Leonardo Calò

Positioning of left ventricular pacing lead guided by intracardiac echocardiography with vector velocity imaging during cardiac resynchronization therapy procedure

LV Lead Positioning Guided by ICE With Vector Velocity Imaging. Introduction: Intraoperative modality for “real‐time” left ventricular (LV) dyssynchrony quantification and optimal resynchronization is not established. This study determined the feasibility, safety, and efficacy of intracardiac echocardiography (ICE), coupled with vector velocity imaging (VVI), to evaluate LV dyssynchrony and to guide LV lead placement at the time of cardiac resynchronization therapy (CRT) implant.

Ganglionated plexi ablation in right atrium to treat cardioinhibitory neurocardiogenic syncope

Cardioinhibitory neurocardiogenic syncope (CNS) is caused by inappropriately trigger-activated cardiac reflex which finally precipitates asystole, sinus bradycardia, or atrioventricular (AV) block [1]. Despite young patients affected by CNS have an excellent prognosis when electro-structural heart diseases are excluded [2], their quality of life may be seriously affected by recurrent episodes [2, 3]. Cardiac pacing might help to control symptoms and therefore is considered in patients aged more than 40 years old with recurrent episodes and documented cardioinhibitory response [1, 4]. In young individuals, the role of cardiac pacing is dubious due to predicted frequent device substitutions and adverse ventricular remodeling over time. Recently, radiofrequency (RF) biatrial ablation of ganglionated plexi (GP) has showed promising results in the shortand long-term treatment of reflex syncope, functional atrioventricular block, or sinus node dysfunction [5, 6]. We report the case of two patients with frequent episodes of CNSwithmarked cardioinhibitory response at head-up tilt test (HUT) who remained highly symptomatic despite common therapeutic measures. Given the young age of the patients, we decided to attempt, on the basis of previous models of atrial denervation [5], a transcatheter ablation at anatomical sites of the right atrial GP, to evaluate if vagal denervation was effective to prevent or to reduce syncope episodes, delaying as long as possible the timing for pacemaker implantation.

Reference values of left heart echocardiographic dimensions and mass in male peri-pubertal athletes

Background Several articles have proposed reference values in healthy paediatric subjects, but none of them has evaluated a large population of healthy trained adolescents. Design The study purpose was to establish normal echocardiographic measurements of left heart (aortic root, left atrium and left ventricular dimensions and mass) in relation to age, weight, height, body mass index, body surface area and training hours in this specific population. Methods We retrospectively evaluated 2151 consecutive, healthy, peri-pubertal athletes (100% male, mean age 12.4 ± 1.4 years, range 8–18) referred to a single centre for pre-participation screening. All participants were young soccer athletes who trained for a mean of 7.2 ± 1.1 h per week. Results Left ventricular internal diameters, wall thickness, left ventricular mass, aortic root and left atrium diameters were significantly correlated to age, body surface area, height and weight (p < 0.01). Age, height, weight and body surface area were found associated with chamber size, while body mass index and training hours were not. Inclusion of both age and body size parameters in the statistical models resulted in improved overall explained variance for diameters and left ventricular mass. Conclusion Equations, mean values and percentile charts for the different age groups may be useful as reference data in efficiently assessing left ventricular parameters in young athletes.

Transcatheter Ablation in Athletes

The natural history of arrhythmias has suffered an epochal change after the advent of transcatheter ablation. It is a minimally invasive procedure that enables the elimination of additional electric circuits or foci that are responsible for supraventricular and ventricular arrhythmias. In most cases it is carried out under local anesthesia, for which the patient, who is perfectly conscious or possibly mildly sedated, follows the operations and cooperates actively in the procedure and can at any moment communicate with the medical team. The catheters are inserted through venous and/or, more rarely, arterial vascular access points and are moved painlessly and under radioscopic guidance towards the heart. All the material used is completely sterile and for single use. The electrocatheters are positioned in certain anatomically defined areas of the heart, and the electric signals corresponding to cardiac activity are registered.

Electrophysiological Studies in Athletes

Electrophysiological studies are instrumental methods enabling the registration of electric endocavitary cardiac signals relative to the various phases of the cardiac cycle. Registration is carried out through unipolar or bipolar electrocatheters, which also allow electrical stimulation of the heart. Stimulation of the cardiac chambers is an extremely useful method for accurately measuring intervals and/or pauses and for reproducing in the laboratory arrhythmias that patients may experience clinically (arrhythmic inducibility test). Electrophysiological evaluations can be performed via the transesophageal or endocavitary pathways. All the material used both for endocavitary and transesophageal electrophysiological studies is sterile and for single use.

L’ablazione transcatetere negli atleti

L’ablazione transcatetere e una procedura che si esegue in anestesia locale, minimamente invasiva e che permette di eliminare i circuiti elettrici accessori o i foci responsabili delle aritmie sopraventricolari e ventricolari.

Lo studio elettrofisiologico negli atleti

Lo studio elettrofisiologico e una metodica strumentale che permette la registrazione dei segnali elettrici endocavitari cardiaci relativi alle varie fasi del ciclo cardiaco. La valutazione elettrofisiologica puo essere effettuata per via transesofagea o endocavitaria. La prima presenta dei limiti che consistono nella esiguita di informazioni elettriche (registrazione solo di segnali atriali) rispetto a uno studio endocavitario completo durante il quale e possibile stimolare sia le camere ventricolari che atriali ed eseguire contestualmente una procedura ablativa.