Publications by authors named "Raimondo Pittorru"
Left 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.
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- 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.
Article 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.
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.
Article 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.
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.
Aims: Patients with cardiomyopathies and channelopathies are usually younger and have a predominantly arrhythmia-related prognosis; they have nearly normal life expectancy thanks to the protection against sudden cardiac death provided by the implantable cardioverter defibrillator (ICD). The subcutaneous ICD (S-ICD) is an effective alternative to the transvenous ICD and has evolved over the years. This study aimed to evaluate the rate of inappropriate shocks (IS), appropriate therapies, and device-related complications in patients with cardiomyopathies and channelopathies who underwent modern S-ICD implantation.
View Article and Find Full Text PDFBackground: The Medtronic SelectSecure Model 3830 lumenless lead (Medtronic, Inc., Minneapolis, MN) is commonly used for conduction system pacing (CSP). However, with this increased use, the potential need for transvenous lead extraction (TLE) also will increase.
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- This study investigates the long-term outcomes of using a third-generation subcutaneous implantable cardioverter defibrillator (S-ICD) combined with the intermuscular two-incision technique in patients with arrhythmogenic cardiomyopathy (ACM).
- Out of 23 patients followed for an average of 45.5 months, 17.4% experienced at least one inappropriate shock, primarily due to muscle activity during exertion, with no cases caused by T-wave oversensing.
- The findings suggest that while the S-ICD implantation is generally safe with low complication rates, the risk of inappropriate shocks from myopotential during physical activity should be acknowledged.
Background: Outcomes of transvenous lead extraction (TLE) are well reported in the general population, However, data on safety, efficacy of TLE in octogenarians with a long lead dwell time, using powered extraction tools are limited. The aim of this multicenter study was to evaluate the safety, effectiveness of TLE in octogenarians using the bidirectional rotational mechanical sheaths and mid-term outcome after TLE.
Methods: The study population comprised 83 patients (78.
Purpose: The aim of the present study was to evaluate the outcome of patients underwent subcutaneous implantable cardioverter defibrillator (S-ICD) implantation with the intermuscular (IM) two-incision technique during 3-year follow-up.
Methods: the study population consisted of 105 consecutive patients (79 male; median 50 [13-77] years) underwent S-ICD implantation with the IM two-incision technique. The composite primary end point of the study consisted of device-related complications and inappropriate shocks (IAS).
Background: Subcutaneous implantable cardioverter defibrillator (S-ICD) is a suitable alternative for transvenous ICD (TV-ICD) patients who have undergone transvenous lead extraction (TLE). Limited data are available on the outcome of S-ICD patients implanted after TLE. We assessed the safety, efficacy, and outcome of S-ICD implantation after TLE of TV-ICD.
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