Lucia De Luca

Catheter ablation of atrial fibrillation in patients with diabetes mellitus type 2: results from a randomized study comparing pulmonary vein isolation versus antiarrhythmic drug therapy.

Introduction: Atrial fibrillation (AF) and diabetes mellitus type 2 (DM2) often coexist; however, a small number of patients with DM2 undergoing catheter ablation (CA) of AF have been included in previous studies. The aim of this study was to evaluate safety and efficacy of ablation therapy in DM2 patients with drug refractory AF.

Patients with left bundle branch block and left axis deviation show a specific left ventricular asynchrony pattern: Implications for left ventricular lead placement during CRT implantation

BACKGROUND Left bundle branch block (LBBB) and left axis deviation (LAD) patients may have poor response to resynchronization therapy (CRT). We sought to assess if LBBB and LAD patients show a specific pattern of mechanical asynchrony. METHODS CRT candidates with non-ischemic cardiomyopathy and LBBB were categorized as having normal QRS axis (within -30° and +90°) or LAD (within -30° and -90°). Patients underwent tissue Doppler imaging (TDI) to measure time interval between onset of QRS complex and peak systolic velocity in ejection period (Q-peak) at basal segments of septal, inferior, lateral and anterior walls, as expression of local timing of mechanical activation. RESULTS Thirty patients (mean age 70.6years; 19 males) were included. Mean left ventricular ejection fraction was 0.28±0.06. Mean QRS duration was 172.5±13.9ms. Fifteen patients showed LBBB with LAD (QRS duration 173±14; EF 0.27±0.06). The other 15 patients had LBBB with a normal QRS axis (QRS duration 172±14; EF 0.29±0.05). Among patients with LAD, Q-peak interval was significantly longer at the anterior wall in comparison to each other walls (septal 201±46ms, inferior 242±58ms, lateral 267±45ms, anterior 302±50ms; p<0.0001). Conversely, in patients without LAD Q-peak interval was longer at lateral wall, when compared to each other (septal 228±65ms, inferior 250±64ms, lateral 328±98ms, anterior 291±86ms; p<0.0001). CONCLUSIONS Patients with heart failure, presenting LBBB and LAD, show a specific pattern of ventricular asynchrony, with latest activation at anterior wall. This finding could affect target vessel selection during CRT procedures in these patients.

An unusual case of arrhythmic palpitations in a volleyball player

A case of a 31 years old woman volleyball player highly symptomatic for arrhythmic palpitations is reported. The woman was disqualified from competitive sport and referred to our centre for atrial fibrillation (AF) ablation. During symptoms surface ECG had documented irregular supraventricular tachyarrhythmia interpreted as AF. Electrophysiological study could reveal double-His conduction as the true arrhythmia mechanism and the patient was successfully treated with nodal slow pathway ablation. Patient was totally asymptomatic at a 12 months follow up and he was readmitted to competitive sport. The case further underlines the concept that young subjects with suspected lone AF should undergo to a careful clinical evaluation in order to reconstruct the exact electrophysiological mechanism to plan a safe and effective therapy.

Safety and feasibility of atrial fibrillation ablation using Amigo® system versus manual approach: A pilot study

Background The Amigo® Remote Catheter System is a relatively new robotic system for catheter navigation. This study compared feasibility and safety using Amigo (RCM) versus manual catheter manipulation (MCM) to treat paroxysmal atrial fibrillation (PAF). Contact force (CF) and force-time integral (FTI) values obtained during pulmonary vein isolation (PVI) ablation were compared. Methods Forty patients were randomly selected for either RCM (20) or MCM (20). All were studied with the Thermocool® SmartTouch® force-sensing catheter (STc). Contact Force (CF), Force Time Integral (FTI) and procedure-related data, were measured/stored in the CARTO®3. Results All cases achieved complete PVI without major complications. Mean CF was significantly higher in the RCM group (13.3 ± 7.7 g in RCM vs. 12.04 ± 7.42 g in MCM p < 0.001), as was overall mean FTI (425.6 gs ± 199.6 gs with RCM and 407.5 gs ± 288.0 gs in MCM (p = 0.007) and was more likely to fall into the optimal FTI range (400-1000) using RCM (66.1% versus 49.1%, p < 0.001). FTI was significantly more likely to fall within the optimal range in each PV, as was CF within its optimal range in the right PVs, but trended higher in the left PVs. Freedom from atrial tachyarrhythmia was 90.0% for the RCM and 70.0% for the MCM group (p = 0,12) at 540 days follow-up. Conclusions This pilot study suggests that use of the Amigo RCM system, with STc catheter, seems to be safe and effective for PVI ablation in paroxysmal AF patients. A not statistically significant favorable trend was observed for RCM in term of AF-free survival.

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.