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Article ; Online: Active Arrhythmia Pattern: A Novel Predictor of ICD Shocks-A Subanalysis From the PARTITA Study.

Radinovic, Andrea / Giacopelli, Daniele / Bisceglia, Caterina / Paglino, Gabriele / Gargaro, Alessio / Della Bella, Paolo

Circulation. Arrhythmia and electrophysiology

2024 , Page(s) e012523

Abstract: Background: In the PARTITA trial (Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator?), antitachycardia pacing (ATP) predicted the occurrence of implantable cardioverter ... ...

Abstract	Background: In the PARTITA trial (Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator?), antitachycardia pacing (ATP) predicted the occurrence of implantable cardioverter defibrillator (ICD) shocks. Catheter ablation of ventricular tachycardia after the first shock reduced the risk of death or worsening heart failure. A threshold of ATPs that might warrant an ablation procedure before ICD shocks is unknown. Our aim was to identify a threshold of ATPs and clinical features that predict the occurrence of shocks and cardiovascular events. Methods: We analyzed data from 517 patients in phase A of the PARTITA study. We used classification and regression tree analysis to develop and test a risk stratification model based on arrhythmia patterns and clinical data to predict ICD shocks. Secondary end points were worsening heart failure and cardiovascular hospitalization. Results: Classification and regression tree classified patients into 6 leaves by increasing shock probability. Patients treated with ≥5 ATPs in 6 months (active arrhythmia pattern) had the highest risk of ICD shocks (93% and 86%, training and testing samples, respectively). Patients without ATPs had the lowest (1% and 2%). Other predictors included left ventricle ejection fraction<35%, age of <60 years, and obesity. Survival analysis revealed a higher risk of worsening heart failure (hazard ratio, 5.45 [95% CI, 1.62-18.4]; Conclusions: Patients with an active arrhythmia pattern (≥5 ATPs in 6 months) are associated with an increased risk of ICD shocks, as well as heart failure hospitalization and cardiovascular hospitalization. These data suggest that additional treatments may be helpful to this high-risk group as a preventive strategy to reduce the incidence of major events. Further prospective randomized trials are needed to confirm the benefits of early ventricular tachycardia ablation in this setting.
Language	English
Publishing date	2024-05-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2426129-4
ISSN	1941-3084 ; 1941-3149
ISSN (online)	1941-3084
ISSN	1941-3149
DOI	10.1161/CIRCEP.123.012523
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Article: Continuous Electrical Monitoring in Patients with Arrhythmic Myocarditis: Insights from a Referral Center.

Peretto, Giovanni / Mazzone, Patrizio / Paglino, Gabriele / Marzi, Alessandra / Tsitsinakis, Georgios / Rizzo, Stefania / Basso, Cristina / Della Bella, Paolo / Sala, Simone

Journal of clinical medicine

2021 Volume 10, Issue 21

Abstract: Background: The incidence and burden of arrhythmias in myocarditis are under-reported.: Objective: We aimed to assess the diagnostic yield and clinical impact of continuous arrhythmia monitoring (CAM) in patients with arrhythmic myocarditis.: ... ...

Abstract	Background: The incidence and burden of arrhythmias in myocarditis are under-reported. Objective: We aimed to assess the diagnostic yield and clinical impact of continuous arrhythmia monitoring (CAM) in patients with arrhythmic myocarditis. Methods: We enrolled consecutive adult patients ( Results: By 3.7 ± 1.6 year follow up, 45 patients (43%) had VT, 67 (64%) NSVT and 102 (98%) premature ventricular complexes (PVC). As compared to the Holter ECG (average 9.5 exams per patient), CAM identified more patients with VA (VT: 45 vs. 4; NSVT: 64 vs. 45; both Conclusion: In patients with arrhythmic myocarditis, CAM allowed accurate arrhythmia detection and showed a considerable clinical impact.
Language	English
Publishing date	2021-11-01
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm10215142
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Article ; Online: The PhysioVP-AF study, a randomized controlled trial to assess the clinical benefit of physiological ventricular pacing vs. managed ventricular pacing for persistent atrial fibrillation prevention in patients with prolonged atrioventricular conduction: design and rationale.

Pastore, Gianni / Bertini, Matteo / Bonanno, Carlo / Coluccia, Giovanni / Dell'Era, Gabriele / De Mattia, Luca / Grieco, Domenico / Katsouras, Grigorius / Maines, Massimiliano / Marcantoni, Lina / Marinaccio, Leonardo / Paglino, Gabriele / Palmisano, Pietro / Ziacchi, Matteo / Zoppo, Franco / Noventa, Franco

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

2023 Volume 25, Issue 5

Abstract: Aims: In patients with prolonged atrioventricular (AV) conduction and pacemaker (PM) indication due to sinus node disease (SND) or intermittent AV-block who do not need continuous ventricular pacing (VP), it may be difficult to determine which strategy ... ...

Abstract	Aims: In patients with prolonged atrioventricular (AV) conduction and pacemaker (PM) indication due to sinus node disease (SND) or intermittent AV-block who do not need continuous ventricular pacing (VP), it may be difficult to determine which strategy to adopt. Currently, the standard of care is to minimize unnecessary VP by specific VP avoidance (VPA) algorithms. The superiority of this strategy over standard DDD or DDD rate-responsive (DDD/DDDR) in improving clinical outcomes is controversial, probably owing to the prolongation of the atrialventricular conduction (PR interval) caused by the algorithms. Conduction system pacing (CSP) may offer the most physiological-VP approach, providing appropriate AV conduction and preventing pacing-induced dyssynchrony. Methods and results: PhysioVP-AF is a prospective, controlled, randomized, single-blind trial designed to determine whether atrial-synchronized conduction system pacing (DDD-CSP) is superior to standard DDD-VPA pacing in terms of 3-year reduction of persistent-AF occurrence. Cardiovascular hospitalization, quality-of-life, and safety will be evaluated. Patients with indication for permanent DDD pacing for SND or intermittent AV-block and prolonged AV conduction (PR interval > 180 ms) will be randomized (1:1 ratio) to DDD-VPA (VPA-algorithms ON, septal/apex position) or to DDD-CSP (His bundle or left bundle branch area pacing, AV-delay setting to control PR interval, VPA-algorithms OFF). Approximately 400 patients will be randomized in 24 months in 13 Italian centres. Conclusion: The PhysioVP-AF study will provide an essential contribution to patient management with prolonged AV conduction and PM indication for sinus nodal disease or paroxysmal 2nd-degree AV-block by determining whether CSP combined with a controlled PR interval is superior to standard management that minimizes unnecessary VP in terms of reducing clinical outcomes.
MeSH term(s)	Humans ; Atrial Fibrillation/complications ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/therapy ; Cardiac Pacing, Artificial/adverse effects ; Cardiac Pacing, Artificial/methods ; Prospective Studies ; Single-Blind Method ; Pacemaker, Artificial ; Atrioventricular Block ; Sick Sinus Syndrome/complications ; Sick Sinus Syndrome/diagnosis ; Sick Sinus Syndrome/therapy
Language	English
Publishing date	2023-03-27
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	1449879-0
ISSN	1532-2092 ; 1099-5129
ISSN (online)	1532-2092
ISSN	1099-5129
DOI	10.1093/europace/euad082
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Article: Step by Step through the Years-High vs. Low Energy Lead Extraction Using Advanced Extraction Techniques.

Zweiker, David / El Sawaf, Basma / D'Angelo, Giuseppe / Radinovic, Andrea / Marzi, Alessandra / Limite, Luca R / Frontera, Antonio / Paglino, Gabriele / Spartalis, Michael / Zachariah, Donah / Nakajima, Kenzaburo / Della Bella, Paolo / Mazzone, Patrizio

Journal of clinical medicine

2022 Volume 11, Issue 16

Abstract: Background: Limited data is available about the outcome of TLE in patients with vs. without high energy leads in the last decade. Methods: This is an analysis of consecutive patients undergoing TLE at a high-volume TLE centre from 2001 to 2021 using the ... ...

Abstract	Background: Limited data is available about the outcome of TLE in patients with vs. without high energy leads in the last decade. Methods: This is an analysis of consecutive patients undergoing TLE at a high-volume TLE centre from 2001 to 2021 using the stepwise approach. Baseline characteristics, procedural details and outcome of patients with high energy lead (ICD group) vs. without high energy lead (non-ICD group) were compared. Results: Out of 667 extractions, 991 leads were extracted in 405 procedures (60.7%) in the ICD group and 439 leads in 262 procedures (39.3%) in the non-ICD group. ICD patients were significantly younger (median 67 vs. 74 years) and were significantly less often female (18.1% vs. 27.7%, p < 0.005 for both). Advanced extraction tools were used significantly more often in the ICD group (73.2% vs. 37.5%, p < 0.001), but there were no significant differences in the successful removal (98.8% vs. 99.2%) or complications (4.7% vs. 3.1%) between the groups (p > 0.2 for both). Discussion: Using the stepwise approach, overall procedural success was high and complication rate was low in a high-volume centre. In patients with a high energy lead, the TLE procedure was more complex, but outcome was similar to comparator patients.
Language	English
Publishing date	2022-08-19
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11164884
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Article ; Online: Use of Cerebral Protection Device in Patients Undergoing Ventricular Tachycardia Catheter Ablation.

Zachariah, Donah / Limite, Luca Rosario / Mazzone, Patrizio / Marzi, Alessandra / Radinovic, Andrea / Baratto, Francesca / Italia, Leonardo / Ancona, Francesco / Paglino, Gabriele / Della Bella, Paolo

JACC. Clinical electrophysiology

2022 Volume 8, Issue 4, Page(s) 528–530

MeSH term(s)	Catheter Ablation/adverse effects ; Humans ; Tachycardia, Ventricular
Language	English
Publishing date	2022-02-23
Publishing country	United States
Document type	Letter
ZDB-ID	2846739-5
ISSN	2405-5018 ; 2405-500X ; 2405-500X
ISSN (online)	2405-5018 ; 2405-500X
ISSN	2405-500X
DOI	10.1016/j.jacep.2022.01.001
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Article: Use of the new rotating dilator sheath TightRail™ for lead extraction: A bicentric experience.

Mazzone, Patrizio / Melillo, Francesco / Radinovic, Andrea / Marzi, Alessandra / Paglino, Gabriele / Della Bella, Paolo / Mascioli, Giosuè

Journal of arrhythmia

2020 Volume 36, Issue 2, Page(s) 343–350

Abstract: Aim: The aim of this study is to assess the safety and efficacy of the new bidirectional rotational mechanical sheath TightRail™ (Spectranetics) for lead extraction.: Methods and results: This is a bicentric prospective study that included patients ... ...

Abstract	Aim: The aim of this study is to assess the safety and efficacy of the new bidirectional rotational mechanical sheath TightRail™ (Spectranetics) for lead extraction. Methods and results: This is a bicentric prospective study that included patients who underwent a transvenous lead extraction (TLE) in two Italian centers (San Raffaele Hospital and Humanitas Gavazzeni Hospital). From November 2016 to December 2018, 26 patients underwent a TLE procedure in which the TightRail™ was used. The new TightRail Sub-C was used in 20 (76%) patients to overcome the fibrosis between the vessel and the first rib. Median age was 69 (IQR 60.7-79.5) years. The indication for TLE were infection (57.7%) or lead dysfunction (42.3%). A total of 57 leads (range 1-4), 40 of which using the TightRail (range 1-4), were extracted. Overall mean implant duration was 98.2.0 ± 66.5 months. Mean age of the lead extracted with the TightRail sheath was 99.1 ± 70.2 months and was higher compared to that of the leads extracted manually (84.4 ± 60.3 months, Conclusion: This initial experience using the TightRail™ suggests a high safety and efficacy profile for extractions in a wide range of lead age.
Language	English
Publishing date	2020-02-14
Publishing country	Japan
Document type	Journal Article
ZDB-ID	2696593-8
ISSN	1883-2148 ; 1880-4276
ISSN (online)	1883-2148
ISSN	1880-4276
DOI	10.1002/joa3.12310
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Article: Long-Term Follow-Up of Catheter Ablation for Premature Ventricular Complexes in the Modern Era: The Importance of Localization and Substrate.

Gulletta, Simone / Gasperetti, Alessio / Schiavone, Marco / Paglino, Gabriele / Vergara, Pasquale / Compagnucci, Paolo / Bisceglia, Caterina / Cireddu, Manuela / Fierro, Nicolai / D'Angelo, Giuseppe / Sala, Simone / Rampa, Lorenzo / Casella, Michela / Mazzone, Patrizio / Dello Russo, Antonio / Forleo, Giovanni Battista / Della Bella, Paolo

Journal of clinical medicine

2022 Volume 11, Issue 21

Abstract: Background: Large-scale studies evaluating long-term recurrence rates in both idiopathic and non-idiopathic PVC catheter ablation (CA) patients have not been reported. Objective: To evaluate the efficacy and safety of idiopathic and non-idiopathic PVC CA, ...

Abstract	Background: Large-scale studies evaluating long-term recurrence rates in both idiopathic and non-idiopathic PVC catheter ablation (CA) patients have not been reported. Objective: To evaluate the efficacy and safety of idiopathic and non-idiopathic PVC CA, investigating the predictors of acute and long-term efficacy. Methods: This retrospective multicentric study included 439 patients who underwent PVC CA at three institutions from April-2015 to December-2021. Clinical success at 6 months’ follow-up, defined as a reduction of at least 80% of the pre-procedural PVC burden, was deemed the primary outcome. The secondary aims of the study were: clinical success at the last available follow-up, predictors of arrhythmic recurrences at long-term follow-up, and safety outcomes. Results: The median age was 51 years, with 24.9% patients being affected suffering from structural heart disease. The median pre-procedural PVC burden was 20.1%. PVCs originating from the RVOT were the most common index PVC observed (29.1%), followed by coronary cusp (CC) and non-outflow tract (OT) LV PVCs (23.1% and 19.0%). The primary outcome at 6 months was reached in 85.1% cases, with a significant reduction in the 24 h% PVC burden (−91.4% [−83.4; −96.7], p < 0.001); long-term efficacy was observed in 82.1% of cases at almost 3-year follow-up. The presence of underlying structural heart disease and non-OT LV region origin (aHR 1.77 [1.07−2.93], p = 0.027 and aHR = 1.96 [1.22−3.14], p = 0.005) was independently associated with recurrences. Conclusion: CA of both idiopathic and non-idiopathic PVCs showed a very good acute and long-term procedural success rate, with an overall low complication. Predictors of arrhythmic recurrence at follow-up were underlying structural heart disease and non-OT LV origin.
Language	English
Publishing date	2022-11-06
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11216583
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Article: Patients with Cardiac Implantable Electronic Device Undergoing Radiation Therapy: Insights from a Ten-Year Tertiary Center Experience.

Gulletta, Simone / Falasconi, Giulio / Cianfanelli, Lorenzo / Centola, Alice / Paglino, Gabriele / Cireddu, Manuela / Radinovic, Andrea / D'Angelo, Giuseppe / Marzi, Alessandra / Sala, Simone / Fierro, Nicolai / Bisceglia, Caterina / Peretto, Giovanni / Di Muzio, Nadia / Della Bella, Paolo / Vergara, Pasquale / Dell'Oca, Italo

Journal of clinical medicine

2022 Volume 11, Issue 17

Abstract: Background: The number of patients with cardiac implantable electronic devices (CIEDs) receiving radiotherapy (RT) is increasing. The management of CIED-carriers undergoing RT is challenging and requires a collaborative multidisciplinary approach.: ... ...

Abstract	Background: The number of patients with cardiac implantable electronic devices (CIEDs) receiving radiotherapy (RT) is increasing. The management of CIED-carriers undergoing RT is challenging and requires a collaborative multidisciplinary approach. Aim: The aim of the study is to report the real-world, ten-year experience of a tertiary multidisciplinary teaching hospital. Methods: We conducted an observational, real-world, retrospective, single-center study, enrolling all CIED-carriers who underwent RT at the San Raffaele University Hospital, between June 2010 and December 2021. All devices were MRI-conditional. The devices were programmed to an asynchronous pacing mode for patients who had an intrinsic heart rate of less than 40 beats per minute. An inhibited pacing mode was used for all other patients. All tachyarrhythmia device functions were temporarily disabled. After each RT session, the CIED were reprogrammed to the original settings. Outcomes included adverse events and changes in the variables that indicate lead and device functions. Results: Between June 2010 and December 2021, 107 patients were enrolled, among which 63 (58.9%) were pacemaker carriers and 44 (41.1%) were ICD carriers. Patients were subjected to a mean of 16.4 (±10.7) RT sessions. The most represented tumors in our cohort were prostate cancer (12; 11%), breast cancer (10; 9%) and lung cancer (28; 26%). No statistically significant changes in device parameters were recorded before and after radiotherapy. Generator failures, power-on resets, changes in pacing threshold or sensing requiring system revision or programming changes, battery depletions, pacing inhibitions and inappropriate therapies did not occur in our cohort of patients during a ten-year time span period. Atrial arrhythmias were recorded during RT session in 14 patients (13.1%) and ventricular arrhythmias were observed at device interrogation in 10 patients (9.9%). Conclusions: Changes in device parameters and arrhythmia occurrence were infrequent, and none resulted in a clinically significant adverse event.
Language	English
Publishing date	2022-08-25
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11174990
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Article ; Online: Grid Mapping Catheter for Ventricular Tachycardia Ablation.

Okubo, Kenji / Frontera, Antonio / Bisceglia, Caterina / Paglino, Gabriele / Radinovic, Andrea / Foppoli, Luca / Calore, Federico / Della Bella, Paolo

Circulation. Arrhythmia and electrophysiology

2019 Volume 12, Issue 9, Page(s) e007500

Abstract: Background: A new grid mapping catheter (GMC)-allowing for bipolar recordings of the electrograms in each orthogonal direction-became available. The aim of the current study is to evaluate the utility of the GMC in creating substrate and ventricular ... ...

Abstract	Background: A new grid mapping catheter (GMC)-allowing for bipolar recordings of the electrograms in each orthogonal direction-became available. The aim of the current study is to evaluate the utility of the GMC in creating substrate and ventricular tachycardia (VT) activation maps during VT ablation procedures. Methods: From December 2017 to July 2018, 41 consecutive patients undergoing a VT ablation procedure using a GMC were studied. During the substrate mapping, 3 different maps were created using the 3 GMC bipolar configurations (along the spline, across the spline, HD wave solution); the low voltage area and late potential areas were compared. In case of inducible VTs, the GMC was used to create the VT activation maps focusing on the diastolic interval. The relation between diastolic activities during VT and substrate abnormality during sinus rhythm was also investigated. Results: The median low-voltage area drawn by the HD wave configuration was 28.9 cm Conclusions: The GMC is a useful tool for performing substrate and VT activation mappings during the VT ablation procedure, precisely identifying the low-voltage areas and quickly visualizing the diastolic pathways.
MeSH term(s)	Aged ; Body Surface Potential Mapping/instrumentation ; Catheter Ablation/methods ; Catheters ; Equipment Design ; Female ; Follow-Up Studies ; Humans ; Male ; Reproducibility of Results ; Retrospective Studies ; Tachycardia, Ventricular/physiopathology ; Tachycardia, Ventricular/surgery
Language	English
Publishing date	2019-09-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2426129-4
ISSN	1941-3084 ; 1941-3149
ISSN (online)	1941-3084
ISSN	1941-3149
DOI	10.1161/CIRCEP.119.007500
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Working on the dirty side-the ipsilateral subclavian access for temporary pacing after lead extraction.

Zweiker, David / Melillo, Francesco / D'Angelo, Giuseppe / Radinovic, Andrea / Marzi, Alessandra / Cianfanelli, Lorenzo / Altizio, Savino / Limite, Luca R / Paglino, Gabriele / Frontera, Antonio / Nakajima, Kenzaburo / Brugliera, Luigia / Malatino, Lorenzo / Della Bella, Paolo / Mazzone, Patrizio

Journal of arrhythmia

2022 Volume 38, Issue 2, Page(s) 192–198

Abstract: Background: Temporary pacing is necessary in pacemaker-dependent patients after transvenous lead extraction (TLE) for cardiac implantable electronic device infection. In case of unavailability of other accesses, we propose to use the ipsilateral ... ...

Abstract	Background: Temporary pacing is necessary in pacemaker-dependent patients after transvenous lead extraction (TLE) for cardiac implantable electronic device infection. In case of unavailability of other accesses, we propose to use the ipsilateral subclavian access (ISA) combined with a standard permanent active fixation lead for the temporary pacemaker and present preliminary data. Methods: We consecutively enrolled patients undergoing TLE who received a temporary pacemaker using the ISA between August 2016 and April 2020 at our centre. Results: During the observation period, 36 patients undergoing TLE for pocket infection (72.2%), endocarditis (25.0%) or other causes received a temporary pacemaker over the ISA. Their mean age was 77.0 ± 10.7 years, and 13.9% were female. Complete TLE was achieved in 94.4%. There were no major periprocedural complications. Intra-hospital mortality was 11.1%. Pocket revision was performed in 19.4%. During long-term follow-up (23 ± 13 months), 8.3% had a relapse of local pocket infection and 2.8% needed rehospitalization for reintervention. Conclusions: Temporary pacing using a standard permanent active fixation lead using the ISA is a convenient alternative to conventional venous accesses. However, risks of implanting a lead into a previously infected area have to be taken into account.
Language	English
Publishing date	2022-02-04
Publishing country	Japan
Document type	Journal Article
ZDB-ID	2696593-8
ISSN	1883-2148 ; 1880-4276
ISSN (online)	1883-2148
ISSN	1880-4276
DOI	10.1002/joa3.12677
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