Luigi Padeletti

Presence and duration of atrial fibrillation detected by continuous monitoring: Crucial implications for the risk of thromboembolic events

AF and the Risk of Thromboembolic Events. Introduction: Asymptomatic atrial fibrillation (AF) can expose patients to the risk of stroke. The primary objective of this study was to assess the incidence of thromboembolic events in relationship with CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke, or transient ischemic attack) score and AF presence/duration. The secondary objective was to compare intermittent versus continuous monitoring strategies.

Electrocardiographic Criteria of True Left Bundle Branch Block: A Simple Sign to Predict a Better Clinical and Instrumental Response to CRT

Background: Cardiac resynchronization therapy (CRT) has proved to be very effective in improving morbidity and mortality in patients affected with severe congestive heart failure. Its efficacy has been shown to be greater in patients with left bundle branch block (LBBB). The aim of our study was to verify if newly proposed criteria for true LBBB identify patients with a better clinical and instrumental response to CRT.

Safety and Performance of a System Specifically Designed for Selective Site Pacing

Introduction: u2002In the right ventricle, selective site pacing (SSP) has been shown to avoid detrimental hemodynamic effects induced by right ventricular apical pacing and, in the right atrium, to prevent the onset of atrial fibrillation and to slow down disease progression. The purpose of our multicenter observational study was to describe the use of a transvenous 4‐French catheter‐delivered lead for SSP in the clinical practice of a large number of centers.

Cardiac Resynchronization Therapy

Cardiac resynchronization refers to pacing techniques that change the degree of atrial and ventricular electromechanical asynchrony in patients with major atrial and ventricular conduction disorders. Atrial and ventricular resynchronization is usually accomplished by pacing from more than one site in an electrical chamber--atrium or ventricle--and occasionally by stimulation at a single unconventional site. Resynchronization produces beneficial hemodynamic and antiarrhythmic effects by providing a more physiologic pattern of depolarization. Atrial resynchronization may prevent atrial fibrillation in selected patients with underlying bradycardia or interatrial block. Its antiarrhythmic effect in the absence of bradycardia is unclear. Ventricular resynchronization is of far greater clinical value than atrial resynchronization. Biventricular (or single-chamber left ventricular) pacing is beneficial for patients with congestive heart failure, severe left ventricular systolic dysfunction, dilated cardiomyopathy (either ischemic or idiopathic), and a major left-sided intraventricular conduction disorder, such as left bundle branch block. The change in electrical activation from resynchronization, which has no positive inotropic effect as such, is translated into mechanical improvement with a more coordinated left ventricular contraction. Several recent randomized trials and a number of observational studies have demonstrated the long-term effectiveness of ventricular resynchronization in the above group of patients. The high incidence of sudden death among these patients has encouraged ongoing clinical trials to evaluate the benefit of a system that combines biventricular pacing and cardioversion-defibrillation into a single implantable device.Aim: Gender related differences in epidemiology, treatment, and prognosis of heart failure (HF) have been reported. We examined the sex influence in patients treated with cardiac resynchronization therapy (CRT).

Rotational mechanics of the left ventricle in AL amyloidosis.

Aims: The aim of this study was to investigate whether alterations in left ventricular (LV) twisting and untwisting motion could be induced by cardiac involvement in patients with immunoglobulin light‐chain (AL) systemic amyloidosis. Methods and Results: Forty‐five patients with AL amyloidosis and 26 control subjects were evaluated. After standard echocardiographic measurement and two‐dimensional (2D) speckle tracking echocardiography, LV rotation at both basal and apical planes, twisting, twisting rate, and longitudinal strain were measured. Tissue Doppler imaging (TDI) derived early diastolic peak velocity at septal mitral annulus (E′) was also evaluated. Twenty‐six of 45 patients with systemic amyloidosis were classified as having cardiac amyloidosis (CA) if the mean value of the LV wall thickness was ≥ 12 mm or not (NCA) if this value was not reached. In NCA patients, both LV twist and untwisting rate were increased while they were decreased in CA patients making them similar to the control group. Longitudinal strain was reduced only in CA patients. Impaired relaxation as indicated by E′ values was progressively reduced in the course of the disease. Conclusions: Both twisting and untwisting motions are increased in patients with AL systemic amyloidosis with no evidence of cardiac involvement while they are reduced in patients with evident amyloidosis cardiac involvement. This finding suggests that impaired LV relaxation induces a compensatory mechanism in the early phase of the disease, which fails in more advanced stage when both twisting and untwisting rates are reduced. The increase in LV rotational mechanics could be a marker of subclinical cardiac involvement. (Echocardiography 2010;27:1061‐1068)

Left Ventricular Dyssynchrony Resulting from Right Ventricular Apical Pacing: Relevance of Baseline Assessment

Objectives: Evaluation of left ventricular (LV) dyssynchrony in patients undergoing short‐term right ventricular apical (RVA) pacing and correlation with baseline echocardiographic and clinical characteristics.

Atrial Tachyarrhythmia Recurrence Temporal Patterns in Bradycardia Patients Implanted with Antitachycardia Pacemakers

Introduction: New‐generation pacemakers allow continuous atrial tachyarrhythmia (AT) monitoring that provides accurate information about AT type, frequency, burden, and temporary evolution.

Predictors of Atrial Antitachycardia Pacing Efficacy in Patients Affected by Brady-Tachy Form of Sick Sinus Syndrome and Implanted with a DDDRP Device

Background: Recent options to treat atrial tachyarrhythmias (ATA) include implantable devices delivering antitachycardia pacing therapies (ATP). No prospective study selected patients with higher chances of episode termination by ATP or indicated the most effective ATP use. Our aim was to study ATP efficacy in patients with brady‐tachy form of sinus node disease (SND), identifying clinical factors, ATA characteristics, and device features predicting ATP efficacy.

Application of the Seattle Heart Failure Model in Patients on Cardiac Resynchronization Therapy

Background: The Seattle Heart Failure Model (SHFM) is a multimarker risk assessment tool able to predict outcome in heart failure (HF) patients.

Temporal Variability of Atrial Fibrillation in Pacemaker Recipients for Bradycardia: Implications for Crossover Designed Trials, Study Sample Size, and Identification of Responder Patients by Means of Arrhythmia Burden

Background: Most clinical trials that have tested pacing therapies to prevent and treat atrial tachyarrhythmias (AT) have chosen endpoints such as AT frequency or burden (defined as percentage of time a patient is in AT), but failed to show unequivocal evidence of a clinical impact.