Publications by authors named "Federico Migliore"
Cardiac implantable electronic devices infections (CIEDI) are associated with poor survival despite the improvement in transvenous lead extraction (TLE). Aetiology and systemic involvement are driving factors of clinical outcomes. The aim of this study was to explore their contribute on overall mortality.
View Article and Find Full Text PDFArticle Synopsis
- * AAs were the first symptom of IAS in 52% of patients, and nearly a quarter had multiple AAs documented.
- * The study found a moderate incidence of severe outcomes, including a yearly primary endpoint rate of 1.4%, with younger patients experiencing higher risks and other complications affecting some patients as well.
Aims: The use of ultrasound (US)-guided venous puncture for cardiac pacing/defibrillation lead placement may minimize the risk of periprocedural complications and radiation exposure. However, none of the published studies have been sufficiently powered to recommend this approach as the standard of care. We compare the safety and efficacy of ultrasound-guided axillary venous puncture (US-AVP) vs.
View Article and Find Full Text PDFLeft ventricular non-compaction (LVNC) is a rare heart muscle disease defined by the presence of prominent left ventricular trabeculation, deep intertrabecular recesses, and a thin compact layer. Several hypotheses have been proposed regarding its pathogenesis, with the most recently accepted one being that compact layer and trabeculated layers develop independently according to an "allometric growth". The current gold-standard diagnostic criteria (in particular, the Petersen index non-compaction/compaction ratio > 2.
View Article and Find Full Text PDFOver the last 20 years, the scientific progresses in molecular biology and genetics in combination with the increasing use in the clinical setting of contrast-enhanced cardiac magnetic resonance (CMR) for morpho-functional imaging and structural myocardial tissue characterization have provided important new insights into our understanding of the distinctive aspects of cardiomyopathy, regarding both the genetic and biologic background and the clinical phenotypic features. This has led to the need of an appropriate revision and upgrading of current nosographic framework and pathobiological categorization of heart muscle disorders. This article proposes a new definition and classification of cardiomyopathies that rely on the combination of the distinctive pathobiological basis (genetics, molecular biology and pathology) and the clinical phenotypic pattern (morpho-functional and structural features), leading to the proposal of three different disease categories, each of either genetic or non-genetic etiology and characterized by a combined designation based on both "anatomic" and "functional" features, i.
View Article and Find Full Text PDFArticle Synopsis
- The EHRA survey aimed to assess the current practices and accessibility of genetic testing for cardiac diseases across Europe, highlighting the increase in clinical indications in recent years.
- From 357 respondents across 69 countries, 39% reported no genetic testing or a low annual rate, with 78% facing limitations in access due to factors like lack of dedicated units and reimbursement issues.
- The survey emphasized the importance of genetic counseling and recommended cascade testing for family members, revealing varied perceptions of the value of genetic testing in diagnosis, prognosis, and treatment based on the specific inherited conditions.
Article Synopsis
- The study aimed to investigate the occurrence and outcomes of significant tricuspid valve regurgitation (TRI) following transvenous lead extraction (TLE) using mechanical rotational sheaths in patients with previously implanted leads.
- Out of 158 patients monitored, 5.7% experienced significant TRI post-extraction linked to prolonged lead implantation, tricuspid valve damage, and reasons for extraction like infection.
- Notably, severe TRI was identified as an independent mortality risk factor, emphasizing the need for physicians to closely observe patients for this complication during the TLE procedure.
Background: Conduction system pacing (CSP) by His bundle pacing or left bundle branch area pacing (LBBAP) is incorporated into Heart Rhythm Society guidelines for the management of bradycardia and cardiac resynchronization therapy. Despite increasing adoption with both lumenless leads and stylet-driven leads, concerns regarding the feasibility and safety of the extraction of CSP leads remain.
Objective: The aim of the study was to report on the safety, feasibility, and clinical outcomes of the extraction of CSP leads.
Aims: Arrhythmia-induced cardiomyopathy (AiCM) represents a subtype of acute heart failure (HF) in the context of sustained arrhythmia. Clear definitions and management recommendations for AiCM are lacking. The European Heart Rhythm Association Scientific Initiatives Committee (EHRA SIC) conducted a survey to explore the current definitions and management of patients with AiCM among European and non-European electrophysiologists.
View Article and Find Full Text PDFArticle Synopsis
- Cardiac pacing traditionally focused on stimulating the right ventricle to address conduction issues, but recent advancements have shifted attention to preventing pacing-induced dyssynchrony through cardiac resynchronization.
- Studies indicate that conduction system pacing (CSP), particularly techniques like His bundle stimulation and left bundle branch pacing, not only prevent dyssynchrony but also effectively address conduction blocks with better outcomes than biventricular pacing.
- Despite promising findings, the European Society of Cardiology guidelines currently recognize CSP's role only minimally, highlighting a gap between emerging practices and official recommendations.
Background And Aims: Available data on continuous rhythm monitoring by implantable loop recorders (ILRs) in patients with Brugada syndrome (BrS) are scarce. The aim of this multi-centre study was to evaluate the diagnostic yield and clinical implication of a continuous rhythm monitoring strategy by ILRs in a large cohort of BrS patients and to assess the precise arrhythmic cause of syncopal episodes.
Methods: A total of 370 patients with BrS and ILRs (mean age 43.
Determinants of Ventricular Arrhythmias in Mitral Valve Prolapse.
JACC Clin Electrophysiol
April 2024
Article Synopsis
- Mitral valve prolapse (MVP) can lead to ventricular arrhythmias (VA) even without significant valve regurgitation, which might be influenced by conditions like mitral annulus disjunction (MAD), curling, and myocardial fibrosis.
- A study with 108 MVP patients found that those with arrhythmic MVP had greater MAD, higher prevalence of curling, and more left ventricular fibrosis compared to non-arrhythmic patients.
- The results suggested that curling directly and indirectly affects VA, while MAD’s association with VA is completely mediated by myocardial fibrosis, indicating that more severe morphologic changes correlate with the severity of VA.
Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia, with an increasing incidence and prevalence because of progressively aging populations. Costs related to AF are both direct and indirect. This systematic review aims to identify the main cost drivers of the illness, assess the potential economic impact resulting from changes in care strategies, and propose interventions where they are most needed.
View Article and Find Full Text PDFArticle Synopsis
- LVADs are becoming more popular for treating advanced heart failure, and this study examines patients who had a subcutaneous ICD prior to LVAD surgery.
- The research involved 30 patients with a median age of 45, focusing on the performance and complications of using both devices together, with follow-up averaging 7 months.
- Results showed high compatibility but highlighted issues like electromagnetic interference affecting device sensing, leading to inappropriate shocks in some patients; careful monitoring for these problems is essential.
Background: There are limited real-world data on the extended prognosis of patients with drug-induced type 1 Brugada electrocardiogram (ECG).
Objective: We assessed the clinical outcomes and predictors of life-threatening arrhythmias in patients with drug-induced type 1 Brugada ECG.
Methods: This multicenter retrospective study, conducted at 21 Italian and Swiss hospitals from July 1997 to May 2021, included consecutive patients with drug-induced type 1 ECG.
Article Synopsis
- Unstable complete atrioventricular block is a serious condition needing immediate treatment, usually until a pacemaker can be implanted.
- While transcutaneous pacing is one option, it can be painful and sometimes ineffective, leading to consideration of drug therapies like atropine, dopamine, and epinephrine.
- A study showed that isoprenaline is safe and more effective than dopamine in treating unstable third-degree AV block, improving patient outcomes and reducing the need for temporary pacing.
Article Synopsis
- * Medical imaging revealed that the pacemaker lead perforated both the right ventricular apex and the left internal mammary artery.
- * The patient was treated with embolization and lead extraction, and he had a successful recovery, emphasizing the need for clinicians to consider right ventricular perforation as a risk post-pacemaker implantation.
Article Synopsis
- Limited data on venous thromboembolism (VTE) risk after right-sided electrophysiological (EP) studies and ablations exist, with no guidelines for managing DVT and PE, unlike left-sided procedures.
- An EHRA survey of 244 participants aimed to assess current anticoagulation practices and VTE prevention during right-sided EP procedures, highlighting that the right femoral vein is the most common access point.
- Findings revealed that most respondents do not routinely use intravenous heparin or prescribe VTE prophylaxis, with only a minority continuing preventive measures post-discharge, despite some operators reporting instances of DVT and PE in the past year.
Background: The Petersen' index reflects an excess of myocardial trabeculation which is not a specific morpho-functional feature of left ventricular non-compaction (LVNC) cardiomyopathy, but a "phenotypic trait" even observed in association with other myocardial diseases and over-loading conditions. The present study was designed to evaluate the relation between a critical thinning of compact layer and the development of systolic dysfunction and LVNC cardiomyopathy.
Methods: We compared CMR morpho-functional features and measurements of LV wall thickness using a 17 segment model of a cohort of patients fulfilling the Petersen criterion for LVNC with LV systolic dysfunction versus those of a cohort of age- and sex-matched controls with LVNC and preserved LV systolic function.