higher in patients with than in those without persistent AF recurrence, while IL-6 levels were equally elevated in the two subgroups. SR maintenance was associated with lower baseline MDA values and faster decrease in IL-6, sICAM-1 and NT levels within the first 2 weeks following SR restoration. Conclusions: Increased markers of inflammation and oxidative stress are found in patients with lone AF, implying that inflammation and oxidative stress may be associated with the presence of the arrhythmia. IL-6, sICAM-1, MDA and NT, assessed prior to and after the first cardioverted episode of persistent arrhythmia, appear to be reliable, early predictors of SR maintenance during the following year.

Research paper thumbnail of Serum markers of deranged myocardial collagen turnover: Their relation to malignant ventricular arrhythmias in cardioverter-defibrillator recipients with heart failure

American Heart Journal, 2012

Research paper thumbnail of Selvester QRS score: an automated algorithm for the quantification of myocardial scar

European Heart Journal, 2013

Purpose: ST-segment deviation score (STDS), a summation of all ST-segment deviations from baselin... more Purpose: ST-segment deviation score (STDS), a summation of all ST-segment deviations from baseline in a standard 12-lead ECG, has shown to correlate with mortality in patients with acute coronary syndrome. However, it is unknown whether these findings can be generalized to the clinical important setting of unselected patients presenting with acute chest pain, in which the early and reliable detection of patients at higher risk still presents an unmet clinical need. Methods: In this prospective multicenter study STDS was determined in 1336 consecutive patients presenting to the emergency department (ED) with symptoms suggestive of acute myocardial infarction. Primary endpoint was the occurrence of death within 30 and 360 days. Patients with left ventricular hypertrophy or bundle branch block were excluded. The STDS was defined as the sum in millimeters (1mm = 1mV) of the absolute value of ST-segment deviations in all 12 leads of the first recorded ECG. Results: STDS at presentation in the highest tertile (≥4.8mm) compared to the intermediate or lowest tertile (<2.7mm) was associated with an increased risk for death in the ensuing 30 days (HR 5.5, p<0.001) and 360 days (HR 3.9, p<0.001). Multivariate analysis showed that initial STDS levels remained an independent predictor of death within 30 days after adjustment for high-sensitive cardiac troponin T levels at presentation (HR 5.2, p=0.002) or TIMI-risk score (HR 5.5, p<0.001).

Research paper thumbnail of Coronary and peripheral blood flow changes following biventricular pacing and their relation to heart failure improvement

Europace, 2006

To study the effect of cardiac resynchronization therapy (CRT) on coronary and peripheral arteria... more To study the effect of cardiac resynchronization therapy (CRT) on coronary and peripheral arterial circulation and to assess whether their changes are related to the improvement in patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; functional capacity and prognostically important biochemical markers. Twenty-five patients were studied (New York Heart Association classes III and IV, left ventricular ejection fraction &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;35%, QRS&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;120 ms, mean age 66 +/- 2.1 years). Coronary blood flow (CBF), forearm blood flow (FBF), and their reserve were measured by transoesophageal echocardiography (in cm/s) and venous occlusion plethysmography (in mL/100 mL/min) at baseline and following 3 months of CRT. N-terminal-pro-brain natriuretic peptide (Nt-pro-BNP) and serum adhesion molecules, sICAM-1 and sVCAM-1 levels were also assessed. CRT induced a non-significant increase in resting CBF (baseline vs. CRT: 52.1 +/- 5.5 vs. 58.2 +/- 3.6, P: NS), whereas hyperaemic CBF was increased by CRT (baseline vs. CRT: 67.8 +/- 6.8 vs. 79.8 +/- 6.2, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Significant increases were observed in resting FBF (baseline vs. CRT: 1.6 +/- 0.2 vs. 2.6 +/- 0.2, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and hyperaemic FBF (baseline vs. CRT: 2.1 +/- 0.2 vs. 3.2 +/- 0.3, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). The per cent difference in hyperaemic FBF was related to the per cent change in Nt-pro-BNP (r = -0.71, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and the per cent improvement in exercise duration (r = 0.80, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). CRT induces favourable changes in coronary and peripheral arterial function. Changes in peripheral blood flow are related to patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; improvement and may be prognostically significant.

Research paper thumbnail of Long-Term Nonoutflow Septal Versus Apical Right Ventricular Pacing: Relation to Left Ventricular Dyssynchrony

Pacing and Clinical Electrophysiology, 2009

Background: Right ventricular (RV) apical pacing deteriorates left ventricular (LV) function. RV ... more Background: Right ventricular (RV) apical pacing deteriorates left ventricular (LV) function. RV nonoutflow (low) septal pacing may better preserve ventricular performance, but this has not been systematically tested. Our aim was to assess (1) whether long-term RV lower septal pacing is superior to RV apical pacing regarding LV volumes and ejection fraction (EF), and (2) if the changes in LV dyssynchrony imposed by pacing are related to the long-term changes in LV volumes and EF.

Research paper thumbnail of Electrophysiologic Effects of Endothelin Receptor–A Blockade in Patients with Coronary Artery Disease

Journal of Interventional Cardiac Electrophysiology, 2003

Selective endothelin receptor-A antagonists are a promising new treatment in patients with heart ... more Selective endothelin receptor-A antagonists are a promising new treatment in patients with heart failure and/or pulmonary hypertension. Animal studies have suggested that these agents may have additional cardiac electrophysiologic actions, however, no data exist in man. We examined the effects of acute endothelin receptor-A blockade on the sinus node, the atrioventricular node and on the ventricular myocardium, in patients with single-vessel coronary artery disease and preserved left ventricular function. The selective endothelin receptor-A antagonist BQ-123 was administered by the intracoronary route, in order to achieve maximum local cardiac effects. After endothelin receptor-A blockade, QT interval increased from 373 ± 30 msec (mean ± SD) to 395 ± 20 msec (p < 0.01) and QTc interval increased from 394 ± 36 msec to 421 ± 28 msec (p < 0.01). QT-dispersion, calculated from 12-lead ECG, decreased from 40 ± 18 msec to 24 ± 8 msec (p < 0.01) and QTc-dispersion decreased from 44 ± 20 msec to 26 ± 9 msec (p < 0.05). These changes were evident only after infusion in the left, but not in the right coronary artery. No effect was found on the sinus node, the atrioventricular node, or the ventricular effective refractory periods. We conclude that selective endothelin receptor A blockade lengthens ventricular repolarization and decreases its inhomogeneity. Further studies are needed to evaluate possible antiarrhythmic actions of this class of agent.

Research paper thumbnail of P4-34

Results: Forty two consecutive pts were evaluated, of whom 31 completed both tests. AP was not po... more Results: Forty two consecutive pts were evaluated, of whom 31 completed both tests. AP was not possible in 10 pts (24%) due to atrioventricular block (7) or atrial fibrillation (3).VP was not possible in 2 (5%) with frequent ectopy. All pts were male, aged 66.7Ϯ10.8 years. Ejection fraction was 32.8 12.6 with coronary artery disease in 76%. Pts were on betablockers (76%), ACE-I (79%), digoxin (23%) and amiodarone (12%) at time of testing. AP was N in 17 pts (53%) and NN in 15 (47%), while VP was N in 16 (40%) and NN in 24 (60%). Twenty five (80%) of 31 paired tests were concordant indicating good agreement between both tests (kϭ0.62, pϽ0.001). VP had a better negative than positive predictive value (NPV 92% vs. PPV 72%) and was more sensitive (93%) than specific (71%) when referenced to AP. There were no differences in clinical variables between pts with concordant or noncordant tests other than amiodarone use which was more likely in nonconcordants (pϭ0.02). Mv from both tests had significant positive correlation (rϭ0.63, pϭ0.05) with a trend toward higher values of Mv by VP (10.7Ϯ5.3 vs. 7.8Ϯ3.9, pϭ0.058). VP noise was significantly higher (1.4Ϯ0.8 vs. 1Ϯ0.8, p Ͻ0.01). Conclusion: Despite overall agreement between results of VP and AP, VP appears to generate higher levels of Mv and noise with higher percentage of NN results. New cutoffs for positive VP may need to be established.

Research paper thumbnail of Vasodilation in Vasovagal Syncope and the Effect of Water Ingestion

with vasovagal syncope (VVS). The objective was to assess reactive vasodilation in supine patient... more with vasovagal syncope (VVS). The objective was to assess reactive vasodilation in supine patients with VVS and its relation to severity of the syndrome. Reactive vasodilation was also assessed after a simple therapeutic intervention (water drinking). Thirty-four patients were studied, all with recurrent VVS and a recent positive head-up tilt test result. Seventeen matched healthy subjects served as controls. Venous occlusion plethysmography was used to assess forearm blood flow (FBF) and forearm vascular resistance resistance (1) at rest and (2) during reactive hyperemia. Clinical severity of the syndrome was related to the intensity and duration of the vasodilative reflex. The same plethysmographic measurements were repeated 60 minutes after drinking 500 ml of water. Before water drinking, no difference was observed between groups in baseline measurements. However, duration of hyperemia was longer in patients (p <0.05) and was related to the duration of the previous positive tilt test (r ‫؍‬ ؊0.69, p <0.05) and total number of each patient's symptomatic vasovagal episodes (r ‫؍‬ 0.49, p <0.05). After water ingestion, baseline FBF decreased in patients (p <0.05) and remained stable in controls. In patients, duration of hyperemia decreased to normal values. Hyperemic FBF remained similar between groups. In conclusion, increased reactive vasodilative reflexes were observed in patients with VVS. They seemed to be of significant pathophysiologic significance. Water drinking can normalize them for >60 minutes.

Research paper thumbnail of Effect of Levosimendan on Ventricular Arrhythmias and Prognostic Autonomic Indexes in Patients With Decompensated Advanced Heart Failure Secondary to Ischemic or Dilated Cardiomyopathy

Positive inotropes used for the treatment of heart failure have been arrhythmogenic. Levosimendan... more Positive inotropes used for the treatment of heart failure have been arrhythmogenic. Levosimendan is a novel calcium sensitizer with vasodilating properties and a complex mechanism of action. Its effect on ventricular arrhythmias and 24-hour Holter electrocardiographically derived prognostic autonomic nervous system-related markers, because it occurs in parallel with changes in cardiac function and neurohormonal response, has not been systematically assessed. Forty-five patients (mean age 65 +/- 1.3 years) with heart failure refractory to conventional therapy and a mean ejection fraction of 23 +/- 1.2%, randomized to levosimendan or placebo, were studied. After Holter electrocardiographic recording, 1 drug was infused for 24 hours (levosimendan at a dose of 0.1 mug/kg/min). During this period, another Holter recording was performed to assess changes in ventricular arrhythmogenesis, 24-hour heart rate variability indexes, QTc, QT variability, and QT/RR slope. Clinical evaluation, echocardiography, and B-type natriuretic peptide measurements were performed at baseline and after treatment. After levosimendan, clinical and echocardiographic improvement was observed, associated with beneficial neurohormonal modulation (mean B-type natriuretic peptide level after levosimendan 668 +/- 108 vs 1,009 +/- 122 pg/ml at baseline, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Episodes of nonsustained ventricular tachycardia increased with levosimendan (21.9 +/- 9.6 vs 3.0 +/- 1.2, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Levosimendan and placebo exerted a neutral effect on all autonomic markers assessed. In conclusion, levosimendan at low doses increases nonsustained ventricular arrhythmias, without affecting Holter-derived, prognostically significant autonomic markers. At the same time, it is associated with improvements in cardiac function and neurohormonal response. These findings may have important clinical and prognostic implications.

Research paper thumbnail of Electrophysiologic effects of endothelin receptor-A blockade in patients with coronary artery disease

Selective endothelin receptor-A antagonists are a promising new treatment in patients with heart ... more Selective endothelin receptor-A antagonists are a promising new treatment in patients with heart failure and/or pulmonary hypertension. Animal studies have suggested that these agents may have additional cardiac electrophysiologic actions, however, no data exist in man. We examined the effects of acute endothelin receptor-A blockade on the sinus node, the atrioventricular node and on the ventricular myocardium, in patients with single-vessel coronary artery disease and preserved left ventricular function. The selective endothelin receptor-A antagonist BQ-123 was administered by the intracoronary route, in order to achieve maximum local cardiac effects.

Research paper thumbnail of Minor Psychiatric Disorders and Syncope: The Role of Psychopathology in the Expression of Vasovagal Reflex

Psychotherapy and Psychosomatics, 2008

A high prevalence of minor psychiatric disorders (MPDs) has been reported in patients with vasova... more A high prevalence of minor psychiatric disorders (MPDs) has been reported in patients with vasovagal syncope (VVS). However, the relationship between the psychiatric substrate and syncope remains unclear. In order to test the hypothesis that MPDs may predispose to VVS, we assessed the prevalence of syncope, the response to head-up tilt test (HUTT) and the efficacy of psychiatric drug treatment in reducing syncopal episodes, in patients with recently diagnosed MPDs. The response to HUTT was compared with that in an equal number of matched (a) patients with VVS and (b) healthy controls. A high rate of patients with MPDs (58%) had a positive HUTT. Additionally, 45% had a history of syncope; among them, the rate of positive HUTT was identical to that in the VVS group (83%). Following psychiatric drug treatment, the number of patients with syncope decreased in the MPD group (6/67 from 30/67, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Psychiatric symptoms and quality of life were also improved. The number of syncopal spells decreased equally in the MPD and VVS groups (0.6 +/- 0.5 from 2.5 +/- 1.4, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01, and 0.7 +/- 0.5 from 2.7 +/- 1.3, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01, respectively). A high proportion of patients with MPDs experience syncope, associated with a high rate of positive HUTT, comparable to that observed in VVS. Psychiatric treatment results in the improvement of syncopal and psychiatric symptoms. These findings suggest involvement of co-occurring MPDs in the pathogenesis of VVS. Therefore, the diagnosis and treatment of MPDs, when present, may be crucial for the effective therapy of vasovagal syndrome.

Research paper thumbnail of Sertindole and impaired atrioventricular function, in the absence of Q-T prolongation: A case report

Psychiatry and Clinical Neurosciences, 2010

Research paper thumbnail of Long-Term Nonoutflow Septal Versus Apical Right Ventricular Pacing: Relation to Left Ventricular Dyssynchrony

Pacing and Clinical Electrophysiology, 2009

Background: Right ventricular (RV) apical pacing deteriorates left ventricular (LV) function. RV ... more Background: Right ventricular (RV) apical pacing deteriorates left ventricular (LV) function. RV nonoutflow (low) septal pacing may better preserve ventricular performance, but this has not been systematically tested. Our aim was to assess (1) whether long-term RV lower septal pacing is superior to RV apical pacing regarding LV volumes and ejection fraction (EF), and (2) if the changes in LV dyssynchrony imposed by pacing are related to the long-term changes in LV volumes and EF.

Research paper thumbnail of Antiinflammatory Effects of Cardiac Resynchronization Therapy in Patients with Chronic Heart Failure

Pacing and Clinical Electrophysiology, 2006

Cardiac resynchronization therapy (CRT) pacing has been proposed as an additional treatment to me... more Cardiac resynchronization therapy (CRT) pacing has been proposed as an additional treatment to medical therapy to improve heart failure patients with left ventricular asynchrony. The aim of this study was to evaluate the influence of CRT treatment on proinflammatory cytokines in patients with heart failure. Twenty patients, with a mean age 64 +/- 2 years, with severe chronic heart failure NYHA class II-IV (mean ejection fraction 25 +/- 2%), were included in the study. Patients were treated with CRT pacing, after failure of optimal therapy. Blood samples were taken at baseline, 3 months after pacing therapy, and after a subsequent 3-month period of no pacing for the assessment of proinflammatory cytokines TNF-alpha and its receptors (sTNFR-I, sTNFR-II), IL-6, adhesion molecules sICAM-1 and sVCAM-1, and the apoptotic indices sFas and sFas-Ligand. Levels of TNF-alpha, sTNFR-I, and sTNFR-II were reduced at the end of 3 months of CRT therapy and further reduced at the end of the no pacing period (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05, compared to baseline). Levels of IL-6 also declined after 3 months of CRT pacing (from 8.9 +/- 2.5 pg/mL to 4.7 +/- 1.3 pg/mL, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and this was maintained during the no pacing period (3.9 +/- 1.1 pg/mL P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05 compared to baseline). The adhesion molecule sICAM-1 levels also reduced (from 265 +/- 17 ng/mL to 235 +/- 12, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) after 3 months of CRT pacing and remained unchanged at the end of the no pacing period (219 +/- 12 ng/mL, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05 compared to baseline values). Major proinflammatory cytokines and the adhesion molecule sICAM-1 are reduced with CRT therapy and this effect is maintained for at least 3 months after discontinuation of pacing.

Research paper thumbnail of The Role of the Selective Serotonin Re-Uptake Inhibitor Sertraline in Nondepressive Patients with Chronic Ischemic Heart Failure: A Preliminary Study

Pacing and Clinical Electrophysiology, 2010

Selective serotonin re-uptake inhibitors (SSRIs) have been associated with better psychiatric sta... more Selective serotonin re-uptake inhibitors (SSRIs) have been associated with better psychiatric status, functional capacity, and fewer arrhythmias in depressive patients with heart failure (HF). In this study, we tested the impact of sertraline (an SSRI) on patients with HF, but not clinical depression. We studied 62 clinically stable, nondepressive patients with ischemic HF (New York Heart Association class: I-II), and implantable cardioverter-defibrillator (ICD). Following psychiatric evaluation and quality of life (QoL) assessment, 24-hour electrocardiogram recordings including heart rate variability (HRV) and ICD interrogation were performed every 4 months for 1 year. Ventricular effective refractory period (ERP) at 600-, 500-, and 400-ms cycle length and the inducibility of ventricular tachycardia (VT) were assessed via the ICD. After that, sertraline 50 mg/day was administered for 12 months and the whole evaluation was repeated. Sertraline was associated with fewer ventricular extrasystoles per 24 hours and a significant change in HRV (increase in mean R-R, 5-minute standard deviation of RR intervals, and root mean-square difference of successive RR intervals, and reduction in ultra and very low frequency). It was also followed by an improvement in patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; QoL. A trend toward a decrease was observed in the number of recalled nonsustained VTs. The episodes of sustained VT were not significantly reduced. Ventricular ERPs and VT inducibility remained unaltered. In clinically stable, nondepressive patients with ischemic HF and ICD, sertraline is associated with reduced ventricular extrasystoles, better QoL, and a possible improvement in some HRV indexes. This suggests that SSRIs may have a favorable clinical impact on these patients, independent of the improvement in depressive symptoms.

Research paper thumbnail of Heart Rate Turbulence After Short Runs of Nonsustained Ventricular Tachycardia in Chronic Heart Failure

Pacing and Clinical Electrophysiology, 2007

Background: Heart rate turbulence (HRT) following isolated premature complexes is a baroreceptorm... more Background: Heart rate turbulence (HRT) following isolated premature complexes is a baroreceptormediated prognostic marker. Short runs of spontaneous, nonsustained ventricular tachycardia (nsVT) exert a greater hemodynamic effect than extrasystoles and may trigger a more potent turbulence-like response (HRT VT ), possibly related to other risk-related markers, such as heart rate variability (HRV)

Research paper thumbnail of Situational Syncope:. Response to Head-Up Tilt Testing and Follow-Up: Comparison with Vasovagal Syncope

Pacing and Clinical Electrophysiology, 2004

LIVANIS, E.G., ET AL.: Situational Syncope: Response to Head-Up Tilt Testing and Follow-Up: Compa... more LIVANIS, E.G., ET AL.: Situational Syncope: Response to Head-Up Tilt Testing and Follow-Up: Comparison with Vasovagal Syncope. Among sequential patients with neurally-mediated syncope, we studied the response to head-up tilt test (HUTT) in patients with situational syncope (SS) and their follow-up. Our findings were compared to those in patients with vasovagal syncope (VVS). The response to HUTT in patients with SS has not to date been fully investigated. Additionally, the prognosis of SS patients has not been systematically studied. We studied 162 consecutive patients with recurrent SS or VVS, all free of structural heart disease. Before study inclusion, they underwent an HUTT and were followed up for 12 months. Patients with SS were advised to avoid the trigger event. Patients with VVS were treated with propranolol or fluoxetine. For each patient we compared the number of syncopal spells during the last 12 months before study inclusion with that during follow-up. Among the 162 patients, 36 had SS and 126 had VVS. The response to HUTT and the number of syncopes before and during follow-up were similar in both groups. Among patients with SS, 10 (28%) had also experienced occasional episodes of VVS; however, they had a similar response to HUTT and prognosis to the remaining 26 SS patients without VVS attacks. Patients with SS have a similar response to HUTT and similarly benign clinical course to patients with VVS. The coexistence of occasional VVS episodes in patients with SS is not associated with a higher rate of positive HUTT or worse prognosis. (PACE 2004; 27:918-923) situational syncope, tilt test, follow-up

Research paper thumbnail of Assessment of therapeutic efficacy in neurocardiogenic syncope: clomipramine versus isoproterenol tilt test

Journal of the American College of Cardiology, 2002

= cD 114A ABSTRACTS -Cardiac Arrhythmlas greater amplitude of far field potentials when performin... more = cD 114A ABSTRACTS -Cardiac Arrhythmlas greater amplitude of far field potentials when performing catheter ablation in the left superior pulmonary vein. The results of this study also demonstrate that pulmonary vein anatomy is highly variable and that a different pattern of branching exists between the right and left pulmonary veins. 11:30 a.m.

Research paper thumbnail of Sustained improvement in peripheral immune response by biventricular pacing and its association with exercise tolerance and quality of life

Journal of the American College of Cardiology, 2003

Research paper thumbnail of Instantaneous electrocardiographic changes and transient sinus rhythm restoration in severe hyperkalaemia

International Journal of Cardiology, 2011

Severe hyperkalaemia is a life threatening electrolyte abnormality that if not treated urgently, ... more Severe hyperkalaemia is a life threatening electrolyte abnormality that if not treated urgently, might cause electric death. Hyperkalaemia induced electrocardiogram (ECG) alterations vary according to the levels and rate of increase of potassium concentration ([K + ]) in the extracellular milieu but the paradox is that not all these cases provide ECG changes. We describe the first case in the literature of transient sinus rhythm (SR) recovery despite severe hyperkalaemia in a 57-year-old (yo) male patient with impressive ECG changes considering the heart rhythm and QRS morphology. We also review the literature for the mechanism of ECG alterations induced by hyperkalaemia.

Research paper thumbnail of The predictive value of inflammatory and oxidative markers following the successful cardioversion of persistent lone atrial fibrillation

International Journal of Cardiology, 2009

Background: Although there is evidence that inflammation and oxidative stress might contribute to... more Background: Although there is evidence that inflammation and oxidative stress might contribute to the pathogenesis of atrial fibrillation (AF), the predictive value of inflammatory and oxidative stress markers in patients with AF has not been fully assessed. The aim of this study is to evaluate these markers as predictors of sinus rhythm (SR) maintenance, in patients with persistent lone AF. Methods: Among 268 patients with symptomatic AF, we studied 46 patients with a first episode of recently established persistent lone AF. We measured the circulating levels of hs-CRP, TNF-α, IL-6, IL-10, sICAM-1, sVCAM-1, malondialdehyde (MDA) and nitrotyrosine (NT) before, 1 h, 24 h, 1, 2, 4 and 6 weeks after cardioversion. During a 12-month follow-up period, AF recurrence was evaluated by Holter ECG recordings every month and when symptoms were reported. Results: Baseline levels of CRP, TNF-α, sICAM-1, MDA, and NT were elevated in patients with AF compared to controls, and higher in patients with than in those without persistent AF recurrence, while IL-6 levels were equally elevated in the two subgroups. SR maintenance was associated with lower baseline MDA values and faster decrease in IL-6, sICAM-1 and NT levels within the first 2 weeks following SR restoration. Conclusions: Increased markers of inflammation and oxidative stress are found in patients with lone AF, implying that inflammation and oxidative stress may be associated with the presence of the arrhythmia. IL-6, sICAM-1, MDA and NT, assessed prior to and after the first cardioverted episode of persistent arrhythmia, appear to be reliable, early predictors of SR maintenance during the following year.