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Article: Cerebral autoregulation and syncope.

Franco Folino, Antonio

2007 Volume 50, Issue 1, Page(s) 49–80

Abstract: Whatever the pathogenesis of syncope is, the ultimate common cause leading to loss of consciousness is insufficient cerebral perfusion with a critical reduction of blood flow to the reticular activating system. Brain circulation has an autoregulation ... ...

Abstract	Whatever the pathogenesis of syncope is, the ultimate common cause leading to loss of consciousness is insufficient cerebral perfusion with a critical reduction of blood flow to the reticular activating system. Brain circulation has an autoregulation system that keeps cerebral blood flow constant over a wide range of systemic blood pressures. Normally, if blood pressure decreases, autoregulation reacts with a reduction in cerebral vascular resistance, in an attempt to prevent cerebral hypoperfusion. However, in some cases, particularly in neurally mediated syncope, it can also be harmful, being actively implicated in a paradox reflex that induces an increase in cerebrovascular resistance and contributes to the critical reduction of cerebral blood flow. This review outlines the anatomic structures involved in cerebral autoregulation, its mechanisms, in normal and pathologic conditions, and the noninvasive neuroimaging techniques used in the study of cerebral circulation and autoregulation. An emphasis is placed on the description of autoregulation pathophysiology in orthostatic and neurally mediated syncope.
MeSH term(s)	Animals ; Autonomic Nervous System/physiopathology ; Cardiovascular Diseases/complications ; Cardiovascular Diseases/pathology ; Cardiovascular Diseases/physiopathology ; Cerebral Arteries/innervation ; Cerebral Arteries/pathology ; Cerebral Arteries/physiopathology ; Cerebrovascular Circulation ; Collateral Circulation ; Diagnostic Imaging/methods ; Homeostasis ; Humans ; Syncope/etiology ; Syncope/pathology ; Syncope/physiopathology ; Syncope, Vasovagal/pathology ; Syncope, Vasovagal/physiopathology
Language	English
Publishing date	2007-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	209312-1
ISSN	1532-8643 ; 1873-1740 ; 0033-0620
ISSN (online)	1532-8643 ; 1873-1740
ISSN	0033-0620
DOI	10.1016/j.pcad.2007.01.001
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Article ; Online: Impact of COVID-19 epidemic on coronary care unit accesses for acute coronary syndrome in Veneto region, Italy.

Folino, Antonio Franco / Zorzi, Alessandro / Cernetti, Carlo / Marchese, Domenico / Pasquetto, Giampaolo / Roncon, Loris / Saccà, Salvatore / Themistoclakis, Sakis / Turiano, Giovanni / Verlato, Roberto / Perazzolo Marra, Martina / Gregori, Dario / Iliceto, Sabino

American heart journal

2020 Volume 226, Page(s) 26–28

MeSH term(s)	Acute Coronary Syndrome/epidemiology ; Air Pollutants/analysis ; Bayes Theorem ; Betacoronavirus ; COVID-19 ; Coronary Care Units/statistics & numerical data ; Coronavirus Infections/epidemiology ; Hospitalization/statistics & numerical data ; Humans ; Italy/epidemiology ; Markov Chains ; Nitrogen Dioxide/analysis ; Non-ST Elevated Myocardial Infarction/epidemiology ; Pandemics ; Patient Acceptance of Health Care/psychology ; Pneumonia, Viral/epidemiology ; SARS-CoV-2 ; ST Elevation Myocardial Infarction/epidemiology
Chemical Substances	Air Pollutants ; Nitrogen Dioxide (S7G510RUBH)
Keywords	covid19
Language	English
Publishing date	2020-05-06
Publishing country	United States
Document type	Letter ; Multicenter Study
ZDB-ID	80026-0
ISSN	1097-6744 ; 0002-8703
ISSN (online)	1097-6744
ISSN	0002-8703
DOI	10.1016/j.ahj.2020.04.021
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Article ; Online: Arrhythmias after tetralogy of fallot repair.

Folino, Antonio Franco / Daliento, Luciano

Indian pacing and electrophysiology journal

2005 Volume 5, Issue 4, Page(s) 312–324

Abstract: Tetralogy of Fallot is the most common cyanotic congenital heart disease, with a good outcome after total surgical correction. In spite of a low perioperative mortality and a good quality of life, late sudden death remains a significant clinical problem, ...

Abstract	Tetralogy of Fallot is the most common cyanotic congenital heart disease, with a good outcome after total surgical correction. In spite of a low perioperative mortality and a good quality of life, late sudden death remains a significant clinical problem, mainly related to episodes of sustained ventricular tachycardia and ventricular fibrillation. Fibro-fatty substitution around infundibular resection, intraventricular septal scar, and patchy myocardial fibrosis, may provide anatomical substrates of abnormal depolarization and repolarization causing reentrant ventricular arrhythmias. Several non-invasive indices based on classical examination such as ECG, signal-averaging ECG, and echocardiography have been proposed to identify patients at high risk of sudden death, with hopeful results. In the last years other more sophisticated invasive and non-invasive tools, such as heart rate variability, electroanatomic mapping and cardiac magnetic resonance added a relevant contribution to risk stratification. Even if each method per se is affected by some limitations, a comprehensive multifactorial clinical and investigative examination can provide an accurate risk evaluation for every patient.
Language	English
Publishing date	2005-10-01
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2123606-9
ISSN	0972-6292 ; 0972-6292
ISSN (online)	0972-6292
ISSN	0972-6292
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Article: Impact of COVID-19 epidemic on coronary care unit accesses for acute coronary syndrome in Veneto region, Italy

Am Heart J

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #186490
Database	COVID19

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Article ; Online: Impact of COVID-19 epidemic on coronary care unit accesses for acute coronary syndrome in Veneto region, Italy

American Heart Journal

2020 Volume 226, Page(s) 26–28

Keywords	Cardiology and Cardiovascular Medicine ; covid19
Language	English
Publisher	Elsevier BV
Publishing country	us
Document type	Article ; Online
ZDB-ID	80026-0
ISSN	1097-6744 ; 0002-8703
ISSN (online)	1097-6744
ISSN	0002-8703
DOI	10.1016/j.ahj.2020.04.021
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Arrhythmias After Tetralogy of Fallot Repair

Antonio Franco Folino / Luciano Daliento

Indian Pacing and Electrophysiology Journal, Vol 5, Iss 4, Pp 312-

2005 Volume 324

Abstract	Tetralogy of Fallot is the most common cyanotic congenital heart disease, with a good outcome after total surgical correction. In spite of a low perioperative mortality and a good quality of life, late sudden death remains a significant clinical problem, mainly related to episodes of sustained ventricular tachycardia and ventricular fibrillation. Fibro-fatty substitution around infundibular resection, intraventricular septal scar, and patchy myocardial fibrosis, may provide anatomical substrates of abnormal depolarization and repolarization causing reentrant ventricular arrhythmias. Several non-invasive indices based on classical examination such as ECG, signal-averaging ECG, and echocardiography have been proposed to identify patients at high risk of sudden death, with hopeful results. In the last years other more sophisticated invasive and non-invasive tools, such as heart rate variability, electroanatomic mapping and cardiac magnetic resonance added a relevant contribution to risk stratification. Even if each method per se is affected by some limitations, a comprehensive multifactorial clinical and investigative examination can provide an accurate risk evaluation for every patient.
Keywords	Tetralogy of Fallot ; surgery ; ventricular arrhythmias ; risk stratification ; Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Cardiovascular ; DOAJ:Medicine (General) ; DOAJ:Health Sciences ; Physiology ; QP1-981 ; Science ; Q ; DOAJ:Physiology ; DOAJ:Biology ; DOAJ:Biology and Life Sciences
Subject code	610
Language	English
Publishing date	2005-10-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Syncope while driving: pathophysiological features and long-term follow-up.

Folino, Antonio Franco / Migliore, Federico / Porta, Alberto / Cerutti, Sergio / Iliceto, Sabino / Buja, Gianfranco

Autonomic neuroscience : basic & clinical

2012 Volume 166, Issue 1-2, Page(s) 60–65

Abstract: Background: Approximately 3% to 10% of patients with syncope experience episodes while driving. The aim of our study was to identify their clinical and pathophysiological features, estimate the incidence of recurrence, and correlate these ... ...

Abstract	Background: Approximately 3% to 10% of patients with syncope experience episodes while driving. The aim of our study was to identify their clinical and pathophysiological features, estimate the incidence of recurrence, and correlate these characteristics with recurrence. Method: We prospectively studied 40 patients who experienced syncope while driving and 50 subjects who experienced syncope in other situations. All cases underwent upright tilt test (UTT), with simultaneous ECG and beat-to-beat blood pressure recordings, to analyze heart rate variability, total peripheral resistance (TPR), and stroke volume (SV). Results: Patients who experienced syncope while driving suffered more frequently from hypertension (40% vs 20%) and vasodepressive reactions during the UTT (52% vs 26%). Moreover, these patients had increased heart rates (p=0.007) and lower SVs (p=0.006) during a positive UTT. TPR rose immediately before symptoms appeared only in patients who suffered from nondriving syncope (p=0.006). During a mean follow-up of 1793±573 days, 8 syncopic patients while driving had recurrences (20%) but never while driving. They were older, experienced more episodes of syncope, and had a higher incidence of vasodepressive reactions during UTT. Conclusions: Our study confirms a good prognosis for patients who experience syncope while driving, and indicates that more accurate risk stratification is needed in subjects aged over 50 years, who have had more than 4 episodes of loss of consciousness and vasodepressive reactions during UTT.
MeSH term(s)	Adult ; Aged ; Automobile Driving ; Autonomic Nervous System Diseases/diagnosis ; Autonomic Nervous System Diseases/etiology ; Autonomic Nervous System Diseases/physiopathology ; Cardiovascular Diseases/diagnosis ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/physiopathology ; Chronic Disease ; Cohort Studies ; Comorbidity/trends ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prospective Studies ; Syncope/diagnosis ; Syncope/epidemiology ; Syncope/physiopathology ; Time
Language	English
Publishing date	2012-01-26
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2020105-9
ISSN	1872-7484 ; 1566-0702
ISSN (online)	1872-7484
ISSN	1566-0702
DOI	10.1016/j.autneu.2011.09.003
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Article ; Online: Urgent Pacemaker Implantation Rates in the Veneto Region of Italy After the COVID-19 Outbreak.

Migliore, Federico / Zorzi, Alessandro / Gregori, Dario / Del Monte, Alvise / Falzone, Pasquale Valerio / Verlato, Roberto / Siciliano, Mariachiara / Themistoclakis, Sakis / China, Paolo / Marchese, Domenico / Pasquetto, Giampaolo / Ignatiuk, Barbara / Cernetti, Carlo / Giacomin, Enrico / Calzolari, Vittorio / Bilato, Claudio / Dalla Valle, Chiara / Frigo, Gianfranco Mario / Marinaccio, Leonardo /

Saccà, Salvatore / Lupo, Antonio / Roncon, Loris / Marcantoni, Lina / Tosi, Alberto / Turiano, Giovanni / Folino, Franco / Perazzolo Marra, Martina / Cacciavillani, Luisa / Iliceto, Sabino

Circulation. Arrhythmia and electrophysiology

2020 Volume 13, Issue 6, Page(s) e008722

MeSH term(s)	Aged ; Aged, 80 and over ; Ambulatory Care/methods ; Betacoronavirus ; Bradycardia/epidemiology ; Bradycardia/etiology ; Bradycardia/therapy ; COVID-19 ; Coronavirus Infections/complications ; Coronavirus Infections/epidemiology ; Female ; Humans ; Incidence ; Italy/epidemiology ; Male ; Pacemaker, Artificial/statistics & numerical data ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/epidemiology ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-05-20
Publishing country	United States
Document type	Letter
ZDB-ID	2426129-4
ISSN	1941-3084 ; 1941-3149
ISSN (online)	1941-3084
ISSN	1941-3149
DOI	10.1161/CIRCEP.120.008722
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Article ; Online: Autonomic modulation and cardiac contractility in vasovagal syncope.

Folino, Antonio Franco / Russo, Giulia / Porta, Alberto / Buja, Gianfranco / Cerutti, Sergio / Iliceto, Sabino

International journal of cardiology

2010 Volume 139, Issue 3, Page(s) 248–253

Abstract: Background: Previous studies proposed as one of the main mechanisms involved in neurally mediated syncope, the stimulation of ventricular mechanoreceptors as the final trigger for vagal discharge.: Objectives: This study aimed to verify the presence ... ...

Abstract	Background: Previous studies proposed as one of the main mechanisms involved in neurally mediated syncope, the stimulation of ventricular mechanoreceptors as the final trigger for vagal discharge. Objectives: This study aimed to verify the presence of a sympathetic driven increase of cardiac contractility before vasovagal syncope. Methods: We studied 23 patients with recurrent syncope. All underwent a 60 ° tilt with pharmacologic challenge (sublingual spray nitrate). Two conditions were used to assess autonomic activity by heart rate variability analysis: in a supine position after 5 min of rest and after 15 min of tilt. Simultaneously, cardiac contractility was quantified by tissue-Doppler echocardiography at the base of the free walls of left ventricle. The peak myocardial velocities during systole (Sw) and late diastole (Aw) were considered. Results: Passive tilt induced a significant increase of the low frequency component (LF) as well as a decrease of the high frequency component (HF) in positive patients (LF: from 49 ± 18 to 65 ± 18 nu, p<0.05; HF: from 41 ± 21 to 26 ± 16 nu, p<0.05). Tissue-Doppler showed a similar increase in Sw in both positive and negative patients but showed a significant decrease of Aw in syncopal subjects (p<0.005). Conclusions: Our results do not show an increase in ventricular contractility before tilt-induced syncope, or in presence of a valuable increase of sympathetic activity. Instead, we observe a reduction of atrial contractility, which may be a contributory component in the pathogenesis of vasovagal syncope.
MeSH term(s)	Adolescent ; Adult ; Aged ; Autonomic Nervous System/physiology ; Echocardiography, Doppler/methods ; Female ; Humans ; Male ; Mechanoreceptors/physiology ; Middle Aged ; Myocardial Contraction/physiology ; Syncope, Vasovagal/diagnosis ; Syncope, Vasovagal/physiopathology ; Tilt-Table Test/methods ; Young Adult
Language	English
Publishing date	2010-03-18
Publishing country	Netherlands
Document type	Comparative Study ; Journal Article
ZDB-ID	779519-1
ISSN	1874-1754 ; 0167-5273
ISSN (online)	1874-1754
ISSN	0167-5273
DOI	10.1016/j.ijcard.2008.10.030
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Article ; Online: Remote follow-up of pacemakers in a selected population of debilitated elderly patients.

Folino, Antonio Franco / Breda, Roberto / Calzavara, Patrizia / Borghetti, Francesca / Comisso, Jennifer / Iliceto, Sabino / Buja, Gianfranco

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology

2013 Volume 15, Issue 3, Page(s) 382–387

Abstract: Aims: The majority of patients with pacemakers are very elderly, many being >85-years old. They often suffer from serious illnesses and have great difficulty in walking. The aim of our study was to compare remote pacemaker monitoring with in-home checks ...

Abstract	Aims: The majority of patients with pacemakers are very elderly, many being >85-years old. They often suffer from serious illnesses and have great difficulty in walking. The aim of our study was to compare remote pacemaker monitoring with in-home checks of pacemakers, in terms of applicability, efficacy, and cost in a selected population of debilitated elderly patients. Methods and results: We selected 72 subjects (mean age 87 ± 8 years) among elderly debilitated patients with Medtronic pacemakers, compatible with the Carelink(®) remote monitoring system (13 patients with DDD pacemaker; 59 patients with single-lead VDD pacemaker). Remote follow-up was compared with in-home checks performed by nurses in 326 patients in similar clinical conditions. A total of 190 transmissions were received by remote monitoring (mean transmissions per month: 7.0; mean per patient: 2.6; range 1-6) during 27 months of follow-up. In this period, seven pacemakers were replaced owing to battery exhaustion, after a mean of 6.7 years from implantation. The occurrence of atrial or ventricular high-rate episodes was reported in 98 transmissions (53%). Nineteen patients died (annual mortality: 11.7%). On comparing the costs borne by the hospital for in-home checks, both for medical personnel and transportation, the estimated average saving was €32 per year per patient. Conclusion: Our study shows that the remote follow-up of pacemakers is a reliable, effective, and cost-saving procedure in elderly, debilitated patients. Moreover, remote controls provided an accurate and early diagnosis of arrhythmia occurrence.
MeSH term(s)	Age Factors ; Aged ; Aged, 80 and over ; Cardiac Pacing, Artificial/economics ; Chi-Square Distribution ; Cost Savings ; Cost-Benefit Analysis ; Electric Power Supplies ; Electrocardiography/economics ; Equipment Design ; Equipment Failure ; Female ; Hospital Costs ; House Calls/economics ; Humans ; Male ; Mobility Limitation ; Pacemaker, Artificial/economics ; Predictive Value of Tests ; Signal Processing, Computer-Assisted ; Telemedicine/economics ; Telemedicine/methods ; Telemetry/economics ; Time Factors
Language	English
Publishing date	2013-03
Publishing country	England
Document type	Comparative Study ; Journal Article
ZDB-ID	1449879-0
ISSN	1532-2092 ; 1099-5129
ISSN (online)	1532-2092
ISSN	1099-5129
DOI	10.1093/europace/eus351
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