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Papers by Salvatore d'Ascia

Expert Review of Cardiovascular Therapy, 2013

Antiarrhythmic drugs (AADs) are often used after ablation for atrial fibrillation (AF); the drugs... more Antiarrhythmic drugs (AADs) are often used after ablation for atrial fibrillation (AF); the drugs employed vary, but most common are the drugs that were unsuccessful prior to ablation since it seems that the efficacy of AADs might substantially increase after catheter ablation of AF. AADs reduce early recurrences of atrial tachyarrhythmias after AF catheter ablation, whereas they did not prevent arrhythmia recurrences occurring later. Several upstream therapies (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statins, corticosteroids and colchicine) have been tested with conflicting results. To date, there is no sufficient evidence to support the use of any upstream therapy after AF catheter ablation. Larger registries and controlled clinical trials in well-defined patient groups and with well-defined outcome parameters are required to further elucidate the role of AADs after AF ablation.

The Journal of Heart and Lung Transplantation, 2021

Finding reliable parameters to identify patients with heart failure (HF) that will respond to car... more Finding reliable parameters to identify patients with heart failure (HF) that will respond to cardiac resynchronization therapy (CRT) represents a major challenge. We and others have observed post-translational modifications of Ryanodine Receptor (RyR) in several tissues (including skeletal muscle and circulating lymphocytes) of patients with advanced HF. We designed a prospective study to test the hypothesis that RyR1 glycation in circulating lymphocytes could predict CRT responsiveness in patients with non-ischemic HF. We enrolled 94 patients who underwent CRT and 30 individuals without HF, examining RyR1 glycation in peripheral lymphocytes at enrollment and after 1 year. We found that baseline RyR1 glycation independently predicts CRT response at 1 year after adjusting for age, diabetes, QRS duration and morphology, echocardiographic dyssynchrony, and hypertension. Moreover, RyR1 glycation in circulating lymphocytes significantly correlated with pathologic intracellular calcium leak. Taken together,

We observed a patient with syncope, who implanted a pacemaker with advanced algorithms such as “a... more We observed a patient with syncope, who implanted a pacemaker with advanced algorithms such as “atrial-tachy response” and “dynamic atrio-ventricular delay”. After one year, conventional ECG Holter showed pacemaker malfunction, wrongly attributed to exposure to electromagnetic field. In fact, telemetry revealed an inappropriate programming and solved our case. Holter monitoring is commonly performed in the evaluation of pacemaker malfunction, albeit it remains a quite shallow diagnostic method especially to detect electromagnetic interferences. New algorithms seem important, but it is reasonable to obtain more suitable analytical tools, too. © 2008 Elsevier Ireland Ltd. All rights reserved.

Circulation, 2020

Introduction: Cardiac resynchronization therapy (CRT) is an effective treatment for patients with... more Introduction: Cardiac resynchronization therapy (CRT) is an effective treatment for patients with advanced heart failure (HF). The management of these patients depends on biomarkers for monitoring disease progression and therapeutic response. HF patients exhibit a pathologic remodeling of Ryanodine Receptors (RyRs) in heart, muscle, as well as circulating lymphocytes, leading to intracellular calcium leak, which has been shown to correlate with the clinical outcome. Hypotheses: 1) post-translational modifications of RyR in circulating lymphocytes in HF patients can predict CRT response; 2) CRT can improve the remodeling of RyRs and intracellular calcium leak. Methods: To test this hypothesis, we enrolled 34 patients who underwent CRT and examined RyR remodeling in peripheral lymphocytes before and 1 year after CRT using established biochemical and flow-cytometry assays. Non-responders to CRT were defined after 1 year of follow-up as patients with at least one of the following charac...

The Journal of clinical investigation, Jan 6, 2015

The type 2 ryanodine receptor (RyR2) is a Ca2+ release channel on the endoplasmic reticulum (ER) ... more The type 2 ryanodine receptor (RyR2) is a Ca2+ release channel on the endoplasmic reticulum (ER) of several types of cells, including cardiomyocytes and pancreatic β cells. In cardiomyocytes, RyR2-dependent Ca2+ release is critical for excitation-contraction coupling; however, a functional role for RyR2 in β cell insulin secretion and diabetes mellitus remains controversial. Here, we took advantage of rare RyR2 mutations that were identified in patients with a genetic form of exercise-induced sudden death (catecholaminergic polymorphic ventricular tachycardia [CPVT]). As these mutations result in a "leaky" RyR2 channel, we exploited them to assess RyR2 channel function in β cell dynamics. We discovered that CPVT patients with mutant leaky RyR2 present with glucose intolerance, which was heretofore unappreciated. In mice, transgenic expression of CPVT-associated RyR2 resulted in impaired glucose homeostasis, and an in-depth evaluation of pancreatic islets and β cells from t...

Nature Precedings, 2012

Albeit several studies examined the association between cardiac resynchronization therapy (CRT) a... more Albeit several studies examined the association between cardiac resynchronization therapy (CRT) and atrial fibrillation (AF) in heart failure (HF), results are still unclear and quite conflicting. We thereby designed a single-center prospective study to determine whether CRT has a favorable effect on the incidence of new-onset AF in a homogeneous population of patients with non-ischemic idiopathic dilated cardiomyopathy and severe heart failure HF. We enrolled 58 patients, AF naïve when received CRT. After 1 year of follow-up our population was subdivided into responders (72.4%) and non (27.6%), so to compare the incidence of AF after 1, 2 and 3 years of follow-up in these two groups. Already after 1 year, there is a significant (p<0.05) difference in new-onset AF in non-responder patients respect to responders (18.2% vs 3.3%). These data are confirmed at 2 year (33.3% vs 12.2%) and 3 year (50.0% vs 15.0%) follow-up. In particular, at 3 year follow-up, non-responders have an incr...

JACC: Cardiovascular Imaging, 2012

International Journal of Clinical Practice, 2011

International Journal of Cardiology, 2010

We observed a patient with syncope, who implanted a pacemaker with advanced algorithms such as "a... more We observed a patient with syncope, who implanted a pacemaker with advanced algorithms such as "atrial-tachy response" and "dynamic atrio-ventricular delay". After one year, conventional ECG Holter showed pacemaker malfunction, wrongly attributed to exposure to electromagnetic field. In fact, telemetry revealed an inappropriate programming and solved our case. Holter monitoring is commonly performed in the evaluation of pacemaker malfunction, albeit it remains a quite shallow diagnostic method especially to detect electromagnetic interferences. New algorithms seem important, but it is reasonable to obtain more suitable analytical tools, too.

Cardiovascular Revascularization Medicine, 2011

Canadian Journal of Cardiology, 2012

American Heart Journal, 2012

Regarding the impact of left ventricular size on response to cardiac resynchronization therapy We... more Regarding the impact of left ventricular size on response to cardiac resynchronization therapy We read with interest the report by Rickard et al 1 in a recent issue of the journal regarding the impact of left ventricular size on response to cardiac resynchronization therapy (CRT). In this study, the effect of CRT is clearly analyzed in 668 patients with nondilated and severely dilated cardiomyopathy, 2 underrepresented categories in the medical literature. The authors show a significant improvement of cardiac function after CRT in these subjects. We have 2 main concerns. First, the role of the different etiology of the cardiomyopathy (ischemic vs nonischemic) on the reverse ventricular remodeling is not well addressed. Given the recent findings about this issue, 2-5 an analysis in a large cohort of subjects 1 could be of keen relevance to the reader. Second, prior studies have yielded inconsistent results regarding the effect of CRT on the incidence of atrial fibrillation (AF) in patients with heart failure. 3 , 6-9 In the study by Rickard et al, the development of AF in the studied groups remains quite unclear. There is a higher incidence of AF in nondilated patients compared with the other groups, but the authors do not present data concerning the relation between CRT and AF. We believe that this information may be remarkable, especially because the authors have a large follow-up subgroup (471 subjects) also with echocardiographic records.

Pacing and Clinical Electrophysiology, 2013

Perisinusal atrial tachycardia may represent a challenging situation due to unsustained burst cha... more Perisinusal atrial tachycardia may represent a challenging situation due to unsustained burst characterizing the arrhythmia, sensitivity to bumping, and potential complications including sinus node ablation. This case describes the use of a noncontact mapping system to map and ablates this arrhythmia. Benefit of this technology is described. (PACE 2011;1-4) ablation, mapping, new technology, SVT Case Presentation A 27-year-old woman was referred to our center for a long history of palpitations during exercise and one recent syncope. The features of palpitation were more compatible with atrial tachycardia (AT) or inappropriate sinus tachycardia than with paroxysmal supraventricular tachycardia. The echocardiogram showed normal findings, except for a trivial mitral regurgitation. Blood exams were normal including thyroid hormones. The 24-hour Holter monitoring revealed frequent episodes of sustained and unsustained AT. P-wave axis was almost the same as during normal sinus rhythm. The patient was then admitted to the hospital for an electrophysiologic study. Mapping and Ablation Propafenone was interrupted 7 days prior to ablation. Surface electrocardiogram and bipolar endocardial electrograms were continuously monitored and stored on a computer-based digital amplifier/recorder system. Intracardiac electrograms were filtered from 30 to 500 Hz. Four quadripolar catheters were introduced via the right femoral vein and the left subclavian vein for electrophysiologic study and placed in the proximal coronary sinus, right ventricle, atrioventricular (AV) node-His region (HBE), and right atrial appendage (RAA) mouth. Conflict of Interest Statement: Giuseppe Augello received minor lecture fees from Biosense Webster and Saint Jude Medical.