Drug delivery to tumours using a novel 5-FU derivative encapsulated into lipid nanocapsules.

In this work, a novel lipophilic 5-fluorouracil (5-FU) derivative was synthesised and encapsulated into lipid nanocapsules (LNC). 5-FU was modified with lauric acid to give a lipophilic mono-lauroyl-derivative (5-FU-C12, MW of about 342 g/mol, yield of reaction 70%). 5-FU-C12 obtained was efficiently encapsulated into LNC (encapsulation efficiency above 90%) without altering the physico-chemical characteristics of LNC.

Maximization of interventricular conduction time by means of quadripolar leads for cardiac resynchronization therapy.

Purpose: Identifying the left ventricular (LV) site associated with the maximum spontaneous interventricular conduction time (right ventricle (RV)-to-LV interval) has proved to be an effective strategy for optimal LV pacing site selection in cardiac resynchronization therapy (CRT). The aim of our study was to determine whether quadripolar LV lead technology allows RV-to-LV interval maximization.

Methods: We enrolled 108 patients undergoing implantation of a CRT system using an LV quadripolar lead and 114 patients who received a bipolar lead.

Comparison between IEGM-based approach and echocardiography in AV/PV and VV delay optimization in CRT-D recipients (Quicksept study).

Background: AtrioVentricular (AV) and InterVentricular (VV) delay optimization can improve ventricular function in Cardiac Resynchronization Therapy (CRT) and is usually performed by means of echocardiography. St Jude Medical has developed an automated algorhythm which calculates the optimal AV and VV delays (QuickOpt™) based on Intracardiac ElectroGrams, (IEGM), within 2 min. So far, the efficacy of the algorhythm has been tested acutely with standard lead position at right ventricular (RV) apex.

Noninvasive monitoring of stroke volume with resynchronization devices in patients with ischemic cardiomyopathy.

Background: A novel method to estimate cardiac volumes based on impedance measurements using the leads of a resynchronization device has been developed. This study investigated the method in patients with ischemic cardiomyopathy and documented wall motion abnormalities.

Method And Results: Fifteen postinfarction patients (age 68 ± 8 years, ejection fraction 27 ± 5%) with symptomatic heart failure and ≥ 1 akinetic or dyskinetic segment were included.

Resynchronization therapy optimization by intracardiac impedance.

Aims: For successful cardiac resynchronization therapy (CRT), an optimization of left ventricular (LV) lead position and stimulation timing is required. The feasibility of optimizing LV lead position, atrioventricular delay (AVd), and interventricular delay (VVd) in CRT using intracardiac impedance measurement was evaluated.

Methods And Results: Heart failure patients (n = 14, NYHA 13×III, 1×II, ejection fraction: 26 ± 6%, QRS: 165 ± 30 ms) were stimulated by AAI and biventricular (DDD-BiV) pacing in turn.

Intracardiac impedance monitors stroke volume in resynchronization therapy patients.

Aims: Monitoring of haemodynamic parameters or surrogate parameters of the left ventricle is especially important for patients under cardiac resynchronization therapy (CRT). Intracardiac impedance reflects left ventricular (LV) volume changes well in animal models. Since it is unknown whether this also holds in humans with heart failure (HF), we examined the correlation of LV intracardiac impedance with haemodynamic parameters in CRT patients for different positions of the LV lead.

Antiarrhythmic effect of reverse ventricular remodeling induced by cardiac resynchronization therapy: the InSync ICD (Implantable Cardioverter-Defibrillator) Italian Registry.

Objectives: We investigated whether the reverse remodeling after cardiac resynchronization therapy (CRT) might reduce the occurrence of ventricular arrhythmias (VAs).

Background: It is currently debated whether CRT has an effect on the burden of VAs.

Methods: The study included 398 patients treated with a CRT defibrillator and with a follow-up of at least 12 months.

Efficacy of cardiac resynchronization therapy in very old patients: the Insync/Insync ICD Italian Registry.

Aims: To assess the effects of cardiac resynchronization therapy (CRT) in > or =80-year-old patients vs. patients <80 years, in terms of clinical, functional, and echocardiographic parameters after 12 month of CRT, survival, and incidence of arrhythmic events.

Methods And Results: The study population consisted of 1181 CRT patients (85 were > or =80 years old).

Clustering of ventricular tachyarrhythmias in heart failure patients implanted with a biventricular cardioverter defibrillator.

Background: Temporal patterns of ventricular tachyarrhythmia (VT/VF) have been studied only in patients who have received implantable cardioverter defibrillators (ICD) for secondary prevention of sudden death, and mainly in ischemic patients. The aim of this study was to evaluate VT/VF recurrence patterns in heart failure (HF) patients with biventricular ICD and to stratify results according to HF etiology and ICD indication.

Methods And Results: We studied 421 patients (91% male, 66 +/- 9 years).

Long-term survival in patients treated with cardiac resynchronization therapy: a 3-year follow-up study from the InSync/InSync ICD Italian Registry.

Background: Studies reporting the long-term survival of patients treated with cardiac resynchronization therapy (CRT) outside the realm of randomized controlled trials are still lacking. The aim of this study was to quantify the survival of patients treated with CRT in clinical practice and to investigate the long-term effects of CRT on clinical status and echocardiographic parameters.

Methods: The study population consisted of 317 consecutive patients with implanted CRT devices from eight Italian University/Teaching Hospitals.

Acute and long-term outcome of transvenous cryothermal catheter ablation of supraventricular arrhythmias involving the perinodal region.

Objective: Cryoenergy is a new valuable treatment option to perform ablation close to the atrioventricular (AV) node in the cure of supraventricular tachycardias because of its favourable properties, such as the possibility of creating reversible lesions. The aim of this study was to report our experience on the effectiveness and safety of catheter cryoablation performed in "critical areas" to treat a large cohort of patients with supraventricular arrhythmias.

Methods: One hundred and thirty-one patients suffering from supraventricular tachycardias underwent catheter cryoablation using a 7F catheter.

Characteristics of ventricular tachyarrhythmias occurring in ischemic versus nonischemic patients implanted with a biventricular cardioverter-defibrillator for primary or secondary prevention of sudden death.

Objectives: The InSync ICD Registry evaluated patients indicated for cardiac resynchronization therapy with defibrillation.

Background: Cardiac resynchronization therapy with defibrillation systems are prescribed for both primary and secondary prevention of sudden cardiac death in patients with heart failure with both ischemic and nonischemic etiology. The characterization of ventricular tachyarrhythmias detected by the ICD is not well known in these subpopulations.

Comparison of 1-year effects of left ventricular and biventricular pacing in patients with heart failure who have ventricular arrhythmias and left bundle-branch block: the Bi vs Left Ventricular Pacing: an International Pilot Evaluation on Heart Failure Patients with Ventricular Arrhythmias (BELIEVE) multicenter prospective randomized pilot study.

Background: Little is known on the chronic effects of left ventricular pacing (LV) in heart failure.

Methods: Seventy-four patients with LBBB, QRS >130 milliseconds, New York Heart Association class (Bradley DJ, Bradley EA, Braughman KL, et al. Cardiac resynchronization and death from progressive heart failure: a meta-analysis of randomized controlled trials.

Right ventricular versus biventricular antitachycardia pacing in the termination of ventricular tachyarrhythmia in patients receiving cardiac resynchronization therapy: the ADVANCE CRT-D trial.

Background: The purpose of this investigation is to compare the efficacy of antitachycardia pacing (ATP) delivered via the right ventricular (RV) lead versus ATP delivered simultaneously via the right and left ventricular leads (biventricular [BiV]) in the termination of ventricular tachyarrhythmia (VT) in patients receiving cardiac resynchronization therapy (CRT) with ICD capabilities.

Methods And Results: The ADVANCE CRT is a prospective, multicenter, randomized, parallel trial evaluating RV versus BiV ATP in the termination of VT in CRT patients. The study will test the hypothesis that BiV ATP is superior to RV ATP in the termination of VT and fast VT.

Typical atrial flutter ablation outcome: correlation with isthmus anatomy using intracardiac echo 3D reconstruction.

Aims: To verify if sites of conduction gaps on the isthmus correlate with anatomical peculiarities using the intracardiac echo (ICE) and a new 3D device to reconstruct the isthmus in patients undergoing cavotricuspid isthmus ablation.

Methods And Results: Twenty patients underwent isthmus ablation using an 8 mm tip ablation catheter. Two-dimensional and 3D ICE reconstruction of the isthmus was made before, during and after ablation.

Functional and echocardiographic improvement following multisite biventricular pacing for congestive heart failure.

Background: Heart failure remains a major cause of morbidity and mortality despite advances in pharmacological treatment. Recently, multisite biventricular pacing has been used in the treatment of patients with heart failure.

Objectives And Methods: The short and medium term effects of this treatment modality were assessed, and the association between baseline clinical characteristics and the positive response to treatment was investigated.

Percutaneous catheter cryothermal ablation of atrioventricular nodal reentrant tachycardia: efficacy and safety of a new ablation technique.

Background: Radiofrequency catheter ablation is nowadays a widely used technique for the treatment of arrhythmias; however, due to the possible complications such as atrioventricular block when radiofrequency is delivered in the septal area, this type of energy is not optimal. In contrast, cryoenergy has several positive features; first of all, it allows for the creation of reversible lesions and hence to test the effects of the ablation while the lesion is still forming thus reducing the number of ineffective and useless lesions. In addition, it also allows for the evaluation of the acute effects on the structures adjacent to the ablation site.

DDDR pacing driven by contractility versus DDI pacing in vasovagal syncope: a multicenter, randomized study.

Recent clinical trials have shown that selected patients with recurrent vasovagal syncope (VVS) may benefit from permanent cardiac pacing. In a previous study using head-up tilt testing (HUT) the authors demonstrated that the increase in sympathetic activity preceding syncope could be sensed by a microaccelerometer located in the tip of a ventricular pacing lead and used to drive a rate adaptive pacer. They compared in a single blind randomized crossover study, DDDR pacing driven by this system, with conventional DDI pacing in patients with recurrent VVS.

Cardiac resynchronization and implantable cardioverter defibrillator therapy: preliminary results from the InSync Implantable Cardioverter Defibrillator Italian Registry.

The aim of this study was to evaluate ventricular arrhythmias occurring in recipients of the InSync ICD for the primary and secondary prevention of sudden death. The InSync ICD was implanted in 142 patients (128 men; mean age 65 +/- 10 years) with heart failure (mean NYHA functional Class 3.0 +/- 0.

Local electrogram assessment of unidirectional isthmus block is sufficient to predict the acute and long-term success of cavo-tricuspid isthmus ablation.

Background: This study investigated whether a minimal approach to typical atrial flutter ablation using an 8 mm tip catheter with a 150 W generator with only the documentation of clockwise block by means of local criteria predicts a good long-term outcome.

Methods: Seventy patients underwent typical atrial flutter ablation. A multipolar catheter was inserted into the coronary sinus (CS) and an 8 mm tip ablation catheter was used to ablate and map the isthmus.

Atrial mapping by basket catheter in patients with atrial fibrillation submitted to linear ablation.

Recently non-pharmacological therapies for atrial fibrillation (AF) have been developed. The electrophysiological mechanisms of AF is thought to be the development of multiple reentrant wavelets circulating around anatomic barriers and variable regions of functional conduction block responsible of the perpetuation of the arrhythmia. Also the role of the triggering foci has been highlighted.

Comparison of defibrillation thresholds using monodirectional electrical vector versus bidirectional electrical vector.

Background: Currently, two main lead configurations are used for implantable cardioverter-defibrillators (ICD). One generates a monodirectional electrical vector by using the can surface as an active part (hot can) together with a right ventricular defibrillation coil. The other one (TRIAD) produces a bidirectional electrical vector by adding a proximal defibrillation electrode on the same lead.

Different patterns of atrial activation in idiopathic atrial fibrillation: simultaneous multisite atrial mapping in patients with paroxysmal and chronic atrial fibrillation.

Objectives: We aimed to evaluate: 1) the behavior of electrical activity simultaneously in different atrial regions during atrial fibrillation (AF); 2) the difference of atrial activation between paroxysmal and chronic AF; 3) the atrial refractoriness dispersion; and 4) the correlation between the effective refractory periods (ERPs) and the FF intervals.

Background: Little data exist on the electrophysiologic characteristics of the different atrial regions in patients with AF. A more detailed knowledge of the electrical activity during AF may provide further insights to improve treatment of AF.