Giovanni Bertero - Academia.edu (original) (raw)
Papers by Giovanni Bertero
European Heart Journal, 2018
Background: Arrhythmias and conduction abnormalities are not uncommon in patients with cardiac am... more Background: Arrhythmias and conduction abnormalities are not uncommon in patients with cardiac amyloidosis (CA). The loss of atrial kick and impaired ventricular filling from atrial fibrillation/flutter (AF/FL) in patients with CA often lead to clinical deterioration necessitating direct-current cardioversion (DCCV). Data on outcomes of DCCV for AF/FL in patients with CA is unknown. Purpose: To examine DCCV procedural outcomes in patients with CA. Methods: Patients with CA undergoing DCCV for AF/FL from January 2000 through December 2012 were identified retrospectively and matched 2:1 with controls by gender, age, type of atrial arrhythmia and date of DCCV. Results: CA patients (n=58, mean age 69±9 years, male 81%) were identified (Table). CA had a significantly higher cardioversion cancellation rate (16/58 [28%] vs. 8/116 [7%], p<0.001) compared to controls. The main reasons for cancellation were intracardiac thrombus identified on transesophageal echocardiogram (TEE) (13/16 [81%] vs. 2/8 [25%], p=0.02) and spontaneous cardioversion (2/16 [13%] vs. 5/8 [63%], p=0.02). Of the patients that proceeded with DCCV, success rate (95% vs. 94%, p=0.83) was not different. However, procedural complications rate was higher in CA vs. controls (6/42 [14%] vs. 2/108 [2%], p=0.003); complications in CA included ventricular tachycardia/fibrillation requiring defibrillation in 2/6, complete heart block requiring pacemaker implantation in 2/6, desaturation in 1/6, and stroke in 1/6. The patient with post-DCCV stroke had no intracardiac thrombus on pre-DCCV TEE and was adequately anticoagulated. The only complication in the control group was self-limited bradyarrhythmias in 2/2.
Journal of cardiovascular medicine (Hagerstown, Md.), 2014
To evaluate the outcome of a population implanted with an implantable cardioverter defibrillator ... more To evaluate the outcome of a population implanted with an implantable cardioverter defibrillator (ICD) for primary prevention in terms of mortality, morbidity and appropriate and inappropriate interventions. Secondly, to compare the performances of single-chamber vs. dual-chamber devices. We examined all patients with CAD or CMD who received an ICD in primary prevention with at least 6 months of follow-up. For each patient were evaluated, primarily, survival, complications related to the implantation and performance of the device (antitachycardia pacing/shock). Of 193 patients, 163 were men (84.5). Mean age was 64.4 ± 10 years. One hundred and twenty patients (62%) were affected by CAD and 73 (38%) by CMD. The ejection fraction was 26 ± 6%. Fifty-three patients (27.5%) received a dual-chamber ICD, whereas 140 (72.5%) received a single-chamber ICD. There were periprocedural complications in 5.2% of the patients. At a mean follow-up of 49.9 months, 55 patients (28.5%) died. Appropriat...
Biomarker di stress Ossidativo in Pazienti con Cardiopatia Ischemic
Minerva cardioangiologica, Jan 19, 2016
Atrial fibrillation (AF) is a cardiac arrhythmia caused by various mechanisms, such as multiple r... more Atrial fibrillation (AF) is a cardiac arrhythmia caused by various mechanisms, such as multiple re-entering wavelets, high frequency activity, and rotor sources. This narrative review was based on papers found on PubMed and MEDLINE up to May 2016. The search terms were "atrial fibrillation" in combination with "catheter ablation, pathophysiology, antiarrhythmic drugs". Antiarrhythmic drugs are the cornerstone of therapy in AF, but their efficacy and safety might have to be improved. In case of failure of pharmacologic therapies, other treatments can be considered. A better understanding of the important role of the pulmonary veins has led to new approaches, such as ablation procedures, which were initially only surgical, while percutaneous options were later added. However, these strategies may present various technical complications also when performed by skilled operators. A promising field of investigation is the genetics of AF, as highlighted by studies on th...
Journal of Cardiovascular Medicine
European heart journal, Jan 26, 2018
We tested the hypothesis that atrioventricular (AV) junction ablation in conjunction biventricula... more We tested the hypothesis that atrioventricular (AV) junction ablation in conjunction biventricular pacing [cardiac resynchronization (CRT)] pacing is superior to pharmacological rate-control therapy in reducing heart failure (HF) and hospitalization in patients with permanent atrial fibrillation (AF) and narrow QRS. We randomly assigned 102 patients (mean age 72 ± 10 years) with severely symptomatic permanent AF (>6 months), narrow QRS (≤110 ms), and at least one hospitalization for HF in the previous year to AV junction ablation and CRT (plus defibrillator according to guidelines) or to pharmacological rate-control therapy (plus defibrillator according to guidelines). After a median follow-up of 16 months, the primary composite outcome of death due to HF, or hospitalization due to HF, or worsening HF had occurred in 10 patients (20%) in the Ablation+CRT arm and in 20 patients (38%) in the Drug arm [hazard ratio (HR) 0.38; 95% confidence interval (CI) 0.18-0.81; P = 0.013]. Signi...
Case reports in cardiology, 2017
We report the case of an anomalous circumflex (Cx) origin from the right sinus of Valsalva with r... more We report the case of an anomalous circumflex (Cx) origin from the right sinus of Valsalva with retroaortic course observed in a modified apical four-chamber view during transthoracic study (TTE). This finding is known as the "crossed aorta sign." Usually, the diagnosis of this congenital anomaly of coronary circulation is established during coronary angiography. In this case, the diagnosis was performed by echocardiography before angiography. We believe that recent improvements in echocardiography increase the potential of this imaging technology also in the diagnosis of coronary artery anomalies.
Journal of Cardiovascular Medicine
: We describe the case of a patient with dyspnea and heterotopic cardiac transplant, ventricular ... more : We describe the case of a patient with dyspnea and heterotopic cardiac transplant, ventricular fibrillation from the native heart and sinus rhythm from the transplanted one. The two hearts were synchronized with a pacemaker. Electric external cardioversion and a different type of pacemaker stimulation were successfully performed, with improving symptoms.
Journal of neurology, 2017
Expert opinion on investigational drugs, Jan 15, 2015
Atrial fibrillation (AF) is a frequent occurrence with advancing age and is associated with incre... more Atrial fibrillation (AF) is a frequent occurrence with advancing age and is associated with increased morbidity and mortality. Unfortunately, the currently available AF therapies have a great deal of side effects. Areas covered: In this review, the authors discuss the evidence upon which the use of Ranolazine as an anti-arrhythmic drug is based. Specifically, the authors review the Phase I-III trials that studied ranolazine as potential treatment for AF. They also discuss the efficacy, safety, tolerability and side effects and compare the MERLIN TIMI 36, HARMONY and ROLE trials. Expert opinion: Although ranolazine is considered an anti-angina drug, it may also be, according to the available data, used in patients with AF. Ranolazine has anti-AF efficacy, both alone or in combination with other drugs such as amiodarone and dronedarone. Indeed, its efficacy has been demonstrated in various settings such as the termination of paroxysmal AF, the facilitation of AF electrical cardioversi...
Minerva cardioangiologica, 1987
La Clinica terapeutica, 2013
Electrical storm (ES) describes the rapidly clustering ventricular fibrillation (VF) that require... more Electrical storm (ES) describes the rapidly clustering ventricular fibrillation (VF) that requires multiple cardioversions. Emerging evidence suggests that Purkinje arborization and sympathetic nerve regeneration play a major role in initiating malignant arrhythmias. We report the case of two patients who, after having survived an acute myocardial infarction (MI), developed repetitive episodes of polymorphic ventricular tachycardia and VF one week after percutaneous revascularization, triggered by monomorphic premature ventricular contractions (PVCs). Owing to repetitive and drug-refractory VF episodes, temporary atrial overdrive pacing was attempted with complete suppression of VF. In the following month, recurrence of ventricular arrhythmia was inversely related to the atrial pacing rate. Although antiarrhythmic drugs other than beta-blockers had been discontinued, neither PVCs nor ventricular arrhythmias recurred at one-month follow-up when the lower pacing rate was set at 60 bpm...
![Research paper thumbnail of [Atrial myxoma presenting during pregnancy]](https://attachments.academia-assets.com/71271275/thumbnails/1.jpg)
](Giornale italiano di cardiologia (2006), 2010
We report a case of left atrial myxoma presenting as acute respiratory failure following surgical... more We report a case of left atrial myxoma presenting as acute respiratory failure following surgical intervention for voluntary interruption of pregnancy. After cardiac surgery T-wave changes were observed on the ECG, most likely due to coronary embolism.
Cardiologia (Rome, Italy), 1983
Pacing and Clinical Electrophysiology, 2015
Fluoroscopic catheter ablation of cardiac arrhythmias in pediatric patients exposes the patients ... more Fluoroscopic catheter ablation of cardiac arrhythmias in pediatric patients exposes the patients to the potential risk of radiation considering the sensitivity of this population and its longer life expectancy. We evaluated the feasibility, safety and efficacy of accessory pathway (AP) ablation guided by CARTO3 electroanatomic mapping (EAM) system with both cryoenergy and radiofrequency (RF) energy in order to avoid x-ray exposure in pediatric patients. We included 44 patients (mean age 13.1±3.3 years); 9/44 presented concealed AP. An electrophysiological study with a 3D EAM reconstruction was performed in every patient with a venous transfemoral direct right atrium approach or an arterial transfemoral retrograde approach to reach the mitral annulus. In 2 patients with left-sided AP, the ablation was performed via a patent foramen ovale. A total of 47 APs were present, left-sided in 45% (21/47) of cases (15 lateral, 1 anterior, 3 postero-septal, 2 postero-lateral) and right sided in 55% (26/47) (1 anterior, 3 antero-lateral, 1 postero-lateral, 3 lateral, 5 para-Hisian, 12 postero-septal, 1 antero-septal). Ablation was successfully performed in every patient, in 33 with RF and in 11 with cryoenergy, in all of them without the use of fluoroscopy. No complication occurred. At a mean follow-up of 16.0 ± 11.7 months we observed 7 recurrences, 3 of them successfully re-ablated without fluoroscopy. In 1 case cryoablation of a para-Hisian AP was ineffective in the long-term. 3Dimensional EAM allowed performing a safe and effective fluoroless AP ablation procedure in pediatric population both with RF and cryoenergy. This article is protected by copyright. All rights reserved.
Journal of Clinical Medicine Research, 2012
We report the case of biventricular pacemaker implantation via the femoral vein, in a patient wit... more We report the case of biventricular pacemaker implantation via the femoral vein, in a patient with impossibility of using standard superior vein approach and a contraindication to epicardial lead placement.
International Journal of Cardiac Imaging, 2000
We reevaluated the magnetic resonance (MR) examinations of 38 healthy volunteers (control group, ... more We reevaluated the magnetic resonance (MR) examinations of 38 healthy volunteers (control group, CG) and of 124 patients with RV arrhythmia with left bundle branch block (LBBB) morphology: 45 with episodes of RV sustained tachycardia and of polymorphic RV premature beats (RVST-PPB group); 36 with only RV out¯ow tract sustained or not sustained tachycardia (RVOTT group); 43 with RV monomorphic premature beats (RVMPB group). All the examinations were reevaluated in a blinded fashion for detecting myocardial adipose replacement (AR) and wall bulges or aneurysms. In RVST-PPB patients, no AR was observed in 9%; 1 RV region involvement, 0%; 2 regions, 4%; P3 regions, 87%; left ventricle (LV), 15%. RVOTT patients: 28%, 53%, 14%, 5%, and 0%, respectively. RVMPB patients: 33%, 46%, 19%, 2%, and 0%, respectively. In CG, AR was observed in 11% (in RV out¯ow tract). RV bulges were detected in 75% of RVST-PPB , 39% of RVOTT, and 14% of RVMPB patients, none of the CG; RV aneurysms in 33% of RVST-PPB patients, none of RVOTT patients, RVMBP patients, and CG. A signi®cant dierence among groups for RV and LV AR as well as RV bulges and aneurysms was found (p < 0:0001). In the direct comparisons, signi®cant dierences were found for: disease duration (RVST-PPB vs. RVMPB, p 0.0396); RV AR (all the patients groups vs. CG, RVST-PPB vs. RVOTT or RVMPB, p < 0:0001); RV aneurysms (RVST-PPB vs. CG. RVST-PPB vs. RVOTT or RVMPB, p < 0.0002); bulges (all comparisons, p < 0.0174). AR is con®rmed as a structural substrate in RV arrhythmias. Number and extension of MR abnormalities are correlated to dierent degrees of RV arrhythmias.
European Heart Journal, 2018
Background: Arrhythmias and conduction abnormalities are not uncommon in patients with cardiac am... more Background: Arrhythmias and conduction abnormalities are not uncommon in patients with cardiac amyloidosis (CA). The loss of atrial kick and impaired ventricular filling from atrial fibrillation/flutter (AF/FL) in patients with CA often lead to clinical deterioration necessitating direct-current cardioversion (DCCV). Data on outcomes of DCCV for AF/FL in patients with CA is unknown. Purpose: To examine DCCV procedural outcomes in patients with CA. Methods: Patients with CA undergoing DCCV for AF/FL from January 2000 through December 2012 were identified retrospectively and matched 2:1 with controls by gender, age, type of atrial arrhythmia and date of DCCV. Results: CA patients (n=58, mean age 69±9 years, male 81%) were identified (Table). CA had a significantly higher cardioversion cancellation rate (16/58 [28%] vs. 8/116 [7%], p<0.001) compared to controls. The main reasons for cancellation were intracardiac thrombus identified on transesophageal echocardiogram (TEE) (13/16 [81%] vs. 2/8 [25%], p=0.02) and spontaneous cardioversion (2/16 [13%] vs. 5/8 [63%], p=0.02). Of the patients that proceeded with DCCV, success rate (95% vs. 94%, p=0.83) was not different. However, procedural complications rate was higher in CA vs. controls (6/42 [14%] vs. 2/108 [2%], p=0.003); complications in CA included ventricular tachycardia/fibrillation requiring defibrillation in 2/6, complete heart block requiring pacemaker implantation in 2/6, desaturation in 1/6, and stroke in 1/6. The patient with post-DCCV stroke had no intracardiac thrombus on pre-DCCV TEE and was adequately anticoagulated. The only complication in the control group was self-limited bradyarrhythmias in 2/2.
Journal of cardiovascular medicine (Hagerstown, Md.), 2014
To evaluate the outcome of a population implanted with an implantable cardioverter defibrillator ... more To evaluate the outcome of a population implanted with an implantable cardioverter defibrillator (ICD) for primary prevention in terms of mortality, morbidity and appropriate and inappropriate interventions. Secondly, to compare the performances of single-chamber vs. dual-chamber devices. We examined all patients with CAD or CMD who received an ICD in primary prevention with at least 6 months of follow-up. For each patient were evaluated, primarily, survival, complications related to the implantation and performance of the device (antitachycardia pacing/shock). Of 193 patients, 163 were men (84.5). Mean age was 64.4 ± 10 years. One hundred and twenty patients (62%) were affected by CAD and 73 (38%) by CMD. The ejection fraction was 26 ± 6%. Fifty-three patients (27.5%) received a dual-chamber ICD, whereas 140 (72.5%) received a single-chamber ICD. There were periprocedural complications in 5.2% of the patients. At a mean follow-up of 49.9 months, 55 patients (28.5%) died. Appropriat...
Biomarker di stress Ossidativo in Pazienti con Cardiopatia Ischemic
Minerva cardioangiologica, Jan 19, 2016
Atrial fibrillation (AF) is a cardiac arrhythmia caused by various mechanisms, such as multiple r... more Atrial fibrillation (AF) is a cardiac arrhythmia caused by various mechanisms, such as multiple re-entering wavelets, high frequency activity, and rotor sources. This narrative review was based on papers found on PubMed and MEDLINE up to May 2016. The search terms were "atrial fibrillation" in combination with "catheter ablation, pathophysiology, antiarrhythmic drugs". Antiarrhythmic drugs are the cornerstone of therapy in AF, but their efficacy and safety might have to be improved. In case of failure of pharmacologic therapies, other treatments can be considered. A better understanding of the important role of the pulmonary veins has led to new approaches, such as ablation procedures, which were initially only surgical, while percutaneous options were later added. However, these strategies may present various technical complications also when performed by skilled operators. A promising field of investigation is the genetics of AF, as highlighted by studies on th...
Journal of Cardiovascular Medicine
European heart journal, Jan 26, 2018
We tested the hypothesis that atrioventricular (AV) junction ablation in conjunction biventricula... more We tested the hypothesis that atrioventricular (AV) junction ablation in conjunction biventricular pacing [cardiac resynchronization (CRT)] pacing is superior to pharmacological rate-control therapy in reducing heart failure (HF) and hospitalization in patients with permanent atrial fibrillation (AF) and narrow QRS. We randomly assigned 102 patients (mean age 72 ± 10 years) with severely symptomatic permanent AF (>6 months), narrow QRS (≤110 ms), and at least one hospitalization for HF in the previous year to AV junction ablation and CRT (plus defibrillator according to guidelines) or to pharmacological rate-control therapy (plus defibrillator according to guidelines). After a median follow-up of 16 months, the primary composite outcome of death due to HF, or hospitalization due to HF, or worsening HF had occurred in 10 patients (20%) in the Ablation+CRT arm and in 20 patients (38%) in the Drug arm [hazard ratio (HR) 0.38; 95% confidence interval (CI) 0.18-0.81; P = 0.013]. Signi...
Case reports in cardiology, 2017
We report the case of an anomalous circumflex (Cx) origin from the right sinus of Valsalva with r... more We report the case of an anomalous circumflex (Cx) origin from the right sinus of Valsalva with retroaortic course observed in a modified apical four-chamber view during transthoracic study (TTE). This finding is known as the "crossed aorta sign." Usually, the diagnosis of this congenital anomaly of coronary circulation is established during coronary angiography. In this case, the diagnosis was performed by echocardiography before angiography. We believe that recent improvements in echocardiography increase the potential of this imaging technology also in the diagnosis of coronary artery anomalies.
Journal of Cardiovascular Medicine
: We describe the case of a patient with dyspnea and heterotopic cardiac transplant, ventricular ... more : We describe the case of a patient with dyspnea and heterotopic cardiac transplant, ventricular fibrillation from the native heart and sinus rhythm from the transplanted one. The two hearts were synchronized with a pacemaker. Electric external cardioversion and a different type of pacemaker stimulation were successfully performed, with improving symptoms.
Journal of neurology, 2017
Expert opinion on investigational drugs, Jan 15, 2015
Atrial fibrillation (AF) is a frequent occurrence with advancing age and is associated with incre... more Atrial fibrillation (AF) is a frequent occurrence with advancing age and is associated with increased morbidity and mortality. Unfortunately, the currently available AF therapies have a great deal of side effects. Areas covered: In this review, the authors discuss the evidence upon which the use of Ranolazine as an anti-arrhythmic drug is based. Specifically, the authors review the Phase I-III trials that studied ranolazine as potential treatment for AF. They also discuss the efficacy, safety, tolerability and side effects and compare the MERLIN TIMI 36, HARMONY and ROLE trials. Expert opinion: Although ranolazine is considered an anti-angina drug, it may also be, according to the available data, used in patients with AF. Ranolazine has anti-AF efficacy, both alone or in combination with other drugs such as amiodarone and dronedarone. Indeed, its efficacy has been demonstrated in various settings such as the termination of paroxysmal AF, the facilitation of AF electrical cardioversi...
Minerva cardioangiologica, 1987
La Clinica terapeutica, 2013
Electrical storm (ES) describes the rapidly clustering ventricular fibrillation (VF) that require... more Electrical storm (ES) describes the rapidly clustering ventricular fibrillation (VF) that requires multiple cardioversions. Emerging evidence suggests that Purkinje arborization and sympathetic nerve regeneration play a major role in initiating malignant arrhythmias. We report the case of two patients who, after having survived an acute myocardial infarction (MI), developed repetitive episodes of polymorphic ventricular tachycardia and VF one week after percutaneous revascularization, triggered by monomorphic premature ventricular contractions (PVCs). Owing to repetitive and drug-refractory VF episodes, temporary atrial overdrive pacing was attempted with complete suppression of VF. In the following month, recurrence of ventricular arrhythmia was inversely related to the atrial pacing rate. Although antiarrhythmic drugs other than beta-blockers had been discontinued, neither PVCs nor ventricular arrhythmias recurred at one-month follow-up when the lower pacing rate was set at 60 bpm...
Giornale italiano di cardiologia (2006), 2010
We report a case of left atrial myxoma presenting as acute respiratory failure following surgical... more We report a case of left atrial myxoma presenting as acute respiratory failure following surgical intervention for voluntary interruption of pregnancy. After cardiac surgery T-wave changes were observed on the ECG, most likely due to coronary embolism.
Cardiologia (Rome, Italy), 1983
Pacing and Clinical Electrophysiology, 2015
Fluoroscopic catheter ablation of cardiac arrhythmias in pediatric patients exposes the patients ... more Fluoroscopic catheter ablation of cardiac arrhythmias in pediatric patients exposes the patients to the potential risk of radiation considering the sensitivity of this population and its longer life expectancy. We evaluated the feasibility, safety and efficacy of accessory pathway (AP) ablation guided by CARTO3 electroanatomic mapping (EAM) system with both cryoenergy and radiofrequency (RF) energy in order to avoid x-ray exposure in pediatric patients. We included 44 patients (mean age 13.1±3.3 years); 9/44 presented concealed AP. An electrophysiological study with a 3D EAM reconstruction was performed in every patient with a venous transfemoral direct right atrium approach or an arterial transfemoral retrograde approach to reach the mitral annulus. In 2 patients with left-sided AP, the ablation was performed via a patent foramen ovale. A total of 47 APs were present, left-sided in 45% (21/47) of cases (15 lateral, 1 anterior, 3 postero-septal, 2 postero-lateral) and right sided in 55% (26/47) (1 anterior, 3 antero-lateral, 1 postero-lateral, 3 lateral, 5 para-Hisian, 12 postero-septal, 1 antero-septal). Ablation was successfully performed in every patient, in 33 with RF and in 11 with cryoenergy, in all of them without the use of fluoroscopy. No complication occurred. At a mean follow-up of 16.0 ± 11.7 months we observed 7 recurrences, 3 of them successfully re-ablated without fluoroscopy. In 1 case cryoablation of a para-Hisian AP was ineffective in the long-term. 3Dimensional EAM allowed performing a safe and effective fluoroless AP ablation procedure in pediatric population both with RF and cryoenergy. This article is protected by copyright. All rights reserved.
Journal of Clinical Medicine Research, 2012
We report the case of biventricular pacemaker implantation via the femoral vein, in a patient wit... more We report the case of biventricular pacemaker implantation via the femoral vein, in a patient with impossibility of using standard superior vein approach and a contraindication to epicardial lead placement.
International Journal of Cardiac Imaging, 2000
We reevaluated the magnetic resonance (MR) examinations of 38 healthy volunteers (control group, ... more We reevaluated the magnetic resonance (MR) examinations of 38 healthy volunteers (control group, CG) and of 124 patients with RV arrhythmia with left bundle branch block (LBBB) morphology: 45 with episodes of RV sustained tachycardia and of polymorphic RV premature beats (RVST-PPB group); 36 with only RV out¯ow tract sustained or not sustained tachycardia (RVOTT group); 43 with RV monomorphic premature beats (RVMPB group). All the examinations were reevaluated in a blinded fashion for detecting myocardial adipose replacement (AR) and wall bulges or aneurysms. In RVST-PPB patients, no AR was observed in 9%; 1 RV region involvement, 0%; 2 regions, 4%; P3 regions, 87%; left ventricle (LV), 15%. RVOTT patients: 28%, 53%, 14%, 5%, and 0%, respectively. RVMPB patients: 33%, 46%, 19%, 2%, and 0%, respectively. In CG, AR was observed in 11% (in RV out¯ow tract). RV bulges were detected in 75% of RVST-PPB , 39% of RVOTT, and 14% of RVMPB patients, none of the CG; RV aneurysms in 33% of RVST-PPB patients, none of RVOTT patients, RVMBP patients, and CG. A signi®cant dierence among groups for RV and LV AR as well as RV bulges and aneurysms was found (p < 0:0001). In the direct comparisons, signi®cant dierences were found for: disease duration (RVST-PPB vs. RVMPB, p 0.0396); RV AR (all the patients groups vs. CG, RVST-PPB vs. RVOTT or RVMPB, p < 0:0001); RV aneurysms (RVST-PPB vs. CG. RVST-PPB vs. RVOTT or RVMPB, p < 0.0002); bulges (all comparisons, p < 0.0174). AR is con®rmed as a structural substrate in RV arrhythmias. Number and extension of MR abnormalities are correlated to dierent degrees of RV arrhythmias.