Papers by Gianluca Zingarini
Journal of Interventional Cardiac Electrophysiology, 2022
Purpose Highly localized impedance (LI) measurements during atrial fibrillation (AF) ablation hav... more Purpose Highly localized impedance (LI) measurements during atrial fibrillation (AF) ablation have emerged as a viable real-time indicator of tissue characteristics and the consequent durability of the lesions created. We investigated the impact of catheter-tissue contact force (CF) on LI behavior during pulmonary vein isolation (PVI). Methods Forty-five consecutive patients of the CHARISMA registry undergoing de novo AF radiofrequency (RF) catheter ablation with a novel open-irrigated-tip catheter endowed with CF and LI measurement capabilities (Stablepoint™ catheter, Boston Scientific) were included. Results A total of 2895 point-by-point RF applications were analyzed (RF delivery time (DT) = 8.7±4s, CF = 13 ±±8 g, LI drop = 23 ±±7 Ω). All PVs were successfully isolated in an overall procedure time of 118 ±±34 min (fluoroscopy time = 13 ±±8 min). The magnitude of LI drop weakly correlated with CF (r = 0.13, 95% confidence interval (CI): 0.09 to 0.16, p < 0.0001), whereas both C...
Cardiac Electrophysiology Clinics
Introduction. The inadvertent lead malposition in the left heart chambers (ILMLH) is an under-rec... more Introduction. The inadvertent lead malposition in the left heart chambers (ILMLH) is an under-recognized event which may complicate implantation of cardiac electronic devices (CIEDs). Methods and Results. We investigated the clinical conditions associated with ILMLH and the treatment strategies in these patients. We made a systematic review of literature and identified 132 studies which reported 157 patients with ILMLH. Mean age of patients was 68 years and 83 were women. ILMLH was diagnosed, on average, 365 days after CIEDs implantation. Coexisting conditions were patent foramen ovale in 29% of patients, arterial puncture in 24%, perforation of the interatrial septum in 20%, atrial septal defect in 16% and perforation of the interventricular septum in 4%. At the time of diagnosis of ILMLH, 46% of patients were asymptomatic, 31% had acute TIA or stroke and 15% had overt heart failure. Overall, 14% of patients were receiving anticoagulants at the time of diagnosis of ILMLH. After dia...
Giornale italiano di cardiologia, 2021
DIAGNOSI ECG? 1. Infarto miocardico acuto laterale 2. Effetto digitalico 3. Infarto miocardico ac... more DIAGNOSI ECG? 1. Infarto miocardico acuto laterale 2. Effetto digitalico 3. Infarto miocardico acuto anteriore 4. Iperkaliemia DESCRIZIONE DEL CASO Un paziente di 72 anni iperteso e affetto da sindrome di Menière allerta il servizio di emergenza territoriale per la comparsa di dolore toracico oppressivo. Viene registrato l'ECG in esame e dopo pochi minuti viene rianimato da un arresto cardiaco ipercinetico da fibrillazione ventricolare.
![Research paper thumbnail of [An unusual case of Takotsubo syndrome after dipyridamole stress echocardiography]](https://a.academia-assets.com/images/blank-paper.jpg)
Giornale italiano di cardiologia, 2019
Takotsubo syndrome is a transient form of left ventricular dysfunction, more common in postmenopa... more Takotsubo syndrome is a transient form of left ventricular dysfunction, more common in postmenopausal women, which involves left ventricular mid-apical akinesis and mimics acute coronary syndrome. It is characterized by left ventricular apical ballooning without significant coronary artery stenosis on coronary angiography. The basic mechanisms of Takotsubo cardiomyopathy are still unclear. There is some evidence that emotional, physical or pharmacological stress associated with increased catecholamine levels, coronary spasm, dynamic left ventricular obstruction, or coronary microvascular dysfunction might be involved. We describe the case of an 81-year-old woman who developed a Takotsubo syndrome only 3 h after pharmacological stress echocardiography with dipyridamole. To our knowledge, this is the first case reported in the literature in such context.
Journal of Cardiovascular Electrophysiology, 2021
Permanent His bundle pacing (PHBP) preserves physiological ventricular activation but technical d... more Permanent His bundle pacing (PHBP) preserves physiological ventricular activation but technical difficulties have limited its widespread use. We report the first experience of PHBP performed with a new specific delivery sheath (Selectra 3D, Biotronik, Berlin, Germany) and an extendable‐retractable active screw, stylet‐driven pacing lead (Solia S 60, Biotronik).
Cardiac Electrophysiology Clinics, 2020
An accessory pathway (AP) can be apparent during sinus rhythm if it depolarizes part of the ventr... more An accessory pathway (AP) can be apparent during sinus rhythm if it depolarizes part of the ventricles ahead of the normal wave front from the conduction system. An AP can generate an anatomic circuit able to sustain a macroreentrant atrioventricular reentrant tachycardia. This arrhythmia can engage the normal conducting system in an antegrade direction or retrogradely, generating, respectively, a narrow or a wide complex tachycardia. The combined use of a standard electrocardiogram and an esophageal recording-pacing can be particularly useful in the first approach to patients with Wolff-Parkinson-White syndrome, further stratifying patients requiring electrophysiology study and transcatheter ablation.
Circulation: Arrhythmia and Electrophysiology, 2020
Journal of Integrative Cardiology, 2017
Sudden cardiac death (SCD) remains a leading cause of cardiovascular mortality in the world. The ... more Sudden cardiac death (SCD) remains a leading cause of cardiovascular mortality in the world. The trans-venous implantable cardioverter-defibrillator(TV-ICD) is the most effective approach for primary and secondary prevention of SCD. In response to the growing treatment complexity associated with long-term endocardial management, the subcutaneous implantable cardioverter-defibrillator ICD (SICD) was developed. We report a case in which S-ICD shocks changed a stable ventricular tachycardia (VT) to unstable VT o ventricular fibrillation (VF).
International Journal of Cardiology, 2017
Increased red blood cell distribution width (RDW) has been associated with poor outcome after car... more Increased red blood cell distribution width (RDW) has been associated with poor outcome after cardiac resynchronization therapy (CRT). However, whether baseline RDW, and its serial changes after CRT implant, have incremental prognostic value is unknown. In 148 consecutive patients (age, 68±9years; 122 men) undergoing CRT, RDW was assessed before and 3months after implant. Patients were categorized according to baseline RDW (≤14.5% vs &amp;amp;amp;amp;amp;amp;gt;14.5%); and as &amp;amp;amp;amp;amp;amp;quot;stable&amp;amp;amp;amp;amp;amp;quot;, &amp;amp;amp;amp;amp;amp;quot;decreased&amp;amp;amp;amp;amp;amp;quot;, &amp;amp;amp;amp;amp;amp;quot;increased&amp;amp;amp;amp;amp;amp;quot;, relative to post-implant changes. Primary end-point was a composite of death/HF hospitalization during follow-up (median 21months). A reduction in left ventricular (LV) end-systolic volume by ≥15% at 6-month identified LV reverse remodeling. By multivariable logistic regression analysis &amp;amp;amp;amp;amp;amp;quot;increased&amp;amp;amp;amp;amp;amp;quot; (OR:0.22, 95%CI: 0.07-0.69, P=0.010) and &amp;amp;amp;amp;amp;amp;quot;stable-high&amp;amp;amp;amp;amp;amp;quot; RDW at follow-up (OR: 0.39, 95%CI: 0.17-0.89, P=0.027) showed a lower likelihood to develop LV reverse remodeling, while baseline RDW was no longer predictive of LV remodeling. During follow-up, there were 57 events. Baseline RDW&amp;amp;amp;amp;amp;amp;gt;14.5% (HR: 2.24, 95%CI: 1.05-4.77, P=0.036), &amp;amp;amp;amp;amp;amp;quot;increased&amp;amp;amp;amp;amp;amp;quot; (HR: 2.55, 95% CI: 1.09-5.97, P=0.030) and &amp;amp;amp;amp;amp;amp;quot;stable-high&amp;amp;amp;amp;amp;amp;quot; RDW (HR: 2.95, 95% CI: 1.45-5.99, P=0.003) independently predicted outcome after adjusting for functional improvement after CRT, radial dyssynchrony, BNP, creatinine clearance, and left atrial volume index. However, integrated discrimination improvement and net reclassification improvement were not statistically significant when both baseline RDW and its changes were added to a base predictive model. Increased and stable-high values of RDW were independently associated with both LV reverse remodeling and outcome after CRT; however, RDW did not show any incremental predictive value.
Circulation Journal
drugs (AADs) after ablation. 2-6 A durable PV isolation (PVI) is optimized by continuity in the a... more drugs (AADs) after ablation. 2-6 A durable PV isolation (PVI) is optimized by continuity in the ablation lesion deployment along the circumferential isolation line. 7,8 Adequate point-by-point information on lesions could be necessary to guarantee the transmurality, continuity, and durability of ablation. Recently, an automated ablation lesion tagging module has been developed. 9 It incorporates indirect parameters of lesion formation that can be indexed by the user, according to the ablation strategy. Our aim A blation strategies that target the pulmonary veins (PVs) are the cornerstone for most atrial fibrillation (AF) ablation procedures, and electrical isolation with at least evidence of entrance block should be the goal of the procedure. 1 A 12-month success rate, defined as the freedom from AF and/or atrial tachycardia (AT) events, appears to be related to the number of procedures and the optimal contact of the ablation catheter with the tissue, and only moderately to the maintenance of antiarrhythmic
Europace, 2015
Aim of this study was to compare a minimally fluoroscopic radiofrequency catheter ablation with c... more Aim of this study was to compare a minimally fluoroscopic radiofrequency catheter ablation with conventional fluoroscopy-guided ablation for supraventricular tachycardias (SVTs) in terms of ionizing radiation exposure for patient and operator and to estimate patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; lifetime attributable risks associated with such exposure. We performed a prospective, multicentre, randomized controlled trial in six electrophysiology (EP) laboratories in Italy. A total of 262 patients undergoing EP studies for SVT were randomized to perform a minimally fluoroscopic approach (MFA) procedure with the EnSite(TM)NavX(TM) navigation system or a conventional approach (ConvA) procedure. The MFA was associated with a significant reduction in patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; radiation dose (0 mSv, iqr 0-0.08 vs. 8.87 mSv, iqr 3.67-22.01; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.00001), total fluoroscopy time (0 s, iqr 0-12 vs. 859 s, iqr 545-1346; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.00001), and operator radiation dose (1.55 vs. 25.33 µS per procedure; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In the MFA group, X-ray was not used at all in 72% (96/134) of cases. The acute success and complication rates were not different between the two groups (P = ns). The reduction in patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; exposure shows a 96% reduction in the estimated risks of cancer incidence and mortality and an important reduction in estimated years of life lost and years of life affected. Based on economic considerations, the benefits of MFA for patients and professionals are likely to justify its additional costs. This is the first multicentre randomized trial showing that a MFA in the ablation of SVTs dramatically reduces patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; exposure, risks of cancer incidence and mortality, and years of life affected and lost, keeping safety and efficacy. clinicaltrials.gov Identifier: NCT01132274.
Internal and Emergency Medicine, 2012
Atrial fibrillation (AF) is intermittent in 30% of patients with cardioembolic stroke and, theref... more Atrial fibrillation (AF) is intermittent in 30% of patients with cardioembolic stroke and, therefore, might not be seen in a single standard ECG recording. The aim of this study was to evaluate if prolonged ECG monitoring (96 h) finds episodes of intermittent AF beyond the 24 h ECG monitoring in patients with cryptogenic stroke or transient ischemic attack (TIA). We prospectively evaluated consecutive patients affected by cryptogenic stroke or TIA who had sinus rhythm on a 12-lead ECG on admission, and during ECG monitoring performed in the acute phase (for at least 24 h). Patients had continuous 96 h Holter ECG monitoring within 30 days from stroke onset. 114 patients were included in the study (mean age 63.1 ± 15.1, 59 males). AF was found in 29 patients (24.3%). In 20 patients, AF was found in the first 24 h of recording, and in nine patients after 24 h. In addition, several other dysrhythmias such as supraventricular ectopic activity (33), ventricular tachycardia (10), sinus pause (4) and sinus-atrial block (1) were found. In patients with cryptogenic stroke or TIA, 96 h ECG monitoring detected a high rate of AF. One-third of AF was seen beyond 24 h of ECG monitoring.
JACC: Cardiovascular Imaging, 2011
The aim of this study was to evaluate whether, in patients with evidence of both electrical and m... more The aim of this study was to evaluate whether, in patients with evidence of both electrical and mechanical left ventricular (LV) dyssynchrony, extensive LV dilation would affect response to cardiac resynchronization therapy (CRT).
International Journal of Cardiology, 2013
Whether and to what extent patients with asymptomatic atrial fibrillation (AF) would benefit from... more Whether and to what extent patients with asymptomatic atrial fibrillation (AF) would benefit from catheter ablation has not been investigated. This is the first multicenter prospective study reporting on the outcome of catheter ablation in patients with asymptomatic AF. Consecutive patients (n = 545) referred for AF ablation were prospectively enrolled in a multicenter Italian registry. Of these patients, 54 have asymptomatic AF and composed our patient population. At 24 month follow-up, catheter ablation in asymptomatic AF patients resulted to be as safe and effective as in patients with drug refractory symptomatic AF. Our study provides significant insights on the role of AF ablation in asymptomatic patients. Further studies in much larger cohorts are needed to validate our conclusions.
International Journal of Cardiology, 2014
Uploads
Papers by Gianluca Zingarini