Patient-specific generation of the Purkinje network driven by clinical measurements of a normal propagation.

The propagation of the electrical signal in the Purkinje network is the starting point for the activation of the ventricular muscular cells leading to the contraction of the ventricle. In the computational models, describing the electrical activity of the ventricle is therefore important to account for the Purkinje fibers. Until now, the inclusion of such fibers has been obtained either by using surrogates such as space-dependent conduction properties or by generating a network based on an a priori anatomical knowledge.

Usefulness of Contrast Intracardiac Echocardiography in Performing Pulmonary Vein Balloon Occlusion during Cryo-ablation for Atrial Fibrillation.

Background: Cryoballoon ablation (CBA) has been proven to be very effective for pulmonary vein (PV) isolation (PVI) if complete occlusion is achieved and conventionally assessed by angiographic injection of contrast within PV lumen. The aim of our study was to assess the usefulness of saline contrast intracardiac echocardiography in guiding CBA with respect to PV angiography.

Methods: Thirty consecutive patients with paroxysmal atrial fibrillation were randomly assigned fluoroscopy plus color-flow Doppler (n = 15; group 1: an iodinated medium as both angiographic and echographic contrast) or contrast intracardiac echocardiography plus color-flow Doppler (n = 15; group 2: saline contrast) for guidance of CBA.

Permanent His-bundle pacing maintains long-term ventricular synchrony and left ventricular performance, unlike conventional right ventricular apical pacing.

Aims: Right ventricular apical pacing (RVAP) may be deleterious, determining abnormal left ventricular (LV) electrical activation and progressive LV dysfunction. Permanent His-bundle pacing (HBP) has been proposed to prevent this detrimental effect. The aim of our study was to compare the long-term effects of HBP on LV synchrony and systolic performance with those of RVAP in the same group of patients.

Intrathoracic impedance and ultrasound lung comets in heart failure deterioration monitoring.

Purpose: Echographic examination of the lung surface may reveal multiple ultrasound lung comets (ULCs) originating from water-thickened interlobular septa. These images were demonstrated to be useful for noninvasive assessment of interstitial pulmonary edema. Similarly, the correlation between implantable defibrillator-measured intrathoracic impedance and pulmonary capillary wedge pressure (PCWP) was demonstrated in heart failure (HF) patients.

ICD and neuromodulation devices: is peaceful coexistence possible?

Aim: The aim of this study was to investigate the potential cross-talk between implantable cardioverter defibrillator device (ICD) and implantable neuromodulation device (IND) during the implantation procedure and the ventricular fibrillation induction test and in daily life.

Methods: We present two cases of patients with an IND who underwent ICD implantation and one case of a patient implanted with a biventricular ICD who received an IND 6 months later. Two of these patients had a spinal cord stimulator (SCS), while the other had a sacral neuromodulator.

Physiopathologic correlates of intrathoracic impedance in chronic heart failure patients.

Background: Increased plasma levels of amino-terminal fraction of brain natriuretic peptide (NT-proBNP) and alterations of diastolic filling as described by Doppler transmitral flow pattern are well-known markers of decompensated heart failure (HF). Recently, some implantable defibrillators have allowed monitoring of intrathoracic impedance, which is related to lung water content, potentially indicating HF deterioration. The aim of this study was to assess the correlation between intrathoracic impedance and NT-proBNP and echo-Doppler transmitral flow indexes.

Intrathoracic impedance and pulmonary wedge pressure for the detection of heart failure deterioration.

Aims: The aims of this analysis were to assess the agreement between implantable defibrillator (ICD)-measured intrathoracic impedance and pulmonary capillary wedge pressure (PCWP) collected during long-term follow-up, as well as to evaluate whether PCWP measures may improve the performance of the impedance detection algorithm in predicting heart failure (HF) worsening.

Methods And Results: We studied 23 HF patients implanted with an ICD capable of intrathoracic impedance measurement and alerting for fluid accumulation diagnosis. At regular follow-up and at visits for HF decompensation or device alert, clinical status was assessed and PCWP was non-invasively estimated with a validated echo-Doppler method.

Pheochromocytoma mimicking a non-ST elevation acute myocardial infarction.

We report a 57 year-old male patient admitted with a diagnosis of non-ST elevation acute myocardial infarction. He had suffered from chest pain, diaphoresis and intense asthenia for three days. The electrocardiogram on admission showed a high frequency sinus tachycardia.

[Chest pain evaluation project].

The evaluation of acute chest pain remains challenging, despite many insights and innovations over the past two decades. The percentage of patients presenting at the emergency department with acute chest pain who are subsequently admitted to the hospital appears to be increasing. Patients with acute coronary syndromes who are inadvertently discharged from the emergency department have an adverse short-term prognosis.

Monitoring intrathoracic impedance with an implantable defibrillator reduces hospitalizations in patients with heart failure.

Purpose: Some implantable cardioverter-defibrillators (ICDs) are now able to monitor intrathoracic impedance. The aim of the study was to describe the use of such monitoring in clinical practice and to evaluate the clinical impact of the fluid accumulation alert feature of these ICDs.

Methods And Results: Five hundred thirty-two heart failure (HF) patients implanted with these ICDs were followed up for 11 +/- 7 months.

Implantable CRT device diagnostics identify patients with increased risk for heart failure hospitalization.

Purpose: To determine the association between device-determined diagnostic indices, including intrathoracic impedance, and heart failure (HF) hospitalization.

Methods: Clinical and device diagnostic data of 558 HF patients indicated for CRT-D therapy (In Sync Sentry, Medtronic Inc.) were prospectively collected from 34 centers.

Usefulness of intrathoracic fluids accumulation monitoring with an implantable biventricular defibrillator in reducing hospitalizations in patients with heart failure: a case-control study.

Background: The reduction of hospitalizations in patients with heart failure (HF) may have clinical and economical implications.

Materials And Methods: In a case-control study, we compared the number of hospital admissions for congestive HF during the same follow-up period in two homogeneous groups of patients, each consisting of 27 consecutive patients treated with biventricular pacing and back-up defibrillator (B-ICD) in our institution. The first group was implanted with an InSync Sentry, (Medtronic Inc, Minneapolis, MN, US), a B-ICD device with the OptiVol feature for monitoring intrathoracic fluid accumulation and equipped with an active acoustic alarm (Group 1); the second group was implanted with an InSync III Marquis (Medtronic), a B-ICD device with similar features except for the absence of the OptiVol (Group 2).

Duration of P-wave is associated with atrial fibrillation hospitalizations in patients with atrial fibrillation and paced for bradycardia.

Background: Atrial fibrillation (AF) is a common problem in pacemaker patients. We conducted a prospective observational study in patients paced for bradycardia with associated paroxysmal or persistent AF, to determine whether P-wave duration may stratify patients at higher risk for AF recurrences and AF-related hospitalizations. The patients were evaluated for the prevalence, cause, and predictors of hospitalization.

Evaluation of thyroid dysfunction in patients with paroxysmal atrial fibrillation.

Objective: Atrial fibrillation (AF) is the most frequent cause of hospitalization for arrhythmias. The aim of our study was to evaluate the prevalence of thyroid dysfunction in patients with paroxysmal AF without any cardiomyopathy.

Methods: Two hundred sixty eight patients (164 women and 104 men, mean age 64.

Primary prevention of sudden cardiac death: can we afford the cost of cardioverter-defibrillators? Data from the Search-MI Registry-Italian sub-study.

Background: Large randomized trials show that in appropriately selected patients with left ventricular dysfunction, implantable cardioverter-defibrillators (ICDs) can improve overall survival at 2-5 years. Since direct implementation of the criteria used in the MADIT II and SCD-HeFT will lead to a marked rise in ICD implants, there is a growing fear that increased use of ICDs may cause a dramatic burden to health care systems. The ICD has traditionally been seen as an expensive form of treatment, which is difficult to accept at the first look.

Permanent direct his bundle pacing does not induce ventricular dyssynchrony unlike conventional right ventricular apical pacing. An intrapatient acute comparison study.

Background: Benefits of A-V synchrony during right ventricular apical pacing are neutralized by induction of ventricular dyssynchrony. Only a few data are reported about direct His bundle pacing influence on ventricular synchronism.

Aim: Was to assess the capability of direct His bundle pacing to prevent pacing-induced ventricular dyssynchrony comparing DDD- (or VVI- in case of Atrial Fibrillation) right ventricular apical pacing with DDD- (or VVI-) direct His bundle pacing in the same patients cohort.

Electrocardiographic abnormalities mimicking myocardial infarction in a patient with intracranial haemorrhage: a possible pitfall for prehospital thrombolysis.

The electrocardiogram, when applied in the prehospital setting, has a significant effect on a patient with chest pain. The potential effect includes both diagnostic and therapeutic issues, including the diagnosis of acute myocardial infarction and the indication for thrombolysis or invasive procedures. We report the case of a man who suffered from a syncope, with a prehospital electrocardiogram showing prominent ST-segment elevation.

[Reduction of radiological exposure time during radiofrequency catheter ablation procedures using a novel intracardiac localization system based on the Ohm's law].

Background: Three-dimensional nonfluoroscopic system may be helpful to guide radiofrequency catheter ablation procedures and to reduce the radiological exposure. A new intracardiac navigation and multicatheter visualization system based on Ohm's law (LocaLisa, Medtronic, Minneapolis, MN, USA) has been recently introduced. The aim of our study was to assess the efficacy of the Loca-Lisa system in comparison to fluoroscopy-based approach in reducing the radiological exposure time required for radiofrequency catheter ablation procedures.

Successful treatment of post-exertion acute myocardial infarction by primary angioplasty and stenting in a patient with antiphospholipid antibody syndrome.

Antiphospholipid syndrome is a disorder characterized by arterial and venous thromboses, thrombocytopaenia and stroke. Acute myocardial infarction is rarely associated with this syndrome. The treatment of these patients is a clinical challenge.

[Type A acute aortic dissection presenting as mental status confusion: is it an atypically really uncommon presentation?].

The most common initial symptom of acute aortic dissection is chest or abdominal pain. Nevertheless, in a minority of cases, it may have an atypical presentation, making the diagnosis clinically challenging. This article reports on a case of acute type A aortic dissection presenting as mental status confusion.

Implantable cardioverter-defibrillator therapy for prevention of sudden death in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia.

Background: Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a condition associated with the risk of sudden death (SD).

Methods And Results: We conducted a multicenter study of the impact of the implantable cardioverter-defibrillator (ICD) for prevention of SD in 132 patients (93 males and 39 females, age 40+/-15 years) with ARVC/D. Implant indications were a history of cardiac arrest in 13 patients (10%), sustained ventricular tachycardia in 82 (62%), syncope in 21 (16%), and other in 16 (12%).

A rare cause of cardiogenic shock: catecholamine cardiomyopathy of pheochromocytoma.

Pheochromocytoma is a rare catecholamine secreting tumor that accounts for about 0.04% of cases of hypertension. Other less common cardiovascular manifestations such as arrhythmias, angina pectoris, acute myocardial infarction, dilated cardiomyopathy, acute heart failure, and cardiogenic shock have occasionally been reported.