Papers by Nicoleta Carmen Sora
Arquivos Brasileiros de Cardiologia, 2012
BioMed Research International, 2015
Atrial fibrillation (AF) is the most common clinically relevant cardiac arrhythmia. AF poses pati... more Atrial fibrillation (AF) is the most common clinically relevant cardiac arrhythmia. AF poses patients at increased risk of thromboembolism, in particular ischemic stroke. The CHADS2 and CHA2DS2-VASc scores are useful in the assessment of thromboembolic risk in nonvalvular AF and are utilized in decision-making about treatment with oral anticoagulation (OAC). However, OAC is underutilized due to poor patient compliance and contraindications, especially major bleedings. The Virchow triad synthesizes the pathogenesis of thrombogenesis in AF: endocardial dysfunction, abnormal blood stasis, and altered hemostasis. This is especially prominent in the left atrial appendage (LAA), where the low flow reaches its minimum. The LAA is the remnant of the embryonic left atrium, with a complex and variable morphology predisposing to stasis, especially during AF. In patients with nonvalvular AF, 90% of thrombi are located in the LAA. So, left atrial appendage occlusion could be an interesting and effective procedure in thromboembolism prevention in AF. After exclusion of LAA as an embolic source, the remaining risk of thromboembolism does not longer justify the use of oral anticoagulants. Various surgical and catheter-based methods have been developed to exclude the LAA. This paper reviews the physiological and pathophysiological role of the LAA and catheter-based methods of LAA exclusion.
Circulation: Arrhythmia and Electrophysiology, 2015
Pag ag agl lino no no, , , MD MD MD; ; ; Pa Pa Patr tr trizio Mazzone, MD; Nicola Tre re evi vi v... more Pag ag agl lino no no, , , MD MD MD; ; ; Pa Pa Patr tr trizio Mazzone, MD; Nicola Tre re evi vi visi s s , MD; Paolo Della a Be Be B lla, MD Ar A Arrhythm m mia i i U U Un n nit an an nd d d Elec c ctr tr rop ophy hy ysi s s o o olo og ogy y La La Labor rato ori i ies es s, O O Osp p peda a ale e e San R R Raf affa fa fae el ele, M M Mil il lan n n, I I Italy y y Co Co Corr rr rres es espo po pond nd nden en ence ce ce: : : by guest on Abstract: Background -Catheter ablation is an important therapeutic option in post-myocardial infarction (MI) patients with ventricular tachycardia (VT). We analyzed the endo-epicardial electroanatomical mapping (EAM) voltage and morphology characteristics, their association with clinical data and their prognostic value in a large cohort of post-MI patients. Methods and Results -We performed total and segmental analysis of voltage (bipolar dense scar-DS and low voltage areas, unipolar low voltage and penumbra areas) and morphology characteristics (presence of abnormal late-LPs and early potentials-EPs) in 100 post-MI patients undergoing EAM-based VT ablation (26 endo-epicardial procedures) from 2010-12. All patients had unipolar low voltage areas while 18% had no identifiable endocardial bipolar DS areas.
Interactive cardiovascular and thoracic surgery, 2011
The mitral-aortic intervalvular fibrosa (MAIF) is involved in the functional integrity of the two... more The mitral-aortic intervalvular fibrosa (MAIF) is involved in the functional integrity of the two valves. We discuss the clinical decision-making in a population with MAIF pseudoaneurysms following valve replacement surgery. From 2003 to 2010, 16 patients (age 65 ± 17 years) were referred to our institute with worsening valvular disease. All the patients had undergone previous aortic or mitral valve replacement surgery. Transthoracic and transesophageal echocardiography was performed in these patients. According to the echocardiographic findings, we described two groups of patients with MAIF pseudoaneurysms: group 1 (seven patients) without previously known infective disease, and group 2 (nine patients) with a medical history of endocarditis. For asymptomatic patients without an infective background or valve regurgitation (group 1), clinical and echocardiographic follow-up was selected. Reintervention was planned for postinfection pseudoaneurysms (group 2), on account of the residua...
We compared ablation strategy with antiarrhythmic drug therapy (ADT) in patients with paroxysmal ... more We compared ablation strategy with antiarrhythmic drug therapy (ADT) in patients with paroxysmal atrial fibrillation (PAF). BACKGROUND Atrial fibrillation (AF) ablation strategy is superior to ADT in patients with an initial history of PAF, but its role in patients with a long history of AF as compared with ADT remains a challenge.
Circulation: Arrhythmia and Electrophysiology, 2014
Background-Successful late potential (LP) abolition and postprocedural ventricular tachycardia (V... more Background-Successful late potential (LP) abolition and postprocedural ventricular tachycardia (VT) noninducibility constitute significant end points after catheter ablation for VT. We investigated the prognostic impact of a combined procedural end point of VT noninducibility and LP abolition in a large series of post-myocardial infarction patients with VT.
Circulation: Arrhythmia and Electrophysiology, 2014
Circulation: Arrhythmia and Electrophysiology, 2014
Journal of Cardiovascular Medicine, 2012
Journal of Cardiovascular Electrophysiology, 2015
In patients with a prior myocardial infarction (MI), angiographic predictors of ventricular tachy... more In patients with a prior myocardial infarction (MI), angiographic predictors of ventricular tachycardia (VT) recurrence after ablation are lacking. Recently, a pro-arrhythmic effect of a chronic total occlusion (CTO) in a coronary artery has been suggested. 191 patients with prior MI were referred to our Hospital between 2010 and June 2013 for a first ablation of VT. Of these, 84 patients (44%) with stable coronary artery disease that underwent a coronary angiography during the index hospitalization were included in this study. A CTO in an infarct-related artery (IRA-CTO) was present in 47 patients (56%). Patients with and without IRA-CTO did not differ in terms of comorbidities, severity of heart failure, presentation of VT or acute outcome of ablation, that was completely successful in 93% of cases. At electroanatomic mapping, IRA-CTO was associated with greater scar and especially with greater area of border zone (34cm(2) vs 19cm(2) , p = 0.001). Median follow-up was 19 months (IQR 18). At follow-up, patients with IRA-CTO had a significantly higher rate of VT recurrence (47% vs 16%, p = 0.003). At multivariate analysis, IRA-CTO resulted to be an independent predictor of VT recurrence after ablation (HR 4.05, p = 0.004). IRA-CTO is an independent predictor of VT recurrence after ablation and identifies a subgroup of patients with high recurrence rate despite a successful procedure. IRA-CTO is associated with greater scars and border zone area; however, this association does not completely justify its pro-arrhythmic effect. This article is protected by copyright. All rights reserved.
Few data have been published on transcatheter ablation of atrial fibrillation (AF) in patients wi... more Few data have been published on transcatheter ablation of atrial fibrillation (AF) in patients with mitral valve prostheses. Thus, we sought to report our experience. BACKGROUND Ablation is an effective treatment for AF. Patients with prosthetic mitral valves represent a special group because of an increased risk from the ablation procedure due to the possibility of damage to the prosthetic valve.
Pacing and Clinical Electrophysiology, 2013
Background: Lead extraction (LE) techniques have evolved from simple traction to extraction with ... more Background: Lead extraction (LE) techniques have evolved from simple traction to extraction with dilators and powered sheaths with very high success rates. On the basis of the systematic implementation of a stepwise approach, we aimed to identify those characteristics that can predict the need for advanced LE techniques. Methods: Between April 2005 and March 2012, 208 consecutive LE procedures were performed and 456 leads were extracted using an initial superior approach. Advanced techniques for LE (step 4 according to our stepwise approach) were used in 122 patients (58.7%). Results: Younger patient age (odds ratio [OR] = 0.963, P = 0.002), longer duration of the initial implantation (OR = 1.013, P = 0.002), the number of extracted leads (OR = 2.184, P < 0.001), and the presence of right ventricular defibrillator leads (OR = 2.144, P = 0.049) independently predicted the necessity of using step 4 in multivariate analysis. A prediction tool was created taking into account four categorical variables derived even from Receiver Operating Curve analysis of quantitative characteristics (age < 70.7 years, implant duration > 37 months, extraction of at least two leads, one of them being a defibrillator lead). The absence of all the four characteristics was accompanied by 0% positive predictive value for the requirement of step 4 for LE, whereas the coexistence of all four risk factors is characterized by 87% requirement of advanced LE. Conclusion: In most of the patients with indication for LE, use of a powered sheath extraction is necessary in order to obtain clinical success. We have identified four patient and lead characteristics that may help the operator plan the means of extraction. (PACE 2013; 00:1-8) lead extraction, implanted cardioverter defibrillators, pacemakers
Journal of the American College of Cardiology, 2005
Few data have been published on transcatheter ablation of atrial fibrillation (AF) in patients wi... more Few data have been published on transcatheter ablation of atrial fibrillation (AF) in patients with mitral valve prostheses. Thus, we sought to report our experience.
Journal of the American College of Cardiology, 2006
We assessed feasibility of magnetic catheter guidance in patients with atrial fibrillation (AF) u... more We assessed feasibility of magnetic catheter guidance in patients with atrial fibrillation (AF) undergoing circumferential pulmonary vein ablation (CPVA).
Journal of the American College of Cardiology, 2006
We compared ablation strategy with antiarrhythmic drug therapy (ADT) in patients with paroxysmal ... more We compared ablation strategy with antiarrhythmic drug therapy (ADT) in patients with paroxysmal atrial fibrillation (PAF).
Journal of Cardiovascular Electrophysiology, 2012
Left Atrium Remodeling in Repeat AF Ablation. Introduction: There is limited information describi... more Left Atrium Remodeling in Repeat AF Ablation. Introduction: There is limited information describing late changes in the electroanatomic characteristics of the left atrium (LA) associated with recurrence after an anatomical circumferential pulmonary vein ablation (CPVA) for atrial fibrillation (AF).
Europace, 2013
The evolution mechanical dilator sheath has been reported to be an effective tool for chronic lea... more The evolution mechanical dilator sheath has been reported to be an effective tool for chronic lead extraction (LE). We examined safety and efficacy of evolution system as compared with laser system.
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Papers by Nicoleta Carmen Sora