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"Paolucci, Marco"
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The Fluoroless Future in Electrophysiology: A State-of-the-Art Review
Fluoroscopy has always been the cornerstone imaging method of interventional cardiology procedures. However, radiation exposure is linked to an increased risk of malignancies and multiorgan diseases. The medical team is even more exposed to X-rays, and a higher incidence of malignancies was reported in this professional group. In the last years, X-ray exposure has increased rapidly, involving, above all, the medical team and young patients and forcing alternative fluoroless imaging methods. In cardiac electrophysiology (EP) and pacing, the advent of 3D electroanatomic mapping systems with dedicated catheters has allowed real-time, high-density reconstruction of both heart anatomy and electrical activity, significantly reducing the use of fluoroscopy. In addition, the diffusion of intracardiac echocardiography has provided high anatomical resolution of moving cardiac structures, providing intraprocedural guidance for more complex catheter ablation procedures. These methods have largely demonstrated safety and effectiveness, allowing for a dramatic reduction in X-ray delivery in most arrhythmias’ ablations. However, some technical concerns, as well as higher costs, currently do not allow their spread out in EP labs and limit their use to only procedures that are considered highly complex and time-consuming and in young patients. In this review, we aim to update the current employment of fluoroless imaging in different EP procedures, focusing on its strengths and weaknesses.
Journal Article
A case of premature ventricular contractions, ventricular tachycardia, and arrhythmic storm induced by right ventricular pacing during cardiac resynchronization therapy: Electrophysiological mechanism and catheter ablation
Abstract A 77-year-old man with ischemic cardiomyopathy and a cardiac resynchronization therapy-defibrillator (CRT-D) device came to our attention due to incessant ventricular tachycardia and multiple implantable cardioverter defibrillator (ICD) shocks. An electrocardiogram showed non-sustained monomorphic ventricular tachycardias (NSVTs) constantly occurring after each biventricular stimulation. During an electrophysiological study, NSVTs reproducibly recurred only after right ventricular (RV) pacing; LV pacing did not induce any NSVTs. The activation map was consistent with a localized reentry at the interventricular septum, and a double exit; at the LV exit site, a single radiofrequency energy application immediately interrupted the occurrence of the NSVTs. Current evidence supports LV pacing to be pro-arrhythmogenic in few CRT patients. This unusual case shows that RV pacing during CRT could produce frequent ventricular arrhythmias and arrhythmic storm. Catheter ablation can be considered an effective therapeutic option, especially when CRT maintenance is highly advisable.
Journal Article
Subcutaneous ICD implantation in a patient with hypertrophic cardiomyopathy after transvenous ICD failure: A case report
We describe the case of a patient with hypertrophic cardiomyopathy who experienced the failure of a transvenous implantable cardioverter defibrillator (T‐ICD) lead and the following inability of a second T‐ICD to convert a ventricular fibrillation. A subcutaneous ICD (S‐ICD) was finally implanted and was effective at defibrillation test.
Journal Article
LA FLORA DI PALENA (PARCO NAZIONALE DELLA MAJELLA): AGGIORNAMENTO FLORISTICO
Il presente lavoro segue un altro del 2012 ed e finalizzato a riportare un elenco floristico aggiornato dei taxa presenti nellambito di studio. La compilazione di una nuova check-list e indispensabile poiché i recenti studi hanno portato a rimaneggiamenti tassonomici, nuove segnalazioni e lesclusione di altri considerati presenti. [elenco floristico attuale comprende 1535 taxa tra cui 162 specie endemiche che accrescono limportanza fitogeografica dellarea di studio. Lo spettro corologico mostra che i taxa censiti appartengono a 47 diversi corotipi, ripartiti in 9 contingenti geografici.
Journal Article
LA FLORA DI TARANTA PELIGNA (ABRUZZO, ITALIA)
The Municipality of Taranta Peligna, located in the Province of Chieti (Abruzzo Region), is partially included in the Majella National Park and occupies an area of 21.65 km². This paper reports a check-list of the taxa present in the study area that includes 1186 entity, including 83 endemic species that increase its phytogeographic importance. The chorological spectrum shows that the surveyed entities belong to 52 different chorotypes divided into 9 geographical contingents.
Journal Article
LA FLORA DI LAMA DEI PELIGNI (ABRUZZO, ITALIA): AGGIORNAMENTO SISTEMATICO E NUOVE SEGNALAZIONI
Il Comune di Lama dei Peligni è situato in Provincia di Chieti (Regione Abruzzo), è parzialmente compreso nel Parco Nazionale della Maiella e occupa la superficie di 31,33 km2. Il presente lavoro segue un altro del 2011 e ha la finalità di riportare un elenco floristico aggiornato dei taxa presenti nell'ambito di studio. La compilazione di una nuova check-list è indispensabile poiché dopo il 2011, i nuovi studi hanno portato a rimaneggiamenti tassonomici, altre segnalazioni e l'esclusione di taxa in precedenza considerati presenti. L'elenco floristico attuale comprende 1360 taxa tra cui 94 specie endemiche che accrescono l'importanza fitogeografica dell'area di studio. Lo spettro corologico mostra che i taxa censiti appartengono a 52 diversi corotipi, ripartiti in 9 contingenti geografici.
Journal Article
Arrhythmogenic Cardiomyopathy: Definition, Classification and Arrhythmic Risk Stratification
Arrhythmogenic cardiomyopathy (ACM) is a heart disease characterized by a fibrotic replacement of myocardial tissue and a consequent predisposition to ventricular arrhythmic events, especially in the young. Post-mortem studies and the subsequent diffusion of cardiac MRI have shown that left ventricular involvement in arrhythmogenic cardiomyopathy is common and often develops early. Regarding the arrhythmic risk stratification, the current scores underestimate the arrhythmic risk of patients with arrhythmogenic cardiomyopathy with left involvement. Indeed, the data on arrhythmic risk stratification in this group of patients are contradictory and not exhaustive, with the consequence of not correctly identifying patients at a high arrhythmic risk who deserve protection from arrhythmic death. We propose a literature review on arrhythmic risk stratification in patients with ACM and left involvement to identify the main features associated with an increased arrhythmic risk in this group of patients.
Journal Article
Protection from sudden cardiac death using a new extravascular implantable cardioverter-defibrillator device: a literature review and a case series from a high-volume single center
The extravascular implantable cardioverter-defibrillator (EV-ICD, Aurora, Medtronic, Minneapolis, MN, USA) has recently been validated as a new device for preventing arrhythmic death with the aim of reducing vascular and mechanical complications of transvenous ICDs and overcoming the limitations of subcutaneous ICDs. A dedicated learning program is required and, in addition to the electrophysiologist, the implantation procedure must be performed with the assistance of an anesthesiologist for general anesthesia induction and, especially in the early stages of training, a cardiothoracic surgeon for assistance during access to the retrosternal space where the lead should be placed. The objective of this case series is to describe the experience at our high-volume hospital where we treated the first 10 patients with the Aurora EV-ICD device over a period of 8 months.
Journal Article
Evaluation of remote monitoring of parturition in dairy cattle as a new tool for calving management
BACKGROUND: Proper calving management of dairy herds is a crucial aspect of the bovine life cycle, as it has profound effects on calf viability and on the post-partum course of the dam. The objectives of this study were to monitor the calving process through the use of a remote alarm system and to determine the impact of prompt emergency obstetric procedures in case of dystocia for the prevention of stillbirths and post-partum reproductive pathologies, and for improving herd fertility. Six groups of experimental animals were studied: monitored heifers (n = 60) and multiparous cows (n = 60) were compared with non-observed animals (n = 60 heifers and n = 60 multiparous) giving birth during the same time period and housed in the calving barn, and with unmonitored animals placed in a dry zone (n = 240 heifers and n = 112 multiparous cows). RESULTS: The incidence of dystocia ranged from a minimum of 23.4% (monitored multiparous cows) to a maximum of 33.3% (monitored heifers), and there were no differences compared with control groups. However, the rate of stillbirth was higher in control groups than in the monitored groups (P < 0.01). Among both heifers and multiparous cows, the incidence of post-partum uterine infections was higher in the unmonitored animals both in the calving barn (P < 0.01) and in the dry zone (P < 0.05) compared with monitored animals. Among both heifers and multiparous cows, the control groups showed higher rates of foetal membrane retention than did the monitored groups (P < 0.001). The calving-to-conception interval was shorter; in particular, observed heifers showed a significant advantage of approximately 46 days compared with the unmonitored group (P < 0.001) and 32 days compared with the group in the calving barn (P < 0.05). Multiparous cows also had a reduction in the number of days open. CONCLUSIONS: The remote alarm system used to monitor the calving process assured the prompt presence of personnel, improving both the cow’s reproductive efficiency and neonatal viability.
Journal Article