Fabrizio Ammirati - Academia.edu (original) (raw)
Papers by Fabrizio Ammirati
Giornale Italiano Di Cardiologia, May 1, 2010
Secondary prevention after acute coronary syndromes should be aimed at reducing the risk of furth... more Secondary prevention after acute coronary syndromes should be aimed at reducing the risk of further adverse cardiovascular events, thereby improving quality of life, and lengthening survival. Despite compelling evidence from large randomized controlled trials, secondary prevention is not fully implemented in most cases after hospitalization for acute coronary syndrome.
Acc Current Journal Review, 2001
A bimodal distribution of RR intervals during CAF is associated with a higher success rate of rad... more A bimodal distribution of RR intervals during CAF is associated with a higher success rate of radiofrequency modification of the AVN and a lower risk of inadvertent atrioventricular block. When a bimodal pattern is present, rate control is achieved by ablation of the posterior inputs to the AVN and when the pattern is unimodal, rate control may require injury to the compact AVN. Perspective: These findings provide insight into the mechanism by which modification of the AVN results in control of the ventricular rate, but are of little practical value. AVN ablation/pacemaker is usually preferred over modification of the AVN because of more reliable outcomes.
Expert Review of Cardiovascular Therapy, 2016
Approximately 1-2% of the adult population in developed countries is affected by heart failure. T... more Approximately 1-2% of the adult population in developed countries is affected by heart failure. The costs of heart failure are enormous both in Europe and in the US and are expected to rise. New technologies and remote monitoring, are valid tools for the management and treatment of these patients. This review aims to cover both implantable and non-implantable devices available for monitoring various hemodynamic parameters and clinical features of patients, as well as algorithms implemented in the new generation ICDs and CRTs capable of simultaneous acquisition and transmission of multiple parameters that indirectly evaluate clinical and/or hemodynamic status. Both internet and PubMed searches were used in order to acquire the most recent developments in the technology of the field. Expert commentary: As new technology offers an enormous data flow, the key for success in the battle against heart failure and related hospitalizations is understanding the correct way of utilizing the data acquired and their importance for the treatment of each individual person.
Giornale Italiano Di Cardiologia, Feb 1, 2008
Methods. To evaluate the effectiveness of ECP-STEMI in the current practice, a prospective observ... more Methods. To evaluate the effectiveness of ECP-STEMI in the current practice, a prospective observational cohort study of ambulance-transported patients with cardiovascular symptoms was conducted in a selected area of the Lazio Region during a 6-month period. The implementation of the ECP was carried out by educational activities for the EMS personnel based on the "experiential learning" methods.
FESC; for the Syncope Diagnosis and Treatment Study Investigators* Background-This clinical inves... more FESC; for the Syncope Diagnosis and Treatment Study Investigators* Background-This clinical investigation was performed to compare the effects of permanent dual-chamber cardiac pacing with pharmacological therapy in patients with recurrent vasovagal syncope. Methods and Results-Patients from 14 centers were randomized to receive either a DDD pacemaker provided with rate-drop response function or the -blocker atenolol at the dosage of 100 mg once a day. Inclusion criteria were age Ͼ35 years, Ն3 syncopal spells in the preceding 2 years, and positive response to tilt table testing with syncope occurring in association with relative bradycardia. The primary outcome was the first recurrence of syncope after randomization. Enrollment was started in December 1997, and the first formal interim analysis was performed on July 30, 2000. By that time, 93 patients (38 men and 55 women; mean age, 58.1Ϯ14.3 years) had been enrolled and randomized, although follow-up data were available for all patients (46 patients in the pacemaker arm, 47 patients in the pharmacological arm). The interim analysis showed a significant effect in favor of permanent cardiac pacing (recurrence of syncope in 2 patients [4.3%] after a median of 390 days) compared with medical treatment (recurrence of syncope in 12 patients [25.5%] after a median of 135 days; OR, 0.133; 95% CI, 0.028 to 0.632; Pϭ0.004). Consequently, enrollment and follow-up were terminated. Conclusions-DDD pacing with rate-drop response function is more effective than -blockade for the prevention of syncopal recurrences in highly symptomatic vasovagal fainters with relative bradycardia during tilt-induced syncope. (Circulation. 2001;104:52-57.)
Pacing and Clinical Electrophysiology Pace, Nov 1, 1998
Pacing for Cardioinhibitory Vasovagal Syncope. Background: The effectiveness of cardiac pacing in... more Pacing for Cardioinhibitory Vasovagal Syncope. Background: The effectiveness of cardiac pacing in preventing vasovagal syncope remains controversial. However, DDI pacing with rate hysteresis has been reported to prevent the recurrence of cardioinhibitory vasovagal syncope in up to 35% of affected subjects and to reduce the overall incidence of syncopal episodes in the others. Recently, DDD pacing with a new promising rate drop response function (Medtronic Thera-I model 7960) has become available in clinical practice. Aim of the study: The aim of the present open trial was to test the effectiveness of this new pacing modality in patients with cardioinhibitory vasovagal syncope. Study population and methods: The study population included 20 patients (12 males and 8 females; mean age 61.1 ± 14 yrs) with recurrent syncope (mean number of prior episode = 6.8, range 5-11) and cardioinhibitory responses during two head-up tilt tests: the first diagnostic and the second during drug therapy with either ^-blockade or etilephrine. The study patients were randomized to receive either DDI pacing with rate hysteresis (8 patients) or DDD pacing with rate drop response function (11 patients). The head-up tilt test performed 1 month after pacemaker implantation was positive in 3 of 12 patients (25%) with DDD pacing with rate drop response function and in 5 of 8 patients (62.5%) with DDI pacing with rate hysteresis. The mean duration of follow-up was 17.7 ± 7.4 months. During follow-up no patients with a DDD pacemaker with rate drop response function had syncope, while 3 of 8 patients with a DDI pacemaker with rate hysteresis had recurrence of syncope (P < 0.05). Conclusions: These data suggest that DDD pacing with rate drop response function is effective in cardioinhibitory vasovagal syncope and may be preferable to DDI pacing with rate hysteresis. (PACE 1998; 21[Pt. 111:2178 21[Pt. 111: -2181 vasovagal syncope, pacemaker therapy
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Jan 26, 2015
The aim of this study was to determine the long-term effects and determinants of success of cardi... more The aim of this study was to determine the long-term effects and determinants of success of cardiac pacing in patients affected by reflex syncope enrolled in the Syncope Unit Project 2 (SUP 2) study. Initial results have validated the effectiveness of a standardized guideline-based algorithm which can be used in clinical practice in order to select suitable candidates for cardiac pacing. In this prospective, multicentre, observational study, patients aged >40 years, affected by severe unpredictable recurrent reflex syncope, underwent carotid sinus massage (CSM), followed by tilt testing (TT) if CSM was negative, followed by implantation of an implantable loop recorder (ILR) if TT was negative. Those who had an asystolic response to one of these tests received a dual-chamber pacemaker. Of 281 patients who met the inclusion criteria, 137 (49%) received a pacemaker and were followed up for a mean of 26 ± 11 months: syncope recurred in 25 (18%) of them. At 3 years, the actuarial sync...
Italian heart journal: official journal of the Italian Federation of Cardiology
Cardiologia (Rome, Italy)
Giornale italiano di cardiologia
While syncope is generally considered a frequent finding in clinical practice, no clear epidemiol... more While syncope is generally considered a frequent finding in clinical practice, no clear epidemiological evidence is available about the relevance of such an event in the general population of Italy. The OESIL Study was designed and undertaken in 15 hospitals of the Italian region of Latium in order to assess the percentage of emergency-room visits and admissions due to syncope, as well as to analyze the in-hospital diagnostic work-up performed for this condition. During a two-month observation period, 781 (372 males and 409 females, mean age 55.2 (22.8 years) consecutive patients came to the emergency rooms of the 15 hospitals included in the investigation due to a syncope spell (0.9% of emergency room visits); 450/781 patients (57.6%) were subsequently hospitalized (1.3% of all admissions): 48.0% of the admissions were admitted to a general medical ward, 29.3% to an observation ward, 13.3% to a cardiology section, 1.6% to a neurology section and 7.8% to other clinical sections (neu...
Revista Espa de Cardiologia
ACC Current Journal Review, 2001
A bimodal distribution of RR intervals during CAF is associated with a higher success rate of rad... more A bimodal distribution of RR intervals during CAF is associated with a higher success rate of radiofrequency modification of the AVN and a lower risk of inadvertent atrioventricular block. When a bimodal pattern is present, rate control is achieved by ablation of the posterior inputs to the AVN and when the pattern is unimodal, rate control may require injury to the compact AVN. Perspective: These findings provide insight into the mechanism by which modification of the AVN results in control of the ventricular rate, but are of little practical value. AVN ablation/pacemaker is usually preferred over modification of the AVN because of more reliable outcomes.
European heart journal, Jan 29, 2015
Opinions differ regarding the effectiveness of cardiac pacing in patients affected by reflex sync... more Opinions differ regarding the effectiveness of cardiac pacing in patients affected by reflex syncope. We assessed a standardized guideline-based algorithm in different forms of reflex syncope. In this prospective, multi-centre, observational study, patients aged >40 years, affected by severe unpredictable recurrent reflex syncopes, underwent carotid sinus massage (CSM), followed by tilt testing (TT) if CSM was negative, followed by implantation of an implantable loop recorder (ILR) if TT was negative. Those who had an asystolic response to one of these tests received a dual-chamber pacemaker. 253 patients, mean age 70 ± 12 years, median 4 (3-6) syncopes, 89% without or with short prodromes. Of these patients, 120 (47%) received a pacemaker and 106 were followed up for a mean of 13 ± 7 months: syncope recurred in 10 (9%). The recurrence rate was similar in 61 CSM+ (11%), 30 TT+ (7%), and 15 ILR+ (7%) patients. The actuarial total syncope recurrence rate was 9% (95% confidence inte...
Giornale italiano di cardiologia (2006), 2010
Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology, 2004
The aim of this study was to evaluate how the main tests for the diagnostic assessment of syncope... more The aim of this study was to evaluate how the main tests for the diagnostic assessment of syncope are currently performed in the Italian hospitals. During the early 2003 dedicated questionnaires were administered to about 400 Italian hospitals. About each test information was requested relative to: test protocol, laboratory equipment, patients evaluated during 2002. Eighty-four hospitals answered the questionnaire. A syncope-dedicated ambulatory (at least once a week) was available during 2002 in 59/84 hospitals, and 56 were dependent on the Cardiology Division. Carotid sinus massage was performed either in clinostatic and in orthostatic position in 60 Centers and was repeated after atropine in 15. To define the test positivity, 35 Centers followed the "symptom method". Only 15 Centers performed > 100 procedures during 2002 (range 3-500). Tilt testing was performed in 72 hospitals. A dedicated tilting bed was available in 65 Centers, continuous beat-to-beat pressure mea...
Journal of Cardiovascular Medicine, 2015
We report a case of a 78-year-old woman admitted to hospital due to cardiac tamponade 3 months af... more We report a case of a 78-year-old woman admitted to hospital due to cardiac tamponade 3 months after surgical mitral valve repair. The patient developed an early left ventricular dysfunction after removal of the pericardial effusion, with complete recovery within 10 days. Transient ventricular dysfunction after pericardiocentesis is a very rare complication, we present a review of the different mechanisms suggested in the literature to explain the pathophysiology of this rare phenomenon.
Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology, 2000
The head-up tilt testing potentiated with oral nitroglycerin, devised by an Italian group, is a s... more The head-up tilt testing potentiated with oral nitroglycerin, devised by an Italian group, is a simple, safe and powerful, but still not a standardized, diagnostic tool. In fact, owing to its rapid diffusion, the original protocol received, often arbitrarily, subsequent modifications. Thus a task force of experienced cardiologists defined the best methodology for the test on strictly evidence-based criteria. Particular attention was reserved to some controversial topics, such as the tilting angle, the duration of the passive and pharmacological stages of the test, the type and dosage of the drug utilized. We hope that the enclosed protocol, named by us as "The Italian Protocol", will be accepted as the standard methodology of the head-up tilt testing potentiated with oral nitrates.
Giornale Italiano Di Cardiologia, May 1, 2010
Secondary prevention after acute coronary syndromes should be aimed at reducing the risk of furth... more Secondary prevention after acute coronary syndromes should be aimed at reducing the risk of further adverse cardiovascular events, thereby improving quality of life, and lengthening survival. Despite compelling evidence from large randomized controlled trials, secondary prevention is not fully implemented in most cases after hospitalization for acute coronary syndrome.
Acc Current Journal Review, 2001
A bimodal distribution of RR intervals during CAF is associated with a higher success rate of rad... more A bimodal distribution of RR intervals during CAF is associated with a higher success rate of radiofrequency modification of the AVN and a lower risk of inadvertent atrioventricular block. When a bimodal pattern is present, rate control is achieved by ablation of the posterior inputs to the AVN and when the pattern is unimodal, rate control may require injury to the compact AVN. Perspective: These findings provide insight into the mechanism by which modification of the AVN results in control of the ventricular rate, but are of little practical value. AVN ablation/pacemaker is usually preferred over modification of the AVN because of more reliable outcomes.
Expert Review of Cardiovascular Therapy, 2016
Approximately 1-2% of the adult population in developed countries is affected by heart failure. T... more Approximately 1-2% of the adult population in developed countries is affected by heart failure. The costs of heart failure are enormous both in Europe and in the US and are expected to rise. New technologies and remote monitoring, are valid tools for the management and treatment of these patients. This review aims to cover both implantable and non-implantable devices available for monitoring various hemodynamic parameters and clinical features of patients, as well as algorithms implemented in the new generation ICDs and CRTs capable of simultaneous acquisition and transmission of multiple parameters that indirectly evaluate clinical and/or hemodynamic status. Both internet and PubMed searches were used in order to acquire the most recent developments in the technology of the field. Expert commentary: As new technology offers an enormous data flow, the key for success in the battle against heart failure and related hospitalizations is understanding the correct way of utilizing the data acquired and their importance for the treatment of each individual person.
Giornale Italiano Di Cardiologia, Feb 1, 2008
Methods. To evaluate the effectiveness of ECP-STEMI in the current practice, a prospective observ... more Methods. To evaluate the effectiveness of ECP-STEMI in the current practice, a prospective observational cohort study of ambulance-transported patients with cardiovascular symptoms was conducted in a selected area of the Lazio Region during a 6-month period. The implementation of the ECP was carried out by educational activities for the EMS personnel based on the "experiential learning" methods.
FESC; for the Syncope Diagnosis and Treatment Study Investigators* Background-This clinical inves... more FESC; for the Syncope Diagnosis and Treatment Study Investigators* Background-This clinical investigation was performed to compare the effects of permanent dual-chamber cardiac pacing with pharmacological therapy in patients with recurrent vasovagal syncope. Methods and Results-Patients from 14 centers were randomized to receive either a DDD pacemaker provided with rate-drop response function or the -blocker atenolol at the dosage of 100 mg once a day. Inclusion criteria were age Ͼ35 years, Ն3 syncopal spells in the preceding 2 years, and positive response to tilt table testing with syncope occurring in association with relative bradycardia. The primary outcome was the first recurrence of syncope after randomization. Enrollment was started in December 1997, and the first formal interim analysis was performed on July 30, 2000. By that time, 93 patients (38 men and 55 women; mean age, 58.1Ϯ14.3 years) had been enrolled and randomized, although follow-up data were available for all patients (46 patients in the pacemaker arm, 47 patients in the pharmacological arm). The interim analysis showed a significant effect in favor of permanent cardiac pacing (recurrence of syncope in 2 patients [4.3%] after a median of 390 days) compared with medical treatment (recurrence of syncope in 12 patients [25.5%] after a median of 135 days; OR, 0.133; 95% CI, 0.028 to 0.632; Pϭ0.004). Consequently, enrollment and follow-up were terminated. Conclusions-DDD pacing with rate-drop response function is more effective than -blockade for the prevention of syncopal recurrences in highly symptomatic vasovagal fainters with relative bradycardia during tilt-induced syncope. (Circulation. 2001;104:52-57.)
Pacing and Clinical Electrophysiology Pace, Nov 1, 1998
Pacing for Cardioinhibitory Vasovagal Syncope. Background: The effectiveness of cardiac pacing in... more Pacing for Cardioinhibitory Vasovagal Syncope. Background: The effectiveness of cardiac pacing in preventing vasovagal syncope remains controversial. However, DDI pacing with rate hysteresis has been reported to prevent the recurrence of cardioinhibitory vasovagal syncope in up to 35% of affected subjects and to reduce the overall incidence of syncopal episodes in the others. Recently, DDD pacing with a new promising rate drop response function (Medtronic Thera-I model 7960) has become available in clinical practice. Aim of the study: The aim of the present open trial was to test the effectiveness of this new pacing modality in patients with cardioinhibitory vasovagal syncope. Study population and methods: The study population included 20 patients (12 males and 8 females; mean age 61.1 ± 14 yrs) with recurrent syncope (mean number of prior episode = 6.8, range 5-11) and cardioinhibitory responses during two head-up tilt tests: the first diagnostic and the second during drug therapy with either ^-blockade or etilephrine. The study patients were randomized to receive either DDI pacing with rate hysteresis (8 patients) or DDD pacing with rate drop response function (11 patients). The head-up tilt test performed 1 month after pacemaker implantation was positive in 3 of 12 patients (25%) with DDD pacing with rate drop response function and in 5 of 8 patients (62.5%) with DDI pacing with rate hysteresis. The mean duration of follow-up was 17.7 ± 7.4 months. During follow-up no patients with a DDD pacemaker with rate drop response function had syncope, while 3 of 8 patients with a DDI pacemaker with rate hysteresis had recurrence of syncope (P < 0.05). Conclusions: These data suggest that DDD pacing with rate drop response function is effective in cardioinhibitory vasovagal syncope and may be preferable to DDI pacing with rate hysteresis. (PACE 1998; 21[Pt. 111:2178 21[Pt. 111: -2181 vasovagal syncope, pacemaker therapy
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Jan 26, 2015
The aim of this study was to determine the long-term effects and determinants of success of cardi... more The aim of this study was to determine the long-term effects and determinants of success of cardiac pacing in patients affected by reflex syncope enrolled in the Syncope Unit Project 2 (SUP 2) study. Initial results have validated the effectiveness of a standardized guideline-based algorithm which can be used in clinical practice in order to select suitable candidates for cardiac pacing. In this prospective, multicentre, observational study, patients aged >40 years, affected by severe unpredictable recurrent reflex syncope, underwent carotid sinus massage (CSM), followed by tilt testing (TT) if CSM was negative, followed by implantation of an implantable loop recorder (ILR) if TT was negative. Those who had an asystolic response to one of these tests received a dual-chamber pacemaker. Of 281 patients who met the inclusion criteria, 137 (49%) received a pacemaker and were followed up for a mean of 26 ± 11 months: syncope recurred in 25 (18%) of them. At 3 years, the actuarial sync...
Italian heart journal: official journal of the Italian Federation of Cardiology
Cardiologia (Rome, Italy)
Giornale italiano di cardiologia
While syncope is generally considered a frequent finding in clinical practice, no clear epidemiol... more While syncope is generally considered a frequent finding in clinical practice, no clear epidemiological evidence is available about the relevance of such an event in the general population of Italy. The OESIL Study was designed and undertaken in 15 hospitals of the Italian region of Latium in order to assess the percentage of emergency-room visits and admissions due to syncope, as well as to analyze the in-hospital diagnostic work-up performed for this condition. During a two-month observation period, 781 (372 males and 409 females, mean age 55.2 (22.8 years) consecutive patients came to the emergency rooms of the 15 hospitals included in the investigation due to a syncope spell (0.9% of emergency room visits); 450/781 patients (57.6%) were subsequently hospitalized (1.3% of all admissions): 48.0% of the admissions were admitted to a general medical ward, 29.3% to an observation ward, 13.3% to a cardiology section, 1.6% to a neurology section and 7.8% to other clinical sections (neu...
Revista Espa de Cardiologia
ACC Current Journal Review, 2001
A bimodal distribution of RR intervals during CAF is associated with a higher success rate of rad... more A bimodal distribution of RR intervals during CAF is associated with a higher success rate of radiofrequency modification of the AVN and a lower risk of inadvertent atrioventricular block. When a bimodal pattern is present, rate control is achieved by ablation of the posterior inputs to the AVN and when the pattern is unimodal, rate control may require injury to the compact AVN. Perspective: These findings provide insight into the mechanism by which modification of the AVN results in control of the ventricular rate, but are of little practical value. AVN ablation/pacemaker is usually preferred over modification of the AVN because of more reliable outcomes.
European heart journal, Jan 29, 2015
Opinions differ regarding the effectiveness of cardiac pacing in patients affected by reflex sync... more Opinions differ regarding the effectiveness of cardiac pacing in patients affected by reflex syncope. We assessed a standardized guideline-based algorithm in different forms of reflex syncope. In this prospective, multi-centre, observational study, patients aged >40 years, affected by severe unpredictable recurrent reflex syncopes, underwent carotid sinus massage (CSM), followed by tilt testing (TT) if CSM was negative, followed by implantation of an implantable loop recorder (ILR) if TT was negative. Those who had an asystolic response to one of these tests received a dual-chamber pacemaker. 253 patients, mean age 70 ± 12 years, median 4 (3-6) syncopes, 89% without or with short prodromes. Of these patients, 120 (47%) received a pacemaker and 106 were followed up for a mean of 13 ± 7 months: syncope recurred in 10 (9%). The recurrence rate was similar in 61 CSM+ (11%), 30 TT+ (7%), and 15 ILR+ (7%) patients. The actuarial total syncope recurrence rate was 9% (95% confidence inte...
Giornale italiano di cardiologia (2006), 2010
Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology, 2004
The aim of this study was to evaluate how the main tests for the diagnostic assessment of syncope... more The aim of this study was to evaluate how the main tests for the diagnostic assessment of syncope are currently performed in the Italian hospitals. During the early 2003 dedicated questionnaires were administered to about 400 Italian hospitals. About each test information was requested relative to: test protocol, laboratory equipment, patients evaluated during 2002. Eighty-four hospitals answered the questionnaire. A syncope-dedicated ambulatory (at least once a week) was available during 2002 in 59/84 hospitals, and 56 were dependent on the Cardiology Division. Carotid sinus massage was performed either in clinostatic and in orthostatic position in 60 Centers and was repeated after atropine in 15. To define the test positivity, 35 Centers followed the "symptom method". Only 15 Centers performed > 100 procedures during 2002 (range 3-500). Tilt testing was performed in 72 hospitals. A dedicated tilting bed was available in 65 Centers, continuous beat-to-beat pressure mea...
Journal of Cardiovascular Medicine, 2015
We report a case of a 78-year-old woman admitted to hospital due to cardiac tamponade 3 months af... more We report a case of a 78-year-old woman admitted to hospital due to cardiac tamponade 3 months after surgical mitral valve repair. The patient developed an early left ventricular dysfunction after removal of the pericardial effusion, with complete recovery within 10 days. Transient ventricular dysfunction after pericardiocentesis is a very rare complication, we present a review of the different mechanisms suggested in the literature to explain the pathophysiology of this rare phenomenon.
Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology, 2000
The head-up tilt testing potentiated with oral nitroglycerin, devised by an Italian group, is a s... more The head-up tilt testing potentiated with oral nitroglycerin, devised by an Italian group, is a simple, safe and powerful, but still not a standardized, diagnostic tool. In fact, owing to its rapid diffusion, the original protocol received, often arbitrarily, subsequent modifications. Thus a task force of experienced cardiologists defined the best methodology for the test on strictly evidence-based criteria. Particular attention was reserved to some controversial topics, such as the tilting angle, the duration of the passive and pharmacological stages of the test, the type and dosage of the drug utilized. We hope that the enclosed protocol, named by us as "The Italian Protocol", will be accepted as the standard methodology of the head-up tilt testing potentiated with oral nitrates.