Publications by authors named "Pasquale Santangeli"
Ventricular Tachycardia Ablation in the Emergency Setting: Walking on Thin Ice.
JACC Clin Electrophysiol
November 2024
Can Ablation of Stable VT in Ischemic Cardiomyopathy and LVEF >35% Obviate the Need for ICD?
JACC Clin Electrophysiol
November 2024
Article Synopsis
- Patients with nonischemic and ischemic cardiomyopathy often experience re-entrant tachycardias related to scar tissue, making effective treatment challenging despite technological advances in mapping and ablation.
- Currently, percutaneous epicardial ablation is the preferred method after endocardial ablation fails, but high recurrence rates are a concern, with some energy sources like pulsed-field having limitations.
- New cryoablation technology using liquid helium shows promise for better outcomes in treating ventricular arrhythmias associated with subepicardial targets in NICM and ICM patients.
Article Synopsis
- Current epicardial ablation methods struggle to create deep lesions and can damage nearby structures, motivating the study of a new cryoablation catheter designed to address these issues.
- The study involved ten healthy pigs, where researchers used both surgical and percutaneous approaches to create epicardial lesions while measuring the effectiveness and safety of a low-temperature cryoablation system called HeartPad.
- Results showed that lesion depth increased significantly with longer exposure times, suggesting that the new catheter design may improve ablation outcomes while potentially protecting surrounding tissues.
Article Synopsis
- Vascular access complications are common in catheter ablation procedures for ventricular arrhythmias, and the impact of vascular closure devices (VCDs) on these complications is unclear.
- This study analyzed 1,016 catheter ablation procedures over four years, categorizing cases based on the use of VCDs: none (manual compression), partial use, or complete use.
- Results showed that the use of VCDs, especially complete VCDs, significantly reduced the rate of vascular complications compared to manual compression and partial use of VCDs.
Outcomes of Atrial Fibrillation Ablation in Heart Failure Subtypes.
Circ Arrhythm Electrophysiol
September 2024
Background: Catheter ablation (CA) improves clinical outcomes in patients with atrial fibrillation (AF) and heart failure (HF) with reduced ejection fraction (HFrEF). We aimed to evaluate the impact of CA on clinical and quality-of-life outcomes across HF subtypes.
Methods: All patients undergoing AF ablation at a tertiary center were enrolled in a prospective registry and included in this study (2013-2021).
Article Synopsis
- * Most patients had drug-refractory VT, with a significant portion having low-voltage zones in the heart, particularly in the interventricular septum, indicating a specific substrate for VT.
- * After an average follow-up of 32 months, 41% of patients experienced sustained VT/VF recurrence, but those achieving complete procedural success had a reduced risk of recurrence compared to those who did not.
Introduction: Cardioneuroablation (CNA) has proven effectiveness in addressing hypervagotonia symptoms, such as neurocardiogenic syncope.
Methods And Results: In this case, we present the first-time application of CNA in a case of vago-glossopharyngeal neuralgia (VGPN). A 59-year-old female with near-syncope, sinus bradycardia, and sinus pauses triggered by recurrent right-sided neck pain was diagnosed with VGPN.
Background: The risk of ventricular arrhythmias (VAs) after cardiac resynchronization therapy (CRT) has been associated with ischemic disease/scar, sex, and possibly left ventricular mass (LVM).
Objective: The purpose of this study was to evaluate sex differences and baseline/postimplant change in LVM on VA risk after CRT implantation in patients with nonischemic cardiomyopathy and left bundle branch block.
Methods: In patients meeting the criteria, baseline and follow-up echocardiographic images were obtained for LVM assessment.
Article Synopsis
- Wolff-Parkinson-White (WPW) syndrome is a condition marked by specific ECG changes leading to premature heart contractions and recurrent rapid heart rhythms.
- The most frequent arrhythmia linked to WPW is atrioventricular re-entry tachycardia (AVRT), while atrial fibrillation (AF) can occur in about half of WPW patients, raising concerns for potential misdiagnosis and incorrect treatments.
- This review emphasizes the importance of recognizing ECG signs of pre-excited AF and discusses effective management strategies, including both medication and invasive procedures, to enhance patient care.
Article Synopsis
- During pulsed field ablation (PFA), researchers studied the impact of various parameters like contact force (CF) and number of bursts on lesion size in beating hearts using a specialized catheter in swine.
- The study involved 11 closed-chest swine and tested different levels of CF and burst pulses, measuring lesion size after euthanization with a specific staining technique.
- Results showed that higher CF and more burst pulses significantly increased lesion depth, with a reliable formula predicting lesion size, while impedance decrease and electrode temperature were not effective predictors.
Article Synopsis
- The study investigates the effectiveness of post-ablation ventricular tachycardia (VT) inducibility through programmed ventricular stimulation (PVS) as a predictor for recurrence and survival outcomes in high-risk patients undergoing VT ablation.
- A retrospective analysis was conducted on 123 high-risk patients who underwent VT ablation, revealing no significant differences in long-term outcomes between those with no VT inducibility and other response groups.
- The findings suggest that post-ablation PVS results do not reliably predict survival or recurrence in high-risk VT ablation patients, challenging its current use as a procedural endpoint.
Article Synopsis
- * This manuscript discusses different anesthesia strategies for cardiac implantable electronic devices and electrophysiology procedures, covering management before, during, and after these procedures.
- * Effective coordination between electrophysiologists and anesthesiologists is essential for successful outcomes, and recent advancements highlight the necessity for specialized anesthesia care in this field.
Article Synopsis
- This study explored how noninvasive programmed ventricular stimulation (NIPS) can predict future arrhythmic events in patients with implantable cardioverter-defibrillators (ICD) for primary prevention, focusing on those with ischemic cardiomyopathy (ICM).
- Among 41 patients, 20% had sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) induced during NIPS at baseline, but the overall occurrence of VT/VF during a 5-year follow-up showed no significant difference based on NIPS results.
- However, the mortality rate was significantly higher in patients where VT/VF was induced during NIPS, indicating a correlation between NIPS
Article Synopsis
- Current treatments for pulmonary vein stenosis (PVS) and total occlusion (PVTO) face challenges with high rates of restenosis, prompting a study on a new method.
- This study compares drug-coated balloon (DCB) angioplasty and stenting to traditional angioplasty and stenting, analyzing data from two patient groups over different time periods.
- Results show that the DCB method significantly lowers the chances of restenosis and need for additional procedures compared to standard care, highlighting its effectiveness and safety.
Background: Comparative efficacy and safety data on radiofrequency ablation (RFA) versus pulsed field ablation (PFA) for common idiopathic left ventricular arrhythmia (LV-VAs) locations are lacking.
Objectives: This study sough to compare RFA with PFA of common idiopathic LV-VAs locations.
Methods: Ten swine were randomized to PFA or RFA of LV interventricular septum, papillary muscle, LV summit via distal coronary sinus, and LV epicardium via subxiphoid approach.
Article Synopsis
- Purkinje fibers are important in causing ventricular fibrillation (VF) and polymorphic ventricular tachycardia (PMVT), and fascicular substrate modification (FSM) is a proposed treatment method for recurrent VF.
- This study examined 18 patients who underwent catheter-based FSM targeting the Purkinje fibers, finding that the procedure was both safe and effective, with no complications and high success rates.
- After 24 months, 88.9% of the patients remained free from arrhythmias, highlighting the efficacy of FSM compared to traditional antiarrhythmic medications.
Article Synopsis
- Epicardial access is important during ventricular tachycardia ablation, and the study compares two methods: traditional ConvEpi access and a newer method called EpiCO, which involves puncturing coronary venous branches.
- The study included 153 patients and found that both methods had similar success rates, but ConvEpi was quicker and associated with more complications, especially significant bleeding.
- Overall, EpiCO access showed a decrease in major complications and bleeding compared to ConvEpi, suggesting it might be a safer option for patients.
The epicardial outflow tract can be a site of origin of idiopathic ventricular arrhythmias. These arrhythmias are most commonly perivalvular and can be targeted from within the coronary venous system or from other adjacent structures, such as the right ventricular and left ventricular outflow tracts or the coronary cusp region. The authors report a case of an epicardial idiopathic outflow tract premature ventricular contraction originating from the midseptal epicardial left ventricle.
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