Panayota Flevari - Academia.edu (original) (raw)

Papers by Panayota Flevari

Research paper thumbnail of The effects of ranolazine on paroxysmal atrial fibrillation in patients with coronary artery disease

European Heart Journal, 2013

Research paper thumbnail of Abstract 11623: Temporal Changes of Noninvasive Electrocardiographic Risk Factors for Sudden Cardiac Death in Post-Myocardial Infarction Patients With Preserved Ejection Fraction: Insights From The Preserve EF Study

Circulation, Nov 19, 2019

Research paper thumbnail of Permanent Sinus Dysfunction After Pulmonary Vein Isolation Ablation: Observations and Potential Mechanisms

Canadian Journal of Cardiology, Oct 1, 2014

Although transient sinus arrest has been reported during pulmonary vein isolation (PVI), the long... more Although transient sinus arrest has been reported during pulmonary vein isolation (PVI), the long-term impairment of sinus node after PVI has not been described. In this report, we present a case of sinus node dysfunction necessitating a permanent pacemaker, caused during PVI. Clinical data, intracardiac electrograms, and cardiac imaging were incompatible with previous sinus node dysfunction, sinus node artery occlusion, or an ectopic atrial rhythm from the pulmonary veins. Impairment of the neural pathways connecting the ganglionated plexi of the right superior pulmonary veins with the sinus node is a possible underlying mechanism.

Research paper thumbnail of 535 Do minor psychiatric disorders predispose to vasovagal episodes?

Europace, 2005

during the first 6 min after the tilt onset. The increase of the HR induced by the tilt showed a ... more during the first 6 min after the tilt onset. The increase of the HR induced by the tilt showed a strong inverse correlation with age (r =-0,63, p<0,001) but did not predict the results of the test. The increment of the HR induced by nitroglycerin was also similar for patients with and without syncope during the pharmacologic phase of the test (Fig. h case A: negative HUT and important increase of HR; case B: positive HUT and flat response of HR). Conclusions: the magnitude of the HR increases during the first minutes after the tilting maneuver and after the administration of nitroglycerin are inversely related to age and do not predict the results of the HUT potentiated with nitrogliycelin.

Research paper thumbnail of Mortality after catheter ablation for atrial fibrillation compared with antiarrhythmic drug therapy. A meta-analysis of randomized trials

American Heart Journal, Jul 1, 2009

Catheter ablation and anti-arrhythmic drug therapy were associated with similar rates of survival... more Catheter ablation and anti-arrhythmic drug therapy were associated with similar rates of survival and stroke/transient ischaemic attack in patients with atrial fibrillation. Findings could probably be explained by the included low-risk populations and relatively short-term follow-up. There were limitations in reporting of review methods, but overall the authors' conclusions appear to be supported by the evidence presented. Authors' objectives To compare the effects on mortality of catheter ablation versus anti-arrhythmic drug therapy in patients with atrial fibrillation. Searching PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 2000 to January 2009 using reported search terms. No language restrictions were applied. In addition, reference lists of retrieved studies and abstracts of four specified conferences were searched. Study selection Randomised controlled trials (RCTs) that compared catheter ablation with anti-arrhythmic drug therapy in patients with atrial fibrillation were eligible for inclusion. The primary review outcome was all-cause mortality during follow-up. The secondary outcome was stroke or transient ischaemic attack. The included trials used pulmonary vein antral ablation or circumferential pulmonary vein ablation combined with linear lesions in the left and right atria, with ablation of non-venous foci in some patients. Trials used a variety of antiarrhythmic drugs, including a wide variety of class I and class III agents or combinations; amiodarone was used as a drug candidate in all but one trial. In most trials patients had failed to respond to at least one anti-arrhythmic drug; in three trials patients had not previously used a membrane active anti-arrhythmic drug. Most trials were in patients with paroxysmal or persistent atrial fibrillation; one trial was in patients with chronic atrial fibrillation. The authors stated that trials were in low-risk populations with a mean age ranging from 51 to 65 years, with low rates of structural heart disease (excluding hypertension) in most trials. Included trials used different oral anti-coagulation regimens in ablation treatment groups; in most trials oral anti-coagulation was discontinued after six weeks to six months in the absence of recurrence of the arrhythmia. The duration of follow-up was one year in all except one trial, in which follow-up was nine months. The authors did not state how many reviewers selected studies. Assessment of study quality Validity was assessed using a modification of the Jadad scale that scored the randomisation method and reporting of withdrawals and drop-outs. Blinding was not assessed, since it was not applicable to the comparison of an intervention with drug therapy. It was not clear how many reviewers assessed validity. Data extraction Authors of trials in which there was no explicit statement about the absence of deaths were contacted for confirmation of the absence of deaths.

Research paper thumbnail of Cryoballoon ablation under transesophageal echocardiographic guidance in dextrocardia

Hellenic Journal of Cardiology, 2019

Research paper thumbnail of How does T-wave alternans correlate with other clinical parameters including those reflecting autonomic tone? An interim analysis form the EUTrigTreat clinical study

Research paper thumbnail of P2876Repeating non-invasive risk stratification tests improves the prediction of outcomes of ICD patients in the EUTrigTreat study

European Heart Journal, Oct 1, 2019

Research paper thumbnail of P794Sphenopalatine ganglion block as a method to modulate cardiac autonomic tone and suppress premature ventricular beats

Europace, Mar 1, 2018

We report here on the electrophysiology (EP) study of eight patients, who were referred to our ce... more We report here on the electrophysiology (EP) study of eight patients, who were referred to our center due to OT-related premature ventricular contractions (OT-PVC). Using programmed atrial stimulation at the interatrial septum or within the coronary sinus, we show that atrial stimulation was capable to evoke OT-PVCs with an ECGmorphology identical to the clinical PVC. Of note, these PVCs occur after an evident atrial capture (as detected by simultaneous recordings from the coronary sinus and the right ventricle) with a stimulus-to-QRS interval shorter than the normal PQ interval during regular sinus beats. (All selected patients exhibited spontaneous PVCs with a low frequency (1-2 PVC/5 min) during the EP study; hence co-incidental occurrence during atrial stimulation could be excluded). Our findings suggest that unique connections might exist between specific atrial locations and the OTs, the activation of which could result in triggering PVCs from the presumed exit point of these pathways in the OT. This is also supported by previous findings describing discrete pre-potentials before the ventricular electrogram of PVCs at specific locations within the OTs. Remnants of the embryologic AV conduction system (referred to as "dead-end-tract") might serve as preferential pathways, through which the atrial activation wavefront might occasionally "leak out" towards the OT regions to trigger PVCs. Our results could have the potential to transform the current approach of OT-IVAablation, and might introduce a novel strategy of extending mapping into the atrium, to identify/ablate the presumed entry-sites of the "dead-end-tract", through which the arrhythmia can be triggered.

Research paper thumbnail of 218 The role of clinical anxiety in the head up tilt test

Research paper thumbnail of Appropriate Shocks and Mortality in Patients With Versus Without Diabetes With Prophylactic Implantable Cardioverter Defibrillators

Diabetes Care, 2019

OBJECTIVE Diabetes increases the risk of all-cause mortality and sudden cardiac death (SCD). The ... more OBJECTIVE Diabetes increases the risk of all-cause mortality and sudden cardiac death (SCD). The exact mechanisms leading to sudden death in diabetes are not well known. We compared the incidence of appropriate shocks and mortality in patients with versus without diabetes with a prophylactic implantable cardioverter defibrillator (ICD) included in the retrospective EU-CERT-ICD registry. RESEARCH DESIGN AND METHODS AND RESULTS A total of 3,535 patients from 12 European EU-CERT-ICD centers with a mean age of 63.7 ± 11.2 years (82% males) at the time of ICD implantation were included in the analysis. A total of 995 patients (28%) had a history of diabetes. All patients had an ICD implanted for primary SCD prevention. End points were appropriate shock and all-cause mortality. Mean follow-up time was 3.2 ± 2.3 years. Diabetes was associated with a lower risk of appropriate shocks (adjusted hazard ratio [HR] 0.77 [95% CI 0.62–0.96], P = 0.02). However, patients with diabetes had significa...

Research paper thumbnail of Sphenopalatine ganglion block: an external gate to modulate cardiac autonomic tone and suppress premature ventricular beats?

Annals of Translational Medicine, 2018

Background: Autonomic modulation is used for treating various cardiovascular diseases, such as ca... more Background: Autonomic modulation is used for treating various cardiovascular diseases, such as cardiac arrhythmias. Sphenopalatine ganglion (SPG) block is an easy, non-invasive therapy for migraine with a potential cardiovascular impact that remains unclear. In this study, we sought to assess the effect of SPG block on cardiac autonomic tone, as expressed by heart rate variability (HRV), and on ventricular arrhythmogenesis. Methods: Forty patients (14 male and 26 female) suffering from migraine were randomized by 1:1 to SPG block or placebo (controls) and HRV parameters were evaluated 1 hour before and hourly after the intervention. Twenty-four additional patients (11 men and 13 women) with premature ventricular contractions (PVCs) from the right ventricular outflow tract underwent the same randomization and the number of PVCs was assessed during 1 hour before and every hour after treatment. Values were summarized as median (1st-3rd quartile).

Research paper thumbnail of Transthoracic 3D echocardiography used as a low-cost and precise technique to facilitate ablation of ventricular tachycardia from the left posteromedial papillary muscle

Hellenic Journal of Cardiology, 2018

Research paper thumbnail of The Effects of Raloxifene and Simvastatin on Plasma Lipids and Endothelium

Cardiovascular Drugs and Therapy, 2003

Raloxifene is a selective estrogen receptor modulator and an attractive alternative to estrogen r... more Raloxifene is a selective estrogen receptor modulator and an attractive alternative to estrogen replacement as it obviates the need for a progestin and does not increase C-reactive protein levels. We compared the effects of simvastatin and raloxifene treatments on the lipid profile, the levels of adhesion molecules and the endothelium dependent and independent vasoreactivity. We treated 12 postmenopausal women with hypercholesterolemia and coronary artery disease with raloxifene 60 mg/day and simvastatin 20 mg/day in a randomized, double-blind, crossover study. Each treatment period was 8 weeks long with a 4-week washout interval. Plasma lipids and cellular adhesion molecules were evaluated and peripheral blood flow studies with venous occlusion plethysmography were performed. Both simvastatin and raloxifene significantly reduced total [33% (27-40), 12% (0-24)] and LDL [44% (36-52), 16% (0-33)] cholesterol compared to baseline values (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) but simvastatin was more effective than raloxifene (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.005). None of the treatments had any significant effect on HDL cholesterol and triglyceride levels. Only raloxifene significantly reduced Lp(a) [18% (1-36)] and ICAM-1 [17% (8-25)] and VCAM-1 [24% (15-33)] plasma levels compared to baseline (p = 0.019, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001 and p = 0.003, respectively). Hyperemic blood flow response on raloxifene was significantly higher compared to baseline [52% (0-105)], (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05), whereas no significant change was noted on simvastatin. Endothelium independent blood flow induced by nitroglycerine was not influenced by either active treatment. Raloxifene administration is associated with lower ICAM-1, VCAM-1 and Lp(a) plasma levels and enhanced endothelium dependent dilation compared to simvastatin although simvastatin is more powerful in total and LDL cholesterol reduction.

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

International Journal of Cardiology, 2011

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

Research paper thumbnail of 413 Biventricular pacing, coronary blood flow and serum adhesion molecules

Europace, 2005

implantation of a pacemaker and 33 (83,5%) an ICD. 4 patients (10%) died during follow-up, 3 from... more implantation of a pacemaker and 33 (83,5%) an ICD. 4 patients (10%) died during follow-up, 3 from heart failure and 1 from sudden death. 3 patients required heart transplantation due to heart failure. Results:

Research paper thumbnail of Apolipoprotein E ε4 allele as a genetic risk factor for left ventricular failure in homozygous β Thalassemia

Research paper thumbnail of P2915Multivariable risk prediction of appropriate shock and mortality in ICD patients

European Heart Journal, 2018

Research paper thumbnail of Prediction of mortality benefit based on periodic repolarisation dynamics in patients undergoing prophylactic implantation of a defibrillator: a prospective, controlled, multicentre cohort study

The Lancet, 2019

Background A small proportion of patients undergoing primary prophylactic implantation of implant... more Background A small proportion of patients undergoing primary prophylactic implantation of implantable cardioverter defibrillators (ICDs) experiences malignant arrhythmias. We postulated that periodic repolarisation dynamics, a novel marker of sympathetic-activity-associated repolarisation instability, could be used to identify electrically vulnerable patients who would benefit from prophylactic implantation of ICDs by way of a reduction in mortality. Methods We did a prespecified substudy of EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU-CERT-ICD), a prospective, investigator-initiated, non-randomised, controlled cohort study done at 44 centres in 15 EU countries. Patients aged 18 years or older with ischaemic or non-ischaemic cardiomyopathy and reduced left ventricular ejection fraction (≤35%) were eligible for inclusion if they met guideline-based criteria for primary prophylactic implantation of ICDs. Periodic repolarisation dynamics from 24-h Holter recordings were assessed blindly in patients the day before ICD implantation or on the day of study enrolment in patients who were conservatively managed. The primary endpoint was all-cause mortality. Propensity scoring and multivariable models were used to assess the interaction between periodic repolarisation dynamics and the treatment effect of ICDs on mortality.

Research paper thumbnail of Differential multivariable risk prediction of appropriate shock versus competing mortality - A prospective cohort study to estimate benefits from ICD therapy

International journal of cardiology, Jan 28, 2018

We prospectively investigated combinations of risk stratifiers including multiple EP diagnostics ... more We prospectively investigated combinations of risk stratifiers including multiple EP diagnostics in a cohort study of ICD patients. For 672 enrolled patients, we collected history, LVEF, EP study and T-wave alternans testing, 24-h Holter, NT-proBNP, and the eGFR. All-cause mortality and first appropriate ICD shock were predefined endpoints. The 635 patients included in the final analyses were 63 ± 13 years old, 81% were male, LVEF averaged 40 ± 14%, 20% were inducible at EP study, 63% had a primary prophylactic ICD. During follow-up over 4.3 ± 1.5 years, 108 patients died (4.0% per year), and appropriate shock therapy occurred in n = 96 (3.9% per year). In multivariate regression, age (p < 0.001), LVEF (p < 0.001), NYHA functional class (p = 0.007), eGFR (p = 0.024), a history of atrial fibrillation (p = 0.011), and NT-pro-BNP (p = 0.002) were predictors of mortality. LVEF (p = 0.002), inducibility at EP study (p = 0.007), and secondary prophylaxis (p = 0.002) were identified ...

Research paper thumbnail of The effects of ranolazine on paroxysmal atrial fibrillation in patients with coronary artery disease

European Heart Journal, 2013

Research paper thumbnail of Abstract 11623: Temporal Changes of Noninvasive Electrocardiographic Risk Factors for Sudden Cardiac Death in Post-Myocardial Infarction Patients With Preserved Ejection Fraction: Insights From The Preserve EF Study

Circulation, Nov 19, 2019

Research paper thumbnail of Permanent Sinus Dysfunction After Pulmonary Vein Isolation Ablation: Observations and Potential Mechanisms

Canadian Journal of Cardiology, Oct 1, 2014

Although transient sinus arrest has been reported during pulmonary vein isolation (PVI), the long... more Although transient sinus arrest has been reported during pulmonary vein isolation (PVI), the long-term impairment of sinus node after PVI has not been described. In this report, we present a case of sinus node dysfunction necessitating a permanent pacemaker, caused during PVI. Clinical data, intracardiac electrograms, and cardiac imaging were incompatible with previous sinus node dysfunction, sinus node artery occlusion, or an ectopic atrial rhythm from the pulmonary veins. Impairment of the neural pathways connecting the ganglionated plexi of the right superior pulmonary veins with the sinus node is a possible underlying mechanism.

Research paper thumbnail of 535 Do minor psychiatric disorders predispose to vasovagal episodes?

Europace, 2005

during the first 6 min after the tilt onset. The increase of the HR induced by the tilt showed a ... more during the first 6 min after the tilt onset. The increase of the HR induced by the tilt showed a strong inverse correlation with age (r =-0,63, p<0,001) but did not predict the results of the test. The increment of the HR induced by nitroglycerin was also similar for patients with and without syncope during the pharmacologic phase of the test (Fig. h case A: negative HUT and important increase of HR; case B: positive HUT and flat response of HR). Conclusions: the magnitude of the HR increases during the first minutes after the tilting maneuver and after the administration of nitroglycerin are inversely related to age and do not predict the results of the HUT potentiated with nitrogliycelin.

Research paper thumbnail of Mortality after catheter ablation for atrial fibrillation compared with antiarrhythmic drug therapy. A meta-analysis of randomized trials

American Heart Journal, Jul 1, 2009

Catheter ablation and anti-arrhythmic drug therapy were associated with similar rates of survival... more Catheter ablation and anti-arrhythmic drug therapy were associated with similar rates of survival and stroke/transient ischaemic attack in patients with atrial fibrillation. Findings could probably be explained by the included low-risk populations and relatively short-term follow-up. There were limitations in reporting of review methods, but overall the authors' conclusions appear to be supported by the evidence presented. Authors' objectives To compare the effects on mortality of catheter ablation versus anti-arrhythmic drug therapy in patients with atrial fibrillation. Searching PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 2000 to January 2009 using reported search terms. No language restrictions were applied. In addition, reference lists of retrieved studies and abstracts of four specified conferences were searched. Study selection Randomised controlled trials (RCTs) that compared catheter ablation with anti-arrhythmic drug therapy in patients with atrial fibrillation were eligible for inclusion. The primary review outcome was all-cause mortality during follow-up. The secondary outcome was stroke or transient ischaemic attack. The included trials used pulmonary vein antral ablation or circumferential pulmonary vein ablation combined with linear lesions in the left and right atria, with ablation of non-venous foci in some patients. Trials used a variety of antiarrhythmic drugs, including a wide variety of class I and class III agents or combinations; amiodarone was used as a drug candidate in all but one trial. In most trials patients had failed to respond to at least one anti-arrhythmic drug; in three trials patients had not previously used a membrane active anti-arrhythmic drug. Most trials were in patients with paroxysmal or persistent atrial fibrillation; one trial was in patients with chronic atrial fibrillation. The authors stated that trials were in low-risk populations with a mean age ranging from 51 to 65 years, with low rates of structural heart disease (excluding hypertension) in most trials. Included trials used different oral anti-coagulation regimens in ablation treatment groups; in most trials oral anti-coagulation was discontinued after six weeks to six months in the absence of recurrence of the arrhythmia. The duration of follow-up was one year in all except one trial, in which follow-up was nine months. The authors did not state how many reviewers selected studies. Assessment of study quality Validity was assessed using a modification of the Jadad scale that scored the randomisation method and reporting of withdrawals and drop-outs. Blinding was not assessed, since it was not applicable to the comparison of an intervention with drug therapy. It was not clear how many reviewers assessed validity. Data extraction Authors of trials in which there was no explicit statement about the absence of deaths were contacted for confirmation of the absence of deaths.

Research paper thumbnail of Cryoballoon ablation under transesophageal echocardiographic guidance in dextrocardia

Hellenic Journal of Cardiology, 2019

Research paper thumbnail of How does T-wave alternans correlate with other clinical parameters including those reflecting autonomic tone? An interim analysis form the EUTrigTreat clinical study

Research paper thumbnail of P2876Repeating non-invasive risk stratification tests improves the prediction of outcomes of ICD patients in the EUTrigTreat study

European Heart Journal, Oct 1, 2019

Research paper thumbnail of P794Sphenopalatine ganglion block as a method to modulate cardiac autonomic tone and suppress premature ventricular beats

Europace, Mar 1, 2018

We report here on the electrophysiology (EP) study of eight patients, who were referred to our ce... more We report here on the electrophysiology (EP) study of eight patients, who were referred to our center due to OT-related premature ventricular contractions (OT-PVC). Using programmed atrial stimulation at the interatrial septum or within the coronary sinus, we show that atrial stimulation was capable to evoke OT-PVCs with an ECGmorphology identical to the clinical PVC. Of note, these PVCs occur after an evident atrial capture (as detected by simultaneous recordings from the coronary sinus and the right ventricle) with a stimulus-to-QRS interval shorter than the normal PQ interval during regular sinus beats. (All selected patients exhibited spontaneous PVCs with a low frequency (1-2 PVC/5 min) during the EP study; hence co-incidental occurrence during atrial stimulation could be excluded). Our findings suggest that unique connections might exist between specific atrial locations and the OTs, the activation of which could result in triggering PVCs from the presumed exit point of these pathways in the OT. This is also supported by previous findings describing discrete pre-potentials before the ventricular electrogram of PVCs at specific locations within the OTs. Remnants of the embryologic AV conduction system (referred to as "dead-end-tract") might serve as preferential pathways, through which the atrial activation wavefront might occasionally "leak out" towards the OT regions to trigger PVCs. Our results could have the potential to transform the current approach of OT-IVAablation, and might introduce a novel strategy of extending mapping into the atrium, to identify/ablate the presumed entry-sites of the "dead-end-tract", through which the arrhythmia can be triggered.

Research paper thumbnail of 218 The role of clinical anxiety in the head up tilt test

Research paper thumbnail of Appropriate Shocks and Mortality in Patients With Versus Without Diabetes With Prophylactic Implantable Cardioverter Defibrillators

Diabetes Care, 2019

OBJECTIVE Diabetes increases the risk of all-cause mortality and sudden cardiac death (SCD). The ... more OBJECTIVE Diabetes increases the risk of all-cause mortality and sudden cardiac death (SCD). The exact mechanisms leading to sudden death in diabetes are not well known. We compared the incidence of appropriate shocks and mortality in patients with versus without diabetes with a prophylactic implantable cardioverter defibrillator (ICD) included in the retrospective EU-CERT-ICD registry. RESEARCH DESIGN AND METHODS AND RESULTS A total of 3,535 patients from 12 European EU-CERT-ICD centers with a mean age of 63.7 ± 11.2 years (82% males) at the time of ICD implantation were included in the analysis. A total of 995 patients (28%) had a history of diabetes. All patients had an ICD implanted for primary SCD prevention. End points were appropriate shock and all-cause mortality. Mean follow-up time was 3.2 ± 2.3 years. Diabetes was associated with a lower risk of appropriate shocks (adjusted hazard ratio [HR] 0.77 [95% CI 0.62–0.96], P = 0.02). However, patients with diabetes had significa...

Research paper thumbnail of Sphenopalatine ganglion block: an external gate to modulate cardiac autonomic tone and suppress premature ventricular beats?

Annals of Translational Medicine, 2018

Background: Autonomic modulation is used for treating various cardiovascular diseases, such as ca... more Background: Autonomic modulation is used for treating various cardiovascular diseases, such as cardiac arrhythmias. Sphenopalatine ganglion (SPG) block is an easy, non-invasive therapy for migraine with a potential cardiovascular impact that remains unclear. In this study, we sought to assess the effect of SPG block on cardiac autonomic tone, as expressed by heart rate variability (HRV), and on ventricular arrhythmogenesis. Methods: Forty patients (14 male and 26 female) suffering from migraine were randomized by 1:1 to SPG block or placebo (controls) and HRV parameters were evaluated 1 hour before and hourly after the intervention. Twenty-four additional patients (11 men and 13 women) with premature ventricular contractions (PVCs) from the right ventricular outflow tract underwent the same randomization and the number of PVCs was assessed during 1 hour before and every hour after treatment. Values were summarized as median (1st-3rd quartile).

Research paper thumbnail of Transthoracic 3D echocardiography used as a low-cost and precise technique to facilitate ablation of ventricular tachycardia from the left posteromedial papillary muscle

Hellenic Journal of Cardiology, 2018

Research paper thumbnail of The Effects of Raloxifene and Simvastatin on Plasma Lipids and Endothelium

Cardiovascular Drugs and Therapy, 2003

Raloxifene is a selective estrogen receptor modulator and an attractive alternative to estrogen r... more Raloxifene is a selective estrogen receptor modulator and an attractive alternative to estrogen replacement as it obviates the need for a progestin and does not increase C-reactive protein levels. We compared the effects of simvastatin and raloxifene treatments on the lipid profile, the levels of adhesion molecules and the endothelium dependent and independent vasoreactivity. We treated 12 postmenopausal women with hypercholesterolemia and coronary artery disease with raloxifene 60 mg/day and simvastatin 20 mg/day in a randomized, double-blind, crossover study. Each treatment period was 8 weeks long with a 4-week washout interval. Plasma lipids and cellular adhesion molecules were evaluated and peripheral blood flow studies with venous occlusion plethysmography were performed. Both simvastatin and raloxifene significantly reduced total [33% (27-40), 12% (0-24)] and LDL [44% (36-52), 16% (0-33)] cholesterol compared to baseline values (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) but simvastatin was more effective than raloxifene (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.005). None of the treatments had any significant effect on HDL cholesterol and triglyceride levels. Only raloxifene significantly reduced Lp(a) [18% (1-36)] and ICAM-1 [17% (8-25)] and VCAM-1 [24% (15-33)] plasma levels compared to baseline (p = 0.019, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001 and p = 0.003, respectively). Hyperemic blood flow response on raloxifene was significantly higher compared to baseline [52% (0-105)], (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05), whereas no significant change was noted on simvastatin. Endothelium independent blood flow induced by nitroglycerine was not influenced by either active treatment. Raloxifene administration is associated with lower ICAM-1, VCAM-1 and Lp(a) plasma levels and enhanced endothelium dependent dilation compared to simvastatin although simvastatin is more powerful in total and LDL cholesterol reduction.

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

International Journal of Cardiology, 2011

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

Research paper thumbnail of 413 Biventricular pacing, coronary blood flow and serum adhesion molecules

Europace, 2005

implantation of a pacemaker and 33 (83,5%) an ICD. 4 patients (10%) died during follow-up, 3 from... more implantation of a pacemaker and 33 (83,5%) an ICD. 4 patients (10%) died during follow-up, 3 from heart failure and 1 from sudden death. 3 patients required heart transplantation due to heart failure. Results:

Research paper thumbnail of Apolipoprotein E ε4 allele as a genetic risk factor for left ventricular failure in homozygous β Thalassemia

Research paper thumbnail of P2915Multivariable risk prediction of appropriate shock and mortality in ICD patients

European Heart Journal, 2018

Research paper thumbnail of Prediction of mortality benefit based on periodic repolarisation dynamics in patients undergoing prophylactic implantation of a defibrillator: a prospective, controlled, multicentre cohort study

The Lancet, 2019

Background A small proportion of patients undergoing primary prophylactic implantation of implant... more Background A small proportion of patients undergoing primary prophylactic implantation of implantable cardioverter defibrillators (ICDs) experiences malignant arrhythmias. We postulated that periodic repolarisation dynamics, a novel marker of sympathetic-activity-associated repolarisation instability, could be used to identify electrically vulnerable patients who would benefit from prophylactic implantation of ICDs by way of a reduction in mortality. Methods We did a prespecified substudy of EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU-CERT-ICD), a prospective, investigator-initiated, non-randomised, controlled cohort study done at 44 centres in 15 EU countries. Patients aged 18 years or older with ischaemic or non-ischaemic cardiomyopathy and reduced left ventricular ejection fraction (≤35%) were eligible for inclusion if they met guideline-based criteria for primary prophylactic implantation of ICDs. Periodic repolarisation dynamics from 24-h Holter recordings were assessed blindly in patients the day before ICD implantation or on the day of study enrolment in patients who were conservatively managed. The primary endpoint was all-cause mortality. Propensity scoring and multivariable models were used to assess the interaction between periodic repolarisation dynamics and the treatment effect of ICDs on mortality.

Research paper thumbnail of Differential multivariable risk prediction of appropriate shock versus competing mortality - A prospective cohort study to estimate benefits from ICD therapy

International journal of cardiology, Jan 28, 2018

We prospectively investigated combinations of risk stratifiers including multiple EP diagnostics ... more We prospectively investigated combinations of risk stratifiers including multiple EP diagnostics in a cohort study of ICD patients. For 672 enrolled patients, we collected history, LVEF, EP study and T-wave alternans testing, 24-h Holter, NT-proBNP, and the eGFR. All-cause mortality and first appropriate ICD shock were predefined endpoints. The 635 patients included in the final analyses were 63 ± 13 years old, 81% were male, LVEF averaged 40 ± 14%, 20% were inducible at EP study, 63% had a primary prophylactic ICD. During follow-up over 4.3 ± 1.5 years, 108 patients died (4.0% per year), and appropriate shock therapy occurred in n = 96 (3.9% per year). In multivariate regression, age (p < 0.001), LVEF (p < 0.001), NYHA functional class (p = 0.007), eGFR (p = 0.024), a history of atrial fibrillation (p = 0.011), and NT-pro-BNP (p = 0.002) were predictors of mortality. LVEF (p = 0.002), inducibility at EP study (p = 0.007), and secondary prophylaxis (p = 0.002) were identified ...