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Article ; Online: Will the blooming of artificial intelligence modify our approach to atrial fibrillation cure?

Sciarra, Luigi / Scarà, Antonio

Journal of cardiovascular electrophysiology

2023 Volume 34, Issue 5, Page(s) 1175–1176

MeSH term(s)	Humans ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/surgery ; Artificial Intelligence ; Catheter Ablation
Language	English
Publishing date	2023-04-13
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	1025989-2
ISSN	1540-8167 ; 1045-3873
ISSN (online)	1540-8167
ISSN	1045-3873
DOI	10.1111/jce.15907
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Zs.A 2863: Show issues

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Article ; Online: CPVT and Complete Atrio-Ventricular Block: The Flipside of the Same Coin.

Petrungaro, Mattia / Scarà, Antonio / Borrelli, Alessio / Sciarra, Luigi

Journal of cardiovascular development and disease

2023 Volume 10, Issue 3

Abstract: Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) is a rare electrical genetic disease characterized by ventricular polymorphic tachycardia and/or bidirectional ventricular tachycardia induced by the release of catecholamines caused by intense ...

Abstract	Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) is a rare electrical genetic disease characterized by ventricular polymorphic tachycardia and/or bidirectional ventricular tachycardia induced by the release of catecholamines caused by intense physical or emotional stress in structurally normal hearts. Mostly, it is caused by mutations in genes that are involved in calcium homeostasis, in particular in the gene encoding for cardiac ryanodine receptor (RyR2). Our observation is the first description of familial CPVT caused by mutation of the RyR2 gene, linked to the complete AV block.
Language	English
Publishing date	2023-02-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2777082-5
ISSN	2308-3425 ; 2308-3425
ISSN (online)	2308-3425
ISSN	2308-3425
DOI	10.3390/jcdd10030097
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Article ; Online: Non-Pharmacological Treatment of Heart Failure-From Physical Activity to Electrical Therapies: A Literature Review.

Scarà, Antonio / Palamà, Zefferino / Robles, Antonio Gianluca / Dei, Lorenzo-Lupo / Borrelli, Alessio / Zanin, Federico / Pignalosa, Leonardo / Romano, Silvio / Sciarra, Luigi

Journal of cardiovascular development and disease

2024 Volume 11, Issue 4

Abstract: Heart failure (HF) represents a significant global health challenge that is still responsible for increasing morbidity and mortality despite advancements in pharmacological treatments. This review investigates the effectiveness of non-pharmacological ... ...

Abstract	Heart failure (HF) represents a significant global health challenge that is still responsible for increasing morbidity and mortality despite advancements in pharmacological treatments. This review investigates the effectiveness of non-pharmacological interventions in the management of HF, examining lifestyle measures, physical activity, and the role of some electrical therapies such as catheter ablation, cardiac resynchronization therapy (CRT), and cardiac contractility modulation (CCM). Structured exercise training is a cornerstone in this field, demonstrating terrific improvements in functional status, quality of life, and mortality risk reduction, particularly in patients with HF with reduced ejection fraction (HFrEF). Catheter ablation for atrial fibrillation, premature ventricular beats, and ventricular tachycardia aids in improving left ventricular function by reducing arrhythmic burden. CRT remains a key intervention for selected HF patients, helping achieve left ventricular reverse remodeling and improving symptoms. Additionally, the emerging therapy of CCM provides a novel opportunity for patients who do not meet CRT criteria or are non-responders. Integrating non-pharmacological interventions such as digital health alongside specific medications is key for optimizing outcomes in HF management. It is imperative to tailor approaches to individual patients in this diverse patient population to maximize benefits. Further research is warranted to improve treatment strategies and enhance patient outcomes in HF management.
Language	English
Publishing date	2024-04-17
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2777082-5
ISSN	2308-3425 ; 2308-3425
ISSN (online)	2308-3425
ISSN	2308-3425
DOI	10.3390/jcdd11040122
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Article ; Online: Long-Term Sports Practice and Atrial Fibrillation: An Updated Review of a Complex Relationship.

Petrungaro, Mattia / Fusco, Liuba / Cavarretta, Elena / Scarà, Antonio / Borrelli, Alessio / Romano, Silvio / Petroni, Renata / D'Ascenzi, Flavio / Sciarra, Luigi

Journal of cardiovascular development and disease

2023 Volume 10, Issue 5

Abstract: Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice, and it is an enormous burden worldwide because of its high morbidity, disability and mortality. It is generally acknowledged that physical activity (PA) is strongly ... ...

Abstract	Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice, and it is an enormous burden worldwide because of its high morbidity, disability and mortality. It is generally acknowledged that physical activity (PA) is strongly associated with a significant reduction in the risk of cardiovascular (CV) disease and all-cause mortality. Moreover, it has been observed that moderate and regular physical activity has the potential to reduce the risk of AF, in addition to improving overall well-being. Nevertheless, some studies have associated intense physical activity with an increased risk of AF. This paper aims to review the main related literature to investigate the association between PA and AF incidence and draw pathophysiological and epidemiological conclusions.
Language	English
Publishing date	2023-05-16
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2777082-5
ISSN	2308-3425 ; 2308-3425
ISSN (online)	2308-3425
ISSN	2308-3425
DOI	10.3390/jcdd10050218
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Article ; Online: Electrocardiographic predictors of left ventricular scar in athletes with right bundle branch block premature ventricular beats.

Sciarra, Luigi / Golia, Paolo / Scarà, Antonio / Robles, Antonio Gianluca / De Maio, Melissa / Palamà, Zefferino / Borrelli, Alessio / Di Roma, Mauro / D'Arielli, Alberto / Calò, Leonardo / Gallina, Sabina / Ricci, Fabrizio / Delise, Pietro / Zorzi, Alessandro / Nesti, Martina / Romano, Silvio / Cavarretta, Elena

European journal of preventive cardiology

2024 Volume 31, Issue 4, Page(s) 486–495

Abstract: Aims: Right bundle branch block (RBBB) morphology non-sustained ventricular arrhythmias (VAs) have been associated with the presence of non-ischaemic left ventricular scar (NLVS) in athletes. The aim of this cross-sectional study was to identify ... ...

Abstract	Aims: Right bundle branch block (RBBB) morphology non-sustained ventricular arrhythmias (VAs) have been associated with the presence of non-ischaemic left ventricular scar (NLVS) in athletes. The aim of this cross-sectional study was to identify clinical and electrocardiogram (ECG) predictors of the presence of NLVS in athletes with RBBB VAs. Methods and results: Sixty-four athletes [median age 39 (24-53) years, 79% males] with non-sustained RBBB VAs underwent cardiac magnetic resonance (CMR) with late gadolinium enhancement in order to exclude the presence of a concealed structural heart disease. Thirty-six athletes (56%) showed NLVS at CMR and were assigned to the NLVS positive group, whereas 28 athletes (44%) to the NLVS negative group. Family history of cardiomyopathy and seven different ECG variables were statistically more prevalent in the NLVS positive group. At univariate analysis, seven ECG variables (low QRS voltages in limb leads, negative T waves in inferior leads, negative T waves in limb leads I-aVL, negative T waves in precordial leads V4-V6, presence of left posterior fascicular block, presence of pathologic Q waves, and poor R-wave progression in right precordial leads) proved to be statistically associated with the finding of NLVS; these were grouped together in a score. A score ≥2 was proved to be the optimal cut-off point, identifying NLVS athletes in 92% of cases and showing the best accuracy (86% sensitivity and 100% specificity, respectively). However, a cut-off ≥1 correctly identified all patients with NLVS (absence of false negatives). Conclusion: In athletes with RBBB morphology non-sustained VAs, specific ECG abnormalities at 12-lead ECG can help in detecting subjects with NLVS at CMR.
MeSH term(s)	Male ; Humans ; Adult ; Female ; Bundle-Branch Block/diagnosis ; Bundle-Branch Block/etiology ; Ventricular Premature Complexes/diagnosis ; Ventricular Premature Complexes/etiology ; Cicatrix/pathology ; Contrast Media ; Cross-Sectional Studies ; Gadolinium ; Electrocardiography
Chemical Substances	Contrast Media ; Gadolinium (AU0V1LM3JT)
Language	English
Publishing date	2024-01-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2626011-6
ISSN	2047-4881 ; 2047-4873
ISSN (online)	2047-4881
ISSN	2047-4873
DOI	10.1093/eurjpc/zwae010
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Zs.A 4686: Show issues

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Article: Long-Term Follow-Up In Paroxysmal Atrial Fibrillation Patients With Documented Isolated Trigger.

Palamà, Zefferino / Robles, Antonio Gianluca / Paoletti, Matteo / Nesti, Martina / De Ruvo, Ermenegildo / Scarà, Antonio / Borrelli, Alessio / De Masi De Luca, Gabriele / Rillo, Mariano / Calò, Leonardo / Cavarretta, Elena / Romano, Silvio / Sciarra, Luigi

Frontiers in cardiovascular medicine

2023 Volume 10, Page(s) 1115328

Abstract: Aims: Supraventricular tachycardias may trigger atrial fibrillation (AF). The aim of the study was to evaluate the prevalence of supraventricular tachycardia (SVT) inducibility in patients referred for AF ablation and to evaluate the effects of SVT ... ...

Abstract	Aims: Supraventricular tachycardias may trigger atrial fibrillation (AF). The aim of the study was to evaluate the prevalence of supraventricular tachycardia (SVT) inducibility in patients referred for AF ablation and to evaluate the effects of SVT ablation on AF recurrences. Methods and results: 249 patients (mean age: 54 ± 14 years) referred for paroxysmal AF ablation were studied. In all patients, only AF relapses had been documented in the clinical history. 47 patients (19%; mean age: 42 ± 11 years) had inducible SVT during the electrophysiological study and underwent an ablation targeted only at SVT suppression. Ablation was successful in all 47 patients. The ablative procedures were: 11 slow-pathway ablations for atrioventricular nodal re-entrant tachycardia; 6 concealed accessory pathway ablations for atrioventricular re-entrant tachycardia; 17 focal ectopic atrial tachycardia ablations; 13 with only one arrhythmogenic pulmonary vein. No recurrences of SVT were observed during the follow-up (32 ± 18 months). 4 patients (8.5%) showed recurrence of at least one episode of AF. Patients with inducible SVT had less structural heart disease and were younger than those without inducible SVT. Conclusion: A significant proportion of candidates for AF ablation are inducible for an SVT. SVT ablation showed a preventive effect on AF recurrences. Those patients should be selected for simpler ablation procedures tailored only to the triggering arrhythmia suppression.
Language	English
Publishing date	2023-07-13
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2781496-8
ISSN	2297-055X
ISSN	2297-055X
DOI	10.3389/fcvm.2023.1115328
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Article ; Online: Intermittent ventricular pre-excitation in symptomatic adults: Always a marker of low risk?

Robles, Antonio Gianluca / Palamà, Zefferino / Pernat, Andrej / Gianfrancesco, Domenico / Bartolomucci, Francesco / Scarà, Antonio / Borrelli, Alessio / De Ruvo, Ermenegildo / Calò, Leonardo / Penco, Maria / Romano, Silvio / Sciarra, Luigi

Pacing and clinical electrophysiology : PACE

2023 Volume 46, Issue 9, Page(s) 1049–1055

Abstract: Background: Intermittent ventricular pre-excitation was considered a low-risk marker for sudden death. However, to date, some studies do not exclude the existence of accessory pathways (APs) with high-risk intermittent antegrade conductive properties. ... ...

Abstract	Background: Intermittent ventricular pre-excitation was considered a low-risk marker for sudden death. However, to date, some studies do not exclude the existence of accessory pathways (APs) with high-risk intermittent antegrade conductive properties. According to current European Guidelines, high-risk features of APs are antegrade pathway conduction ≤250 ms in baseline or during the adrenergic stimulus, inducibility of atrioventricular reciprocating tachycardias (AVRT), inducibility of pre-excited atrial fibrillation (AF), and presence of multiple APs. For all of these transcatheter ablation is recommended. The aim of our study was to evaluate the existence of differences in risk characteristics between patients with intermittent pre-excitation (IPX) and those with persistent pre-excitation (PPX), from a sample of adults with ventricular pre-excitation and symptoms like palpitations. Methods: 293 adults [IPX: 51 (17.4%); PPX: 242 (82.6%)] underwent electrophysiological study and then catheter ablation of their APs if arrhythmia inducibility (AVRT/AF) was noted, or, conversely, if it was appreciated a fast AP antegrade conduction, in baseline or during intravenous isoproterenol infusion, or if multiple APs were detected. Results: There were no statistically significant differences in demographic characteristics (age and gender), AVRT/AF inducibility, antegrade conductive properties, the prevalence of multiple APs, and APs locations between IPX and PPX patients. Conclusions: In our study, patients with IPX did not show significant differences in clinical and electrophysiological features versus PPX patients.
MeSH term(s)	Humans ; Adult ; Wolff-Parkinson-White Syndrome ; Pre-Excitation Syndromes ; Accessory Atrioventricular Bundle/surgery ; Atrial Fibrillation/surgery ; Risk Factors ; Catheter Ablation ; Electrocardiography
Language	English
Publishing date	2023-08-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	424437-0
ISSN	1540-8159 ; 0147-8389
ISSN (online)	1540-8159
ISSN	0147-8389
DOI	10.1111/pace.14798
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Zs.A 1466: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 399: Show issues

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Article: Cardiac resynchronization therapy guided by the new KODEX-EPD imaging system.

Scarà, Antonio / Sciarra, Luigi / Bressi, Edoardo / De Ruvo, Ermenegildo / Grieco, Domenico / Borrelli, Alessio / Zecchi, Paolo / Calò, Leonardo

Journal of arrhythmia

2021 Volume 37, Issue 5, Page(s) 1383–1387

Abstract: Nowadays, fluoroscopy is the standard tool used to help physicians during pacing lead implantation. However, its use entails significant radiation exposure for physicians and especially for patients. For the first time, the present case report describes ... ...

Abstract	Nowadays, fluoroscopy is the standard tool used to help physicians during pacing lead implantation. However, its use entails significant radiation exposure for physicians and especially for patients. For the first time, the present case report describes the use of the electro-anatomical mapping (EAM) navigation system KODEX-EPD for cardiac resynchronization therapy (CRT) implantation. These findings suggest that CRT implantation guided by the KODEX-EPD system is feasible and safe with the minimization of X-ray and dye exposure.
Language	English
Publishing date	2021-08-30
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/joa3.12627
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Article: Tailoring the Ablative Strategy for Atrial Fibrillation: A State-of-the-Art Review.

Palamà, Zefferino / Nesti, Martina / Robles, Antonio Gianluca / Scarà, Antonio / Romano, Silvio / Cavarretta, Elena / Penco, Maria / Delise, Pietro / Rillo, Mariano / Calò, Leonardo / Sciarra, Luigi

Cardiology research and practice

2022 Volume 2022, Page(s) 9295326

Abstract: In spite of technological progress and the improving skills of operators, atrial fibrillation (AF) ablation results appear to date to be at a plateau. In any case, the superiority of ablation over pharmacological therapy in terms of effectiveness, ... ...

Abstract	In spite of technological progress and the improving skills of operators, atrial fibrillation (AF) ablation results appear to date to be at a plateau. In any case, the superiority of ablation over pharmacological therapy in terms of effectiveness, reduction of hospitalizations, and improvement has been well demonstrated in recent randomized trials. Triggers, substrate, and modulating factors (elements of Coumel's triangle) play different roles in paroxysmal and persistent AF, so induction and perpetuation mechanisms of arrhythmia may be different in each patient. Although effective ablative strategies are available for the treatment of paroxysmal AF triggers and persistent AF substrates, an adequate clinical evaluation of the patient is crucial in order to increase the chances of success. Recognizing triggers allows not only performing an effective ablation but also to avoid unnecessary lesions and at the same time reducing the risk of complications. AF beginning and triggers could be recorded by 12-lead ECG, continuous Holter monitoring, or implantable devices. In case of an unsuccessful noninvasive evaluation, nonpulmonary vein triggers should be investigated with an electrophysiological study. Persistent AF needs more effort to perform an accurate substrate characterization. Among the many methods proposed, recently the use of high-density mapping and multipolar catheters seems of particular benefit in order to clarify the arrhythmia mechanisms. Surgical and hybrid techniques allow to treat regions such as the posterior wall or Bachmann's bundle, which is fundamental for an ablative strategy that goes beyond just pulmonary vein isolation. Too often, patients are referred to electrophysiology laboratories without adequate preprocedural screening and planning in order to submit them to a standard "ready-made" procedure. The accurate search for triggers in paroxysmal AF and the correct recognition of the link between a possible underlying heart disease and the substrate in persistent AF could allow us to tailor the interventional approach in order to overcome the current plateau, increasing ablative procedure success and minimizing complications.
Language	English
Publishing date	2022-02-28
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2506187-2
ISSN	2090-0597 ; 2090-8016
ISSN (online)	2090-0597
ISSN	2090-8016
DOI	10.1155/2022/9295326
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Article ; Online: Abnormal venous return: Still a challenge for electrophysiology procedures? A case report.

Robles, Antonio Gianluca / Borrelli, Alessio / de Ruvo, Ermenegildo / Sciarra, Luigi / Scarà, Antonio / De Luca, Lucia / Grieco, Domenico / Calò, Leonardo

Journal of cardiology cases

2020 Volume 23, Issue 5, Page(s) 202–205

Abstract: Catheter ablation of cardiac arrhythmias is usually performed through the femoral venous approach. Systemic venous return anomalies such as interruption of the inferior vena cava may represent a challenge during electrophysiological procedures. A 55-year- ...

Abstract	Catheter ablation of cardiac arrhythmias is usually performed through the femoral venous approach. Systemic venous return anomalies such as interruption of the inferior vena cava may represent a challenge during electrophysiological procedures. A 55-year-old patient with previous surgical correction of abnormal pulmonary venous return was admitted for poorly tolerated atrial flutter recurrences. He also had an interrupted inferior vena cava continuing as azygos vein and left superior vena cava draining via coronary sinus into the right atrium. Cavotricuspid isthmus radiofrequency ablation was successfully performed through the persistent left superior vena cava using a three-dimensional (3D) electroanatomical mapping system. Despite systemic venous abnormalities may potentially have important implications during electrophysiological procedures, arrhythmias can be successfully ablated with the aid of 3D electroanatomical mapping systems. <
Language	English
Publishing date	2020-12-01
Publishing country	Japan
Document type	Case Reports
ISSN	1878-5409
ISSN (online)	1878-5409
DOI	10.1016/j.jccase.2020.10.016
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