Papers by Sergio Valsecchi
European Heart Journal Supplements, Dec 1, 2021
Aims: 12-lead electrocardiogram (ECG) still represents the first line approach for cardiovascular... more Aims: 12-lead electrocardiogram (ECG) still represents the first line approach for cardiovascular assessment even in patients with COVID-19. We therefore sought to describe and compare ECG findings in three different hospital settings: intensive care unit (ICU) (invasive ventilatory support), respiratory care unit (RCU) (non-invasive ventilatory support) and Covid-19 dedicated internal medicine unit (IMU) (oxygen supplement with or without high flow). Methods and results: We retrospectively analysed the 12-lead ECGs of 1124 consecutive patients hospitalized for respiratory distress and COVID-19 in a single III level hospital. Age, gender, main clinical data and in-hospital survival were recorded. 548 patients were hospitalized in IMU, 361 in RCU, 215 in ICU. Arrhythmias in general were less frequently found in RCU (16% vs. 26%, P < 0.001). Deaths occurred more frequently in ICU patients (43% vs. 20-21%, P < 0.001). After pooling predictors of mortality (age, intensity of care setting, heart rate, ST-elevation, QTc prolongation, Q-waves, right bundle branch block, and atrial fibrillation), the risk of in-hospital death can be estimated by using a derived score. Three zones of mortality risk can be thus identified: <5%, score <5 points; 5-50% score 5-10, and >50%, score >10 points. The accuracy of the score assessed at ROC curve analysis was 0.791. Conclusions: ECG differences at admission con be found in COVID-19 patients according to different clinical settings and intensity of care. A simplified score derived from few clinical and ECG variables may predict in-hospital mortality with a good accuracy.
European Heart Journal, 2007
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Europace, Mar 1, 2018
Aims. In 2017, a new definition of 'valvular/non-valvular' atrial fibrillation (AF) has been prop... more Aims. In 2017, a new definition of 'valvular/non-valvular' atrial fibrillation (AF) has been proposed for use in everyday clinical practice. We therefore compared thromboembolic (TE) and bleeding risks in patients with AF according to the new 'Evaluated Heartvalves, Rheumatic or Artificial' (EHRA) valve classification. Methods: Patients were divided into 3 categories: (i) EHRA type 1 corresponds to the previous 'valvular' AF patients, including those with either rheumatic mitral valve stenosis or mechanical prosthetic heart valves; (ii) EHRA type 2 includes AF patients with other valvular heart disease (VHD) and valve bioprosthesis or repair; and (iii) 'non-VHD controls' i.e. all AF patients with neither VHD nor post-surgical valve disease. Among 8962 AF patients seen between 2000 and 2010, 357 (4%) were EHRA type 1, 1,754 (20%) were EHRA type 2 and 6,851 (76%) non-VHD controls. Results: Type 2 patients were older and had a higher CHA2DS2-VASc and HAS-BLED scores than either type 1 and non-VHD patients. After a mean follow-up of 1,26461,160 days (median 922, interquartile range 234-2,083), 715 stroke/TE events and 274 major bleeding (3 in BARC definition) were recorded. The occurrence of TE events was significantly higher in EHRA type 2 than non-VHD patients (HR (95%CI): 1.30 1.09-1.54), p¼0.003; also, p¼0.31 for type 1 vs 2, p¼0.68 for type 1 vs non-VHD controls). The rate of major BARC bleeding events for AF patients was higher in either EHRA type 1 (HR (95%CI): 3.16(2.11-4.72), p<0.0001) and type 2 (HR (95%CI): 2.19(1.69-2.84), p<0.0001) than in non-VHD controls. Conclusion: This systematic analysis in 'real life' conditions shows that distinguishing AF patients according to the new EHRA valve classification could be relevant for creating more homogenous groups of patients in terms of TE and bleeding risk. This classification, which advantage is to be clearer than the previous one, should be useful as in clinical research for harmonization of studies, as well as in clinical practice for targeted choices of OAC therapy.
Europace, 2001
Background: Previous studies have shown that the site of left ventdcular (LV) stimulation influen... more Background: Previous studies have shown that the site of left ventdcular (LV) stimulation influences the hemodynamic (HD) effect of biventdcular pacing (BWP). LV pacing via a transvenous (TrV) approach has an overall success rate of 85%. Moreover, the limited availability of suitable coronary sinus (CS) tributaries makes it difficult to test different sites to find the optimal pacing electrode location. In this study, the HD effect of different epicardial LV pacing sites was intraoperatively evaluated in a patient dudng combined TrVIthoracothomic (Th'l') BWP. Methods: A 58 yrs old male patient with left bundle branch block (QRS=160ms) and refractory heart failure due to dilated cardiomyopathy was submitted to combined TrV/ThT BWP after a failed attempt to TrV implantation of a LV pacing lead through the CS. After the TrV implantation of the right atrial and ventricular leads, an epicardial lead (Medtronic 4965-50) was sutured to epimiocardium of the LV free wall using a mini-ThT approach. Due to the limited operating field the HD evaluation could be carded out in only two different pacing sites: a) LV lateral wall base b) LV postero-lateral wall base. A catheter was placed in the aorta to obtain the following parameters, by means of a dedicated acquidnglmeasudng system: aortic systolic pressure (ASP), aortic diastolic pressure (ADP), aortic pulse pressure (APP) and aortic pressure derivative maximum (PDM). Results: The site a) provided better acute HD results than the b) (ASP 117mmHg vs 112mmHg, ADP 57mmHg vs 57mmHg, APP 62 mmHg vs 57 mmHg and PDM 1354mmHg/s vs 1287mmHg/s) and was selected for the final LV lead location. The recovery after surgery was uneventful and the patient was discharged on post-operative day 10. Conclusions: Combined TrV/rhT BiVP seems to tie an alternative when TrV LV pacing is not feasible. The use of acute HD measurements, during the procedure, may help to select the optimal pacing site. Further studies are needed to evaluate the clinical value of this approach.
Pacing and Clinical Electrophysiology, May 15, 2021
Background: During the COVID-19 pandemic in-person visits for patients with cardiac implantable e... more Background: During the COVID-19 pandemic in-person visits for patients with cardiac implantable electronic devices should be replaced by remote monitoring (RM), in order to prevent viral transmission. A direct home-delivery service of the RM communicator has been implemented at 49 Italian arrhythmia centers. Methods: According to individual patient preference or the organizational decision of the center, patients were assigned to the home-delivery group or the standard in-clinic delivery group. In the former case, patients received telephone training on the activation process and use of the communicator. In June 2020, the centers were asked to
European Journal of Heart Failure Supplements, Jun 1, 2008
Clinical Cardiology, Dec 14, 2022
Journal of Cardiovascular Medicine, Jul 6, 2022
Europace, Jun 1, 2020
No funding Multiple left ventricular pacing strategies have been suggested for improving response... more No funding Multiple left ventricular pacing strategies have been suggested for improving response to cardiac resynchronization therapy (CRT). However, these programming strategies can be obtained by accepting configurations with high pacing threshold and accelerated battery drain. We assessed the feasibility of predefined pacing programming protocols and we evaluated their impact on device longevity and their cost-impact. We estimated battery longevity in 167 CRT-D (RESONATE, Boston Scientific) patients based on measured pacing parameters and according to multiple programming strategies: single-site pacing associated with lowest threshold, non-apical location, longest interventricular delay, pacing from two electrodes. To determine the economic impact of each programming strategy, we applied the results of a published model-based cost analysis to a 15-year time-horizon. Selecting the electrode with the lowest threshold resulted in a median device longevity of 11.5 years. Non-apical pacing and interventricular delay maximization were feasible in most patients (99% non-apical pacing, 65% RV-to-LV interval >80ms), and were obtained at the price of a few months of battery life. Device longevity of >10 years was preserved in 87% of cases of non-apical pacing and in 77% on pacing at the longest interventricular delay. The mean reduction in battery life when the second electrode was activated was 1.5 years. Single-site pacing strategies increased the therapy cost by 4-6%, and multi-site pacing by 12-13%, in comparison with the best-case scenario. Modern CRT-D systems ensure effective pacing and allow multiple optimization strategies for maximizing service life or for enhancing effectiveness. Single- or multi-site pacing strategies can be implemented without compromising device service life and at an acceptable increase in therapy cost. Abstract Figure. Image1
Kardiologia Polska, Apr 23, 2021
and wide QRS with left bundle branch block morphology-despite optimal medical therapy-has clearly... more and wide QRS with left bundle branch block morphology-despite optimal medical therapy-has clearly been established. 1,2 It has to be considered though, that a minority of patients IntroductIon The pivotal role of cardiac resynchronization therapy (CRT) in symptomatic patients with chronic heart failure (HF), severely depressed left ventricular (LV) ejection fraction,
SpringerPlus, Sep 21, 2015
We describe a case of inappropriate shocks due to temporary epicardial pacing after cardiothoraci... more We describe a case of inappropriate shocks due to temporary epicardial pacing after cardiothoracic surgery in a patient with a subcutaneous ICD.
Pacing and Clinical Electrophysiology, Jun 10, 2022
BackgroundTransvenous lead extraction is the standard therapy for cardiac device‐related infectio... more BackgroundTransvenous lead extraction is the standard therapy for cardiac device‐related infection. In some patients, however, a hybrid surgical and transvenous approach may be necessary.Methods and ResultsWe present three cases who underwent transvenous lead extraction for an infected CRT‐D system. In all cases the CS lead could not be retrieved transvenously due to extensive fibrosis. The lead was successfully extracted through left minithoracotomy in two patients and midline sternotomy in one patient.ConclusionIn cases where the coronary sinus lead shows severe fibrosis, a transvenous approach can be used to free the proximal part of the lead, while the distal adhesions can be removed surgically through a limited thoracic incision.
Leadless pacemaker implantation (LPI) has fewer device complications and reduced chance of infect... more Leadless pacemaker implantation (LPI) has fewer device complications and reduced chance of infection compared to conventional pacemakers. Dextrocardia with situs viscerum inversus (DC+SVI) is a rare condition, which seldom leads to cardiac complications. However, its presence poses a challenge to operators in cardiac procedures. LPI reports in DC patients are scarce. We report a case of LPI in a DC+SVI patient, followed by a brief but comprehensive literature review.
Pacing and Clinical Electrophysiology, Jun 6, 2023
IntroductionPermanent His bundle pacing (HBP) is the most physiological pacing modality, and new ... more IntroductionPermanent His bundle pacing (HBP) is the most physiological pacing modality, and new implantation systems are now available. The aim of the present study was to describe and compare four different techniques to perform HBP.Methods and resultsWe included all consecutive patients who underwent a HBP attempt in our initial experience between June 2020 and May 2022. The success and characteristics of the procedure were compared among four implantation techniques: the Biotronik Selectra 3D sheath with Solia S60 lead (Selectra 3D), the Boston Scientific Site Selective Pacing Catheter with Ingevity lead (SSPC), the Abbott steerable stylet locator with Tendril lead (Locator), and the use of a standard stylet manually pre‐shaped with a conventional pacing lead (Curved stylet). Ninety‐eight patients (median age 79 years [interquartile range, 73‐83], 83% men) were identified. The Selectra 3D technique was used in 43 procedures, SSPC in 26, Locator in 18 and Curved stylet in 11. The groups had similar clinical characteristics. Overall, procedural success was achieved in 91 patients (93%) with similar proportions among groups (p = .986). Fluoroscopy and procedural times were 6.0 (4.4‐8.5) and 60 (45‐75) min, respectively, without significant differences (p = .333 and p = .790). The rate of selective capture, the pacing threshold, and the paced QRS duration were also comparable. There was one pre‐discharge HBP lead dislodgment (1%) that required implant revision.ConclusionIn our experience, four techniques for HBP achieved comparable results in terms of safety and effectiveness. The availability of different systems may lead to widespread use of physiological pacing.
Heart Rhythm, May 1, 2022
Social Science Research Network, 2021
Pacing and Clinical Electrophysiology, Aug 1, 2022
Superior vena cava (SVC) syndrome is a rare disease induced by thrombosis and consequent occlusio... more Superior vena cava (SVC) syndrome is a rare disease induced by thrombosis and consequent occlusion of SVC, negatively affecting morbidity and mortality. The incidence of SVC syndrome from central venous catheters and pacemaker or defibrillator leads is increasing. Optimal treatment of pacemaker or defibrillator‐related SVC syndrome is not well defined. Lead extraction causes mechanical trauma to the vessel wall. In addition, subsequent device implantation on the contralateral side can be an added factor for venous occlusion. The use of leadless pacemakers could be an interesting option to reduce the risk of SVC restenosis after lead extraction. We report a clinical case of PM leads‐related SVC syndrome referred to our centers and treated with transvenous lead extraction, leadless pacemaker implantation and subsequent percutaneous angioplasty and stenting of the SVC and left innominate vein.
Journal of Cardiovascular Electrophysiology, Nov 28, 2021
BackgroundThe subcutaneous implantable cardioverter‐defibrillator (S‐ICD) is an effective alterna... more BackgroundThe subcutaneous implantable cardioverter‐defibrillator (S‐ICD) is an effective alternative to the transvenous ICD. No study has yet compared S‐ICD and transvenous ICD by assessing patient acceptance as a patient‐centered outcome.ObjectiveTo evaluate the patient acceptance of the S‐ICD and to investigate its association with clinical and implantation variables. In patients with symptomatic heart failure and reduced ejection fraction (HFrEF), the acceptance of the S‐ICD was compared with a control group of patients who received a transvenous ICD.MethodsPatient acceptance was calculated with the Florida Patient Acceptance Survey (FPAS) which measures four factors: return to function (RTF), device‐related distress (DRD), positive appraisal (PA), and body image concerns (BIC). The survey was administered 12 months after implantation.Results176 patients underwent S‐ICD implantation. The total FPAS and the single factors did not differ according to gender, body habitus, or generator positioning. Patients with HFrEF had lower FPAS and RTF. Younger patients showed better RTF (75 [56–94] vs. 56 [50–81], p = .029). Patients who experienced device complications or device therapies showed higher DRD (40 [35–60] vs. 25 [10–50], p = .019). Patients with HFrEF receiving the S‐ICD had comparable FPAS, RTF, DRD, and BIC to HFrEF patients implanted with the transvenous ICD while exhibited significantly better PA (88 [75–100] vs. 81 [63–94], p = .02).ConclusionsOur analysis revealed positive patient acceptance of the S‐ICD, even in groups at risk of more distress such as women or patients with thinner body habitus, and regardless of the generator positioning. Among patients receiving ICDs for HFrEF, S‐ICD was associated with better PA versus transvenous ICD.
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Papers by Sergio Valsecchi