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Papers by Gaetano Pinnacchio

Research paper thumbnail of 610 Emerging Triggers of Arrhythmic Events in Remote Monitored Patients

European Heart Journal Supplements, Dec 14, 2022

Research paper thumbnail of 352 Prognostic Value of the Tpeak-Tend Interval for In-Hospital Subacute Ventricular Arrhythmias in Takotsubo Syndrome

European Heart Journal Supplements

Introduction and objectives The clinical value of ECG repolarization parameters associated with v... more Introduction and objectives The clinical value of ECG repolarization parameters associated with ventricular arrhythmias (VAs) in Takotsubo syndrome is still under debate. We aimed to evaluate ECG predictors of subacute VAs, defined as those occurring after the first 48 hours from admission. Methods This is a single-center observational study enrolling patients admitted to the Cardiology Department between 2012 and 2018 with confirmed diagnosis of Takotsubo syndrome. Data collection included a 12-lead ECG on admission and at 48 hours, continuous telemetry monitoring, blood testing, transthoracic echocardiography and coronary angiography during hospitalization. VAs events were defined as: premature ventricular contractions ≥2000 within a 24-hour window of telemetry monitoring, ventricular fibrillation, sustained ventricular tachycardia (VT), polymorphic VT and non-sustained VT. Results A total of 87 patients (age 72±12 years old) were enrolled. During an average of 16±14 days of hospi...

Research paper thumbnail of 752 Cardiogenic Shock as the First Presentation of Acute Antracycline Cardiotoxicity: A Clinical Case

European Heart Journal Supplements

Background Several therapeutic strategies are available for cancer patients, leading to a longer ... more Background Several therapeutic strategies are available for cancer patients, leading to a longer life expectancy; however, each drug might have different side effects, which increase morbidity and mortality. Cardiovascular diseases are one of the most frequent and dramatic of these side effects, leading to interruption of a potentially lifesaving treatment or hesitating into heart failure. Clinical Case A 50 year-old female with recent diagnosis of breast cancer presented to our Emergency Department (ED) for asthenia, vomiting and dyspnea. A first dose of epirubicin and cyclophosphamide as neoadjuvant chemotherapy (CT) was administered three days before the onset of symptoms. Screening echocardiogram performed before starting the CT showed normal systolic ejection fraction, normal diastolic function and no valvular disease. At ED admission, the patient presented hypotension, tachycardia, sweating and mental confusion. The ECG showed sinus tachycardia with diffuse ST segment elevatio...

Research paper thumbnail of Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation

Frontiers in Cardiovascular Medicine

IntroductionUnrecognized incomplete pulmonary vein (PV) isolation during the index procedure, can... more IntroductionUnrecognized incomplete pulmonary vein (PV) isolation during the index procedure, can be a major cause of clinical recurrences of atrial fibrillation (AF) after cryoballoon (CB) ablation. We aimed to characterize the extension of the lesions produced by CB ablation and to assess the value of using an ultra-high resolution electroanatomic mapping (UHDM) system to detect incomplete CB lesions.Materials and methodsTwenty-nine consecutive patients from the CHARISMA registry undergoing AF ablation at four Italian centers were prospectively evaluated. The Rhythmia™ mapping system and the Orion™ (Boston Scientific) mapping catheter were used to systematically map the left atrium and PVs before and after cryoablation.ResultsA total of 116 PVs were targeted and isolated. Quantitative assessment of the lesions revealed a significant reduction of the antral surface area of the PV, resulting in an ablated area of 5.7 ± 0.7 cm2 and 5.1 ± 0.8 cm2 for the left PV pair and right PV pair...

Research paper thumbnail of Short-Term Atrioventricular Dysfunction Recovery after Post-TAVI Pacemaker Implantation

Journal of Cardiovascular Development and Disease

Permanent pacemaker implantation (PPI) represents a frequent complication after transcatheter aor... more Permanent pacemaker implantation (PPI) represents a frequent complication after transcatheter aortic valve implantation (TAVI) due to atrio-ventricular (AV) node injury. Predictors of early AV function recovery were investigated. We analyzed 50 consecutive patients (82 ± 6 years, 58% males, EuroSCORE: 7.8 ± 3.3%, STS mortality score: 5 ± 2.8%). Pacemaker interrogations within 4–6 weeks from PPI were performed to collect data on AV conduction. The most common indication of PPI was persistent third-degree (44%)/high-degree (20%) AV block/atrial fibrillation (AF) with slow ventricular conduction (16%) after TAVI. At follow-up, 13 patients (26%) recovered AV conduction (i.e., sinus rhythm with stable 1:1 AV conduction/AF with a mean ventricular response >50 bpm, associated with a long-term ventricular pacing percentage < 5%). At multivariate analysis, complete atrio-ventricular block independently predicted pacemaker dependency at follow-up (p = 0.019). Patients with persistent AV...

Research paper thumbnail of Atrioventricular conduction in PM recipients after transcatheter aortic valve implantation: Implications using Wenckebach point measurement

Frontiers in Cardiovascular Medicine

BackgroundAtrioventricular (AV) conduction disturbances requiring permanent pacemaker implantatio... more BackgroundAtrioventricular (AV) conduction disturbances requiring permanent pacemaker implantation (PPI) are a common complication after transcatheter aortic valve implantation (TAVI). However, a significant proportion of patients might recover AV conduction at follow-up.ObjectivesThe aim of our study was to evaluate the recovery of AV conduction by determination through Wenckebach point in patients with PPI and therefore identify patients who could benefit from device reprogramming to avoid unnecessary RV pacing.MethodsWe enrolled 43 patients that underwent PM implantation after TAVI at our Department from January 2018 to January 2021. PM interrogation was performed at follow-up and patients with native spontaneous rhythm were further assessed for AV conduction through WP determination.ResultsA total of 43 patients requiring a PM represented the final study population, divided in patients with severely impaired AV conduction (no spontaneous valid rhythm or WP < 100; 26) and pati...

Research paper thumbnail of Successful ventricular tachycardia radioablation in a patient with previous chemical pleurodesis: A case report

Frontiers in Cardiovascular Medicine

IntroductionStereotactic arrhythmia radioablation (STAR) is a novel technique for the ablation of... more IntroductionStereotactic arrhythmia radioablation (STAR) is a novel technique for the ablation of ventricular tachycardia in patients with contraindications to standard procedures, i.e., radiofrequency ablation.Case presentationWe report the case of a 73-year-old man with non-ischemic dilated cardiomyopathy and recurrent VT episodes. Electroanatomic mapping showed VT prevalently of epicardial origin, but direct epicardial access through subxyphoid puncture could not be performed due to pleuropericardial adhesions from a past history of chemical pleurodesis. STAR was performed, with no VT recurrence at 6 months follow-up.ConclusionsPrevious experiences with STAR have demonstrated its importance in the management of patients with refractory VT in whom other ablation strategies were not successful. Our case report highlights the use of STAR as a second choice in a patient with an unfavorable VT anatomical location and technical limitations to an optimal radiofrequency ablation. Moreove...

Research paper thumbnail of 493 Prognostic value of myocardial scar and chamber enlargement at electroanatomical mapping during catheter ablation in adult congenital heart disease

European Heart Journal Supplements, 2021

Aims Atrial and ventricular tachyarrhythmias are common among patients with adult congenital hear... more Aims Atrial and ventricular tachyarrhythmias are common among patients with adult congenital heart disease (ACHD) and can impair quality of life and prognosis. Catheter ablation is often the main treatment option in this population, despite anatomical hurdles. Substrate mapping findings have not been thoroughly investigated as predictors of arrhythmia recurrence success and cardiovascular clinical outcome after ablation. We sought to determine the prognostic value of myocardial scar and chamber enlargement detected at electroanatomical mapping in ACHD patients undergoing catheter ablation of tachyarrhythmias. Methods and results Consecutive ACHD patients undergoing catheter ablation of atrial and ventricular tachycardias using different electroanatomical mapping systems were retrospectively identified from a hospital-based database. Scar extent detected at the electroanatomical mapping, as well as the total mapped area, was calculated. Arrhythmia recurrence, hospitalization for card...

Research paper thumbnail of 500 The impact on healthcare of reimplantation and long-term mortality after transvenous lead extraction in patients with device related infection

European Heart Journal Supplements, 2021

Transvenous lead extraction (TLE) has become a pivotal part of a comprehensive lead management st... more Transvenous lead extraction (TLE) has become a pivotal part of a comprehensive lead management strategy, dealing with a continuously increasing demand. Nonetheless, literature about long-term outcomes and the impact of a new device implantation on survival is still lacking. Given these knowledge gaps, the aim of our study was to analyse reimplantation and both early and long-term mortality in patients undergoing TLE, even in a public health perspective, specifically clarifying concerns about reimplantation. This prospective, single-centre, observational, real-world registry consecutively enrolled patients (pts) with cardiac implantable electronic device who underwent TLE at our Hospital, from January 2005 to September 2020. The primary endpoint was to analyse major adverse cardiovascular events (MACEs) in both re-implanted (R Group) and non reimplanted (NR Group); secondary end-point was long-term (after discharge) mortality of the whole cohort, in order to investigate long-term mor...

Research paper thumbnail of Assessment of patients presenting with life-threatening ventricular arrhythmias and suspected myocarditis: The key role of endomyocardial biopsy

Heart Rhythm, 2021

BACKGROUND Life-threatening ventricular tachyarrhythmias (VAs) represent a significant cause of d... more BACKGROUND Life-threatening ventricular tachyarrhythmias (VAs) represent a significant cause of death in myocarditis. OBJECTIVE To identify predictors of sustained VAs in patients with myocarditis and ventricular phenotype diagnosed by workflow including endomyocardial biopsy (EMB) guided by 3D-electroanatomic mapping (3D-EAM). METHODS We prospectively enrolled patients with suspected myocarditis and VAs, undergoing cardiac magnetic resonance (CMR), coronary angiography, 3D-EAM and EMB guided by 3D-EAM. At follow-up, sustained VAs were detected by device interrogation and Holter-ECG monitoring. RESULTS We enrolled 54 consecutive patients (32 males, mean age 41 years), with normal ventricular function; left ventricular (LV) and right ventricular (RV) late gadolinium enhancement was present in 21 (46%) and 6 (13%) of the 46 patients who underwent CMR, respectively. In 31 patients histological diagnosis was myocarditis, while in 14 patients focal replacement myocardial fibrosis (FRMF); in 9 patients specimens were inadequate (diagnostic yield of EMB= 83%). 3D-EAM showed a larger endocardial scar area for both ventricles in myocarditis than in FRMF (RV bipolar mean scar area 22±16 cm2 vs. 3±2 cm2, p= 0.02; LV bipolar mean scar area 13±5 cm2 vs. 4±2 cm2, p= 0.02, respectively). At a follow-up of 21 months, freedom from sustained VAs was 58% in myocarditis and 92% in FRMF (p-log-rank= 0.008). Histological diagnosis of myocarditis and RV endocardial scar were independent predictors of sustained VAs (p= 0.02 for both). CONCLUSION Our data highlight the need for 3D-EAM-guided EMB in apparently healthy young patients with suspected myocarditis and VAs.

Research paper thumbnail of The potential impact of acute coronary syndromes on automatic sensing system in Subcutaneous-ICDs

IJC Heart & Vasculature, 2021

Background: The Subcutaneous-ICD (S-ICD) is emerging as a suitable option for most ICD candidates... more Background: The Subcutaneous-ICD (S-ICD) is emerging as a suitable option for most ICD candidates, however some open issues regarding the sensing algorithm still remain. Objectives: We aimed to examine the performance of the S-ICD sensing algorithm in patients hospitalized for ST elevation myocardial infarction (STEMI), non ST elevation acute coronary syndrome (NSTE-ACS) or chronic coronary syndrome (CCS), before and after revascularization. Methods: We performed a S-ICD automated screening on 75 patients, 21 hospitalized for STEMI, 23 for NSTE-ACS and 31 for CCS, before and after percutaneous revascularization, regardless their eligibility to ICD implantation. Results: Patients did not differ in clinical, electrocardiographic and echocardiographic parameters. Rates of screening pass were significantly lower in STEMI patients compared to NSTE-ACS and CCS (5% vs 56.7% vs 81% respectively, p < .0001). The viability of the primary vector was lower in STEMI patients compared to NSTE-ACS and CCS (33% vs 56% vs 71%, p .027 respectively). After revascularization, there were no more significant differences between groups. Pairing subjects at baseline and after revascularization, STEMI subjects percentages of screening success were respectively 5% and 81% (p < .001) and the rates of primary vector viability were 33% and 81% (p .002). STEMI was the only independent predictor of screening failure at multivariate logistic regression analysis (odds ratio 10.68 confidence interval 2.77-41.38, p = .001) Conclusion: The performance of the S-ICD and possible malfunction detections in the context of an acute ischemic event deserve further evaluation. Adequate patient selection and the development of dynamic device programming are warranted.

Research paper thumbnail of Coexistence of Vagus Nerve Stimulation and Epicardial Implantable Cardioverter-Defibrillator System, Possible Interference: A Case Report and Systematic Review of the Literature

Biomedical Journal of Scientific & Technical Research, 2021

Vagal nerve stimulation (VNS) is an effective treatment for drugresistant epilepsies. The possibl... more Vagal nerve stimulation (VNS) is an effective treatment for drugresistant epilepsies. The possible interaction of VNS and electronic cardiac devices such as pacemaker and implantable cardioverter-defibrillator (ICD) is poorly studied...

Research paper thumbnail of Diagnostic Workflow in Competitive Athletes with Ventricular Arrhythmias and Suspected Concealed Cardiomyopathies

Medicina, 2021

The diagnosis of structural heart disease in athletes with ventricular arrhythmias (VAs) and an a... more The diagnosis of structural heart disease in athletes with ventricular arrhythmias (VAs) and an apparently normal heart can be very challenging. Several pieces of evidence demonstrate the importance of an extensive diagnostic work-up in apparently healthy young patients for the characterization of concealed cardiomyopathies. This study shows the various diagnostic levels and tools to help identify which athletes need deeper investigation in order to unmask possible underlying heart disease.

Research paper thumbnail of Severity of spleep apnea syndrome and life‐threatening tachyarrhythmias in patients with implantable cardioverter defibrillator

Pacing and Clinical Electrophysiology, 2021

Sleep apnea syndrome (SAS) has been reported to be associated with a higher incidence of ventricu... more Sleep apnea syndrome (SAS) has been reported to be associated with a higher incidence of ventricular arrhythmias. The aim of this study was twofold: (1) to investigate whether in SAS patients receiving an implantable cardioverter defibrillator (ICD) the severity of SAS was associated with the occurrence of ventricular arrhythmias; (2) to assess whether changes in nocturnal apnoic/hypopnoic episodes may favor the occurrence of life‐threatening arrhythmias, that is, sustained ventricular tachycardia (VT)/fibrillation (VF), requiring ICD intervention.

Research paper thumbnail of B-PO05-098 Local Impedance Characteristics of Pulmonary Vein Reconnections During Repeated Atrial Fibrillation Ablation Procedures: Insight from an Italian Multicenter Registry

Research paper thumbnail of Case Report: A Case Report of Stereotactic Ventricular Arrhythmia Radioablation (STAR) on Large Cardiac Target Volume by Highly Personalized Inter- and Intra-fractional Image Guidance

Frontiers in Cardiovascular Medicine, 2020

Introduction: Although catheter ablation is the current gold standard treatment for refractory ve... more Introduction: Although catheter ablation is the current gold standard treatment for refractory ventricular arrhythmias, sometimes its efficacy is not optimal and it's associated with high risks of procedural complication and death. Stereotactic arrhythmia radioablation (STAR) is increasingly being adopted for such clinical presentation, considering its efficacy and safety.Case Presentation: We do report our experience managing a case of high volume of left ventricle for refractory ventricular tachycardia in advanced heart failure patient, by delivering a single fraction of STAR through an highly personalization of dose delivery applying repeated inter- and continuous intra-fraction image guidance.Conclusion: According to the literature reports, we recommend considering increasing as much as possible the personalization features and safety technical procedure as long as that is not significantly affecting the STAR duration. Moreover, the duration in itself shouldn't be the ma...

Research paper thumbnail of Long-Term Arrhythmic Risk Assessment in Biopsy-Proven Myocarditis

JACC: Clinical Electrophysiology, 2020

OBJECTIVES This study sought to assess long-term arrhythmic risk in patients with myocarditis who... more OBJECTIVES This study sought to assess long-term arrhythmic risk in patients with myocarditis who received an implantable cardioverter-defibrillator (ICD). BACKGROUND The arrhythmic risk of patients with myocarditis overtime remains poorly known. METHODS The study enrolled 56 patients with biopsy-proven myocarditis who received an ICD for either primary (57%) or secondary prevention (43%) according to current guidelines. Clinical characteristics, biopsy findings, electrophysiological data from endocardial 3-dimensional electroanatomic voltage mapping, and device interrogation data were analyzed to detect arrhythmic events overtime. Coronary angiography excluded significant coronary artery disease in all patients. RESULTS At a mean follow-up of 74 AE 60 months (median 65 months), 25 (45%) patients had major ventricular arrhythmias treated by ICD intervention (76% being terminated by ICD shock and 24% by antitachyarrhythmia burst pacing). At multivariable analysis, the presence of sustained ventricular tachycardia on admission (hazard ratio: 13; 95% confidence interval: 2 to 35; p ¼ 0.032) and the extension of the areas of low potentials at the bipolar endocardial mapping (hazard ratio: 1.19; 95% confidence interval: 1.04 to 1.37; p ¼ 0.013) were the only independent predictors of appropriate ICD interventions. A cutoff value of 10% of abnormal bipolar area at electroanatomical ventricular mapping discriminated patients with appropriate ICD interventions with a sensitivity of 89% and a specificity of 85%. CONCLUSIONS The study demonstrates that the prevalence of life-threatening ventricular arrhythmias in patients with myocarditis receiving an ICD according to current guidelines is high and the arrhythmic risk persists late overtime. Electroanatomical ventricular mapping may be a useful tool to identify patients at greater arrhythmic risk.

Research paper thumbnail of P1016Ventricular arrhythmias in athletes and non-athletes: diagnostic role of electroanatomic mapping and CARTO-guided endomyocardial biopsy

European Heart Journal, 2018

Survival analysis with most cases occurring in middle-aged male athletes with a better prognosis ... more Survival analysis with most cases occurring in middle-aged male athletes with a better prognosis than SCA during other activities. P1014 Risk stratification scores for sudden cardiac death in hypertrophic cardiomyopathy: is volume better than diameter?

Research paper thumbnail of Role of extensive diagnostic workup in young athletes and nonathletes with complex ventricular arrhythmias

Heart Rhythm, 2019

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of P366Robotic ablation of atrial fibrillation: impact of lesion efficacy and biomarkers on recurrences

EP Europace, 2017

Background: Pulmonary vein isolation (PVI) is an effective treatment option for patients with sym... more Background: Pulmonary vein isolation (PVI) is an effective treatment option for patients with symptomatic drug-refractory paroxysmal atrial fibrillation (AF). During the ablation procedures, transseptal (TS) puncture is needed to access the left-sided heart. In case of a radiofrequency ablation (RF) procedure, left atrial access is commonly achieved with a double transseptal puncture. While, during cryoballoon ablation (CB) a single transseptal puncture is performed with a larger diameter sheath. The ablation technique can affect the incidence of postprocedural iatrogenic atrial septal defect (IASD). Methods and Results: In this prospective study, a total of 94 pts (RF: 48, CB: 46, 64 male, mean age 62610 years) with paroxysmal AF were enrolled who had undergone a PVI procedure for the first time. Transoesophageal echocardiography (TEE) was performed prior each procedure to prove the intact interatrial septum. During RF two 8,5 Fr sheaths while during CB one 15 Fr sheath were introduced into the left atrium. Left atrial catheter dwelling time was significantly higher in the RF group compared to the CB group (89625 min vs 57618 min, p<0.05). TEE was performed after 3 months in all cases. If it revealed IASD then TEE was repeated at 1-year FU too. New-onset IASDs were detected in 18 patients (19,1%) at 3-month FU, in 9-9 pts in each the RF (18,8%) and CB (19,6%) group. The mean maximum IASD diameter did not significantly differ between the two groups (RF: 0,2260,11 cm vs CB: 0,2560,14 cm). Only left to right atrial shunt was observed. 1-year FU was completed in 7 pts, and IASD was detected in 2 pts in the CB group. There was no clinical occurrence of paradoxical embolism or other major complications. Conclusion: Persistent iatrogenic atrial septal defects are relatively common following atrial fibrillation catheter ablation procedures. No difference was observed between the ablation techniques concerning the presence of IASD at 3-month. Although, no adverse clinical events were recorded in these patient cohorts, further studies are needed to confirm our findings.

Research paper thumbnail of 610 Emerging Triggers of Arrhythmic Events in Remote Monitored Patients

European Heart Journal Supplements, Dec 14, 2022

Research paper thumbnail of 352 Prognostic Value of the Tpeak-Tend Interval for In-Hospital Subacute Ventricular Arrhythmias in Takotsubo Syndrome

European Heart Journal Supplements

Introduction and objectives The clinical value of ECG repolarization parameters associated with v... more Introduction and objectives The clinical value of ECG repolarization parameters associated with ventricular arrhythmias (VAs) in Takotsubo syndrome is still under debate. We aimed to evaluate ECG predictors of subacute VAs, defined as those occurring after the first 48 hours from admission. Methods This is a single-center observational study enrolling patients admitted to the Cardiology Department between 2012 and 2018 with confirmed diagnosis of Takotsubo syndrome. Data collection included a 12-lead ECG on admission and at 48 hours, continuous telemetry monitoring, blood testing, transthoracic echocardiography and coronary angiography during hospitalization. VAs events were defined as: premature ventricular contractions ≥2000 within a 24-hour window of telemetry monitoring, ventricular fibrillation, sustained ventricular tachycardia (VT), polymorphic VT and non-sustained VT. Results A total of 87 patients (age 72±12 years old) were enrolled. During an average of 16±14 days of hospi...

Research paper thumbnail of 752 Cardiogenic Shock as the First Presentation of Acute Antracycline Cardiotoxicity: A Clinical Case

European Heart Journal Supplements

Background Several therapeutic strategies are available for cancer patients, leading to a longer ... more Background Several therapeutic strategies are available for cancer patients, leading to a longer life expectancy; however, each drug might have different side effects, which increase morbidity and mortality. Cardiovascular diseases are one of the most frequent and dramatic of these side effects, leading to interruption of a potentially lifesaving treatment or hesitating into heart failure. Clinical Case A 50 year-old female with recent diagnosis of breast cancer presented to our Emergency Department (ED) for asthenia, vomiting and dyspnea. A first dose of epirubicin and cyclophosphamide as neoadjuvant chemotherapy (CT) was administered three days before the onset of symptoms. Screening echocardiogram performed before starting the CT showed normal systolic ejection fraction, normal diastolic function and no valvular disease. At ED admission, the patient presented hypotension, tachycardia, sweating and mental confusion. The ECG showed sinus tachycardia with diffuse ST segment elevatio...

Research paper thumbnail of Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation

Frontiers in Cardiovascular Medicine

IntroductionUnrecognized incomplete pulmonary vein (PV) isolation during the index procedure, can... more IntroductionUnrecognized incomplete pulmonary vein (PV) isolation during the index procedure, can be a major cause of clinical recurrences of atrial fibrillation (AF) after cryoballoon (CB) ablation. We aimed to characterize the extension of the lesions produced by CB ablation and to assess the value of using an ultra-high resolution electroanatomic mapping (UHDM) system to detect incomplete CB lesions.Materials and methodsTwenty-nine consecutive patients from the CHARISMA registry undergoing AF ablation at four Italian centers were prospectively evaluated. The Rhythmia™ mapping system and the Orion™ (Boston Scientific) mapping catheter were used to systematically map the left atrium and PVs before and after cryoablation.ResultsA total of 116 PVs were targeted and isolated. Quantitative assessment of the lesions revealed a significant reduction of the antral surface area of the PV, resulting in an ablated area of 5.7 ± 0.7 cm2 and 5.1 ± 0.8 cm2 for the left PV pair and right PV pair...

Research paper thumbnail of Short-Term Atrioventricular Dysfunction Recovery after Post-TAVI Pacemaker Implantation

Journal of Cardiovascular Development and Disease

Permanent pacemaker implantation (PPI) represents a frequent complication after transcatheter aor... more Permanent pacemaker implantation (PPI) represents a frequent complication after transcatheter aortic valve implantation (TAVI) due to atrio-ventricular (AV) node injury. Predictors of early AV function recovery were investigated. We analyzed 50 consecutive patients (82 ± 6 years, 58% males, EuroSCORE: 7.8 ± 3.3%, STS mortality score: 5 ± 2.8%). Pacemaker interrogations within 4–6 weeks from PPI were performed to collect data on AV conduction. The most common indication of PPI was persistent third-degree (44%)/high-degree (20%) AV block/atrial fibrillation (AF) with slow ventricular conduction (16%) after TAVI. At follow-up, 13 patients (26%) recovered AV conduction (i.e., sinus rhythm with stable 1:1 AV conduction/AF with a mean ventricular response >50 bpm, associated with a long-term ventricular pacing percentage < 5%). At multivariate analysis, complete atrio-ventricular block independently predicted pacemaker dependency at follow-up (p = 0.019). Patients with persistent AV...

Research paper thumbnail of Atrioventricular conduction in PM recipients after transcatheter aortic valve implantation: Implications using Wenckebach point measurement

Frontiers in Cardiovascular Medicine

BackgroundAtrioventricular (AV) conduction disturbances requiring permanent pacemaker implantatio... more BackgroundAtrioventricular (AV) conduction disturbances requiring permanent pacemaker implantation (PPI) are a common complication after transcatheter aortic valve implantation (TAVI). However, a significant proportion of patients might recover AV conduction at follow-up.ObjectivesThe aim of our study was to evaluate the recovery of AV conduction by determination through Wenckebach point in patients with PPI and therefore identify patients who could benefit from device reprogramming to avoid unnecessary RV pacing.MethodsWe enrolled 43 patients that underwent PM implantation after TAVI at our Department from January 2018 to January 2021. PM interrogation was performed at follow-up and patients with native spontaneous rhythm were further assessed for AV conduction through WP determination.ResultsA total of 43 patients requiring a PM represented the final study population, divided in patients with severely impaired AV conduction (no spontaneous valid rhythm or WP < 100; 26) and pati...

Research paper thumbnail of Successful ventricular tachycardia radioablation in a patient with previous chemical pleurodesis: A case report

Frontiers in Cardiovascular Medicine

IntroductionStereotactic arrhythmia radioablation (STAR) is a novel technique for the ablation of... more IntroductionStereotactic arrhythmia radioablation (STAR) is a novel technique for the ablation of ventricular tachycardia in patients with contraindications to standard procedures, i.e., radiofrequency ablation.Case presentationWe report the case of a 73-year-old man with non-ischemic dilated cardiomyopathy and recurrent VT episodes. Electroanatomic mapping showed VT prevalently of epicardial origin, but direct epicardial access through subxyphoid puncture could not be performed due to pleuropericardial adhesions from a past history of chemical pleurodesis. STAR was performed, with no VT recurrence at 6 months follow-up.ConclusionsPrevious experiences with STAR have demonstrated its importance in the management of patients with refractory VT in whom other ablation strategies were not successful. Our case report highlights the use of STAR as a second choice in a patient with an unfavorable VT anatomical location and technical limitations to an optimal radiofrequency ablation. Moreove...

Research paper thumbnail of 493 Prognostic value of myocardial scar and chamber enlargement at electroanatomical mapping during catheter ablation in adult congenital heart disease

European Heart Journal Supplements, 2021

Aims Atrial and ventricular tachyarrhythmias are common among patients with adult congenital hear... more Aims Atrial and ventricular tachyarrhythmias are common among patients with adult congenital heart disease (ACHD) and can impair quality of life and prognosis. Catheter ablation is often the main treatment option in this population, despite anatomical hurdles. Substrate mapping findings have not been thoroughly investigated as predictors of arrhythmia recurrence success and cardiovascular clinical outcome after ablation. We sought to determine the prognostic value of myocardial scar and chamber enlargement detected at electroanatomical mapping in ACHD patients undergoing catheter ablation of tachyarrhythmias. Methods and results Consecutive ACHD patients undergoing catheter ablation of atrial and ventricular tachycardias using different electroanatomical mapping systems were retrospectively identified from a hospital-based database. Scar extent detected at the electroanatomical mapping, as well as the total mapped area, was calculated. Arrhythmia recurrence, hospitalization for card...

Research paper thumbnail of 500 The impact on healthcare of reimplantation and long-term mortality after transvenous lead extraction in patients with device related infection

European Heart Journal Supplements, 2021

Transvenous lead extraction (TLE) has become a pivotal part of a comprehensive lead management st... more Transvenous lead extraction (TLE) has become a pivotal part of a comprehensive lead management strategy, dealing with a continuously increasing demand. Nonetheless, literature about long-term outcomes and the impact of a new device implantation on survival is still lacking. Given these knowledge gaps, the aim of our study was to analyse reimplantation and both early and long-term mortality in patients undergoing TLE, even in a public health perspective, specifically clarifying concerns about reimplantation. This prospective, single-centre, observational, real-world registry consecutively enrolled patients (pts) with cardiac implantable electronic device who underwent TLE at our Hospital, from January 2005 to September 2020. The primary endpoint was to analyse major adverse cardiovascular events (MACEs) in both re-implanted (R Group) and non reimplanted (NR Group); secondary end-point was long-term (after discharge) mortality of the whole cohort, in order to investigate long-term mor...

Research paper thumbnail of Assessment of patients presenting with life-threatening ventricular arrhythmias and suspected myocarditis: The key role of endomyocardial biopsy

Heart Rhythm, 2021

BACKGROUND Life-threatening ventricular tachyarrhythmias (VAs) represent a significant cause of d... more BACKGROUND Life-threatening ventricular tachyarrhythmias (VAs) represent a significant cause of death in myocarditis. OBJECTIVE To identify predictors of sustained VAs in patients with myocarditis and ventricular phenotype diagnosed by workflow including endomyocardial biopsy (EMB) guided by 3D-electroanatomic mapping (3D-EAM). METHODS We prospectively enrolled patients with suspected myocarditis and VAs, undergoing cardiac magnetic resonance (CMR), coronary angiography, 3D-EAM and EMB guided by 3D-EAM. At follow-up, sustained VAs were detected by device interrogation and Holter-ECG monitoring. RESULTS We enrolled 54 consecutive patients (32 males, mean age 41 years), with normal ventricular function; left ventricular (LV) and right ventricular (RV) late gadolinium enhancement was present in 21 (46%) and 6 (13%) of the 46 patients who underwent CMR, respectively. In 31 patients histological diagnosis was myocarditis, while in 14 patients focal replacement myocardial fibrosis (FRMF); in 9 patients specimens were inadequate (diagnostic yield of EMB= 83%). 3D-EAM showed a larger endocardial scar area for both ventricles in myocarditis than in FRMF (RV bipolar mean scar area 22±16 cm2 vs. 3±2 cm2, p= 0.02; LV bipolar mean scar area 13±5 cm2 vs. 4±2 cm2, p= 0.02, respectively). At a follow-up of 21 months, freedom from sustained VAs was 58% in myocarditis and 92% in FRMF (p-log-rank= 0.008). Histological diagnosis of myocarditis and RV endocardial scar were independent predictors of sustained VAs (p= 0.02 for both). CONCLUSION Our data highlight the need for 3D-EAM-guided EMB in apparently healthy young patients with suspected myocarditis and VAs.

Research paper thumbnail of The potential impact of acute coronary syndromes on automatic sensing system in Subcutaneous-ICDs

IJC Heart & Vasculature, 2021

Background: The Subcutaneous-ICD (S-ICD) is emerging as a suitable option for most ICD candidates... more Background: The Subcutaneous-ICD (S-ICD) is emerging as a suitable option for most ICD candidates, however some open issues regarding the sensing algorithm still remain. Objectives: We aimed to examine the performance of the S-ICD sensing algorithm in patients hospitalized for ST elevation myocardial infarction (STEMI), non ST elevation acute coronary syndrome (NSTE-ACS) or chronic coronary syndrome (CCS), before and after revascularization. Methods: We performed a S-ICD automated screening on 75 patients, 21 hospitalized for STEMI, 23 for NSTE-ACS and 31 for CCS, before and after percutaneous revascularization, regardless their eligibility to ICD implantation. Results: Patients did not differ in clinical, electrocardiographic and echocardiographic parameters. Rates of screening pass were significantly lower in STEMI patients compared to NSTE-ACS and CCS (5% vs 56.7% vs 81% respectively, p < .0001). The viability of the primary vector was lower in STEMI patients compared to NSTE-ACS and CCS (33% vs 56% vs 71%, p .027 respectively). After revascularization, there were no more significant differences between groups. Pairing subjects at baseline and after revascularization, STEMI subjects percentages of screening success were respectively 5% and 81% (p < .001) and the rates of primary vector viability were 33% and 81% (p .002). STEMI was the only independent predictor of screening failure at multivariate logistic regression analysis (odds ratio 10.68 confidence interval 2.77-41.38, p = .001) Conclusion: The performance of the S-ICD and possible malfunction detections in the context of an acute ischemic event deserve further evaluation. Adequate patient selection and the development of dynamic device programming are warranted.

Research paper thumbnail of Coexistence of Vagus Nerve Stimulation and Epicardial Implantable Cardioverter-Defibrillator System, Possible Interference: A Case Report and Systematic Review of the Literature

Biomedical Journal of Scientific & Technical Research, 2021

Vagal nerve stimulation (VNS) is an effective treatment for drugresistant epilepsies. The possibl... more Vagal nerve stimulation (VNS) is an effective treatment for drugresistant epilepsies. The possible interaction of VNS and electronic cardiac devices such as pacemaker and implantable cardioverter-defibrillator (ICD) is poorly studied...

Research paper thumbnail of Diagnostic Workflow in Competitive Athletes with Ventricular Arrhythmias and Suspected Concealed Cardiomyopathies

Medicina, 2021

The diagnosis of structural heart disease in athletes with ventricular arrhythmias (VAs) and an a... more The diagnosis of structural heart disease in athletes with ventricular arrhythmias (VAs) and an apparently normal heart can be very challenging. Several pieces of evidence demonstrate the importance of an extensive diagnostic work-up in apparently healthy young patients for the characterization of concealed cardiomyopathies. This study shows the various diagnostic levels and tools to help identify which athletes need deeper investigation in order to unmask possible underlying heart disease.

Research paper thumbnail of Severity of spleep apnea syndrome and life‐threatening tachyarrhythmias in patients with implantable cardioverter defibrillator

Pacing and Clinical Electrophysiology, 2021

Sleep apnea syndrome (SAS) has been reported to be associated with a higher incidence of ventricu... more Sleep apnea syndrome (SAS) has been reported to be associated with a higher incidence of ventricular arrhythmias. The aim of this study was twofold: (1) to investigate whether in SAS patients receiving an implantable cardioverter defibrillator (ICD) the severity of SAS was associated with the occurrence of ventricular arrhythmias; (2) to assess whether changes in nocturnal apnoic/hypopnoic episodes may favor the occurrence of life‐threatening arrhythmias, that is, sustained ventricular tachycardia (VT)/fibrillation (VF), requiring ICD intervention.

Research paper thumbnail of B-PO05-098 Local Impedance Characteristics of Pulmonary Vein Reconnections During Repeated Atrial Fibrillation Ablation Procedures: Insight from an Italian Multicenter Registry

Research paper thumbnail of Case Report: A Case Report of Stereotactic Ventricular Arrhythmia Radioablation (STAR) on Large Cardiac Target Volume by Highly Personalized Inter- and Intra-fractional Image Guidance

Frontiers in Cardiovascular Medicine, 2020

Introduction: Although catheter ablation is the current gold standard treatment for refractory ve... more Introduction: Although catheter ablation is the current gold standard treatment for refractory ventricular arrhythmias, sometimes its efficacy is not optimal and it's associated with high risks of procedural complication and death. Stereotactic arrhythmia radioablation (STAR) is increasingly being adopted for such clinical presentation, considering its efficacy and safety.Case Presentation: We do report our experience managing a case of high volume of left ventricle for refractory ventricular tachycardia in advanced heart failure patient, by delivering a single fraction of STAR through an highly personalization of dose delivery applying repeated inter- and continuous intra-fraction image guidance.Conclusion: According to the literature reports, we recommend considering increasing as much as possible the personalization features and safety technical procedure as long as that is not significantly affecting the STAR duration. Moreover, the duration in itself shouldn't be the ma...

Research paper thumbnail of Long-Term Arrhythmic Risk Assessment in Biopsy-Proven Myocarditis

JACC: Clinical Electrophysiology, 2020

OBJECTIVES This study sought to assess long-term arrhythmic risk in patients with myocarditis who... more OBJECTIVES This study sought to assess long-term arrhythmic risk in patients with myocarditis who received an implantable cardioverter-defibrillator (ICD). BACKGROUND The arrhythmic risk of patients with myocarditis overtime remains poorly known. METHODS The study enrolled 56 patients with biopsy-proven myocarditis who received an ICD for either primary (57%) or secondary prevention (43%) according to current guidelines. Clinical characteristics, biopsy findings, electrophysiological data from endocardial 3-dimensional electroanatomic voltage mapping, and device interrogation data were analyzed to detect arrhythmic events overtime. Coronary angiography excluded significant coronary artery disease in all patients. RESULTS At a mean follow-up of 74 AE 60 months (median 65 months), 25 (45%) patients had major ventricular arrhythmias treated by ICD intervention (76% being terminated by ICD shock and 24% by antitachyarrhythmia burst pacing). At multivariable analysis, the presence of sustained ventricular tachycardia on admission (hazard ratio: 13; 95% confidence interval: 2 to 35; p ¼ 0.032) and the extension of the areas of low potentials at the bipolar endocardial mapping (hazard ratio: 1.19; 95% confidence interval: 1.04 to 1.37; p ¼ 0.013) were the only independent predictors of appropriate ICD interventions. A cutoff value of 10% of abnormal bipolar area at electroanatomical ventricular mapping discriminated patients with appropriate ICD interventions with a sensitivity of 89% and a specificity of 85%. CONCLUSIONS The study demonstrates that the prevalence of life-threatening ventricular arrhythmias in patients with myocarditis receiving an ICD according to current guidelines is high and the arrhythmic risk persists late overtime. Electroanatomical ventricular mapping may be a useful tool to identify patients at greater arrhythmic risk.

Research paper thumbnail of P1016Ventricular arrhythmias in athletes and non-athletes: diagnostic role of electroanatomic mapping and CARTO-guided endomyocardial biopsy

European Heart Journal, 2018

Survival analysis with most cases occurring in middle-aged male athletes with a better prognosis ... more Survival analysis with most cases occurring in middle-aged male athletes with a better prognosis than SCA during other activities. P1014 Risk stratification scores for sudden cardiac death in hypertrophic cardiomyopathy: is volume better than diameter?

Research paper thumbnail of Role of extensive diagnostic workup in young athletes and nonathletes with complex ventricular arrhythmias

Heart Rhythm, 2019

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of P366Robotic ablation of atrial fibrillation: impact of lesion efficacy and biomarkers on recurrences

EP Europace, 2017

Background: Pulmonary vein isolation (PVI) is an effective treatment option for patients with sym... more Background: Pulmonary vein isolation (PVI) is an effective treatment option for patients with symptomatic drug-refractory paroxysmal atrial fibrillation (AF). During the ablation procedures, transseptal (TS) puncture is needed to access the left-sided heart. In case of a radiofrequency ablation (RF) procedure, left atrial access is commonly achieved with a double transseptal puncture. While, during cryoballoon ablation (CB) a single transseptal puncture is performed with a larger diameter sheath. The ablation technique can affect the incidence of postprocedural iatrogenic atrial septal defect (IASD). Methods and Results: In this prospective study, a total of 94 pts (RF: 48, CB: 46, 64 male, mean age 62610 years) with paroxysmal AF were enrolled who had undergone a PVI procedure for the first time. Transoesophageal echocardiography (TEE) was performed prior each procedure to prove the intact interatrial septum. During RF two 8,5 Fr sheaths while during CB one 15 Fr sheath were introduced into the left atrium. Left atrial catheter dwelling time was significantly higher in the RF group compared to the CB group (89625 min vs 57618 min, p<0.05). TEE was performed after 3 months in all cases. If it revealed IASD then TEE was repeated at 1-year FU too. New-onset IASDs were detected in 18 patients (19,1%) at 3-month FU, in 9-9 pts in each the RF (18,8%) and CB (19,6%) group. The mean maximum IASD diameter did not significantly differ between the two groups (RF: 0,2260,11 cm vs CB: 0,2560,14 cm). Only left to right atrial shunt was observed. 1-year FU was completed in 7 pts, and IASD was detected in 2 pts in the CB group. There was no clinical occurrence of paradoxical embolism or other major complications. Conclusion: Persistent iatrogenic atrial septal defects are relatively common following atrial fibrillation catheter ablation procedures. No difference was observed between the ablation techniques concerning the presence of IASD at 3-month. Although, no adverse clinical events were recorded in these patient cohorts, further studies are needed to confirm our findings.