PubMed Health⌕ Search

Biomedical subjects

Federico Lombardi

Publications and source records attributed to Federico Lombardi.

25 records · Page 2Linked to original sources
PubMed2004

Atrial fibrillation requiring urgent medical care. Approach and outcome in the various departments of admission. Data from the atrial Fibrillation/flutter Italian REgistry (FIRE).

BACKGROUND: The atrial Fibrillation/flutter Italian REgistry (FIRE) study was designed to obtain updated information regarding the clinical characteristics of and medical approach to patients requiring urgent medical care for atrial fibrillation (AF) or atrial flutter in a nationwide and representative series of hospitals. METHODS: 4570 consecutive patients admitted to the emergency room for AF/atrial flutter were enrolled in 207 hospitals. Of these, 2838 (61.9%) were hospitalized (median 6 days, 43% in cardiology and 57% in internal medicine departments), and constitute the population of this study. RESULTS: AF/atrial flutter represented 1.5% of all emergency room admissions and 3.3% of all hospitalizations. The mean age was 70 +/- 12 years; 89.9% had AF and 10.1% atrial flutter. In 31% of the hospitalized patients no cardiac disease was present, and in 18% no disease (either cardiac or non-cardiac) could be detected. Predictors of no attempt of cardioversion (37.5% of patients) included: onset of AF > 48 hours, heart failure, increasing age, syncope, admission to a non-cardiology department, stroke or transient ischemic attack (TIA). Predictors of in-hospital mortality (2.2%) included: age, heart failure, diabetes, admission to a non-cardiology department, and stroke or TIA. Predictors of the absence of sinus rhythm at discharge (35.6% of patients) included: no attempt of cardioversion, heart failure, chronic anticoagulation, AF duration > 48 hours, increasing age, stroke or TIA, and admission to a non-cardiology department. Transesophageal echocardiography was performed in only 6% of patients. CONCLUSIONS: AF/atrial flutter represent a significant burden on the health care system with a higher than expected hospitalization rate from the emergency room. One out of three discharged patients is not in sinus rhythm. There is still a wide gap between evidence-based medicine and real practice in the treatment of patients with AF.

Admitting Department, Hospital↗
PubMed2003

Heart rate turbulence in Chagas disease.

Heart rate turbulence (HRT) quantifies the biphasic response of the sinus node to ventricular premature complexes (VPCs) and is a powerful electrocardiogram related risk predictor. VPCs are frequent in Chagas disease, a potentially lethal illness, and can hamper the analysis by conventional methods of autonomic heart control. The aim of the study was to examine HRT in patients with Chagas disease. Chagas disease patients and healthy controls (group 0, n = 11) without other diseases were submitted to a standardized protocol, including electrocardiogram, echocardiography, and 24-hour Holter monitoring. Chagas disease patients were divided according to their left ventricular systolic function: normal (group 1, n = 103) and reduced ejection fraction (group 2, n = 23). Two HRT indices, turbulence onset (TO) and turbulence slope (TS), were calculated and compared among groups after adjustment for covariates like the prevalence of VPCs and the mean heart rate. Chagas disease patients had significantly altered TO (group 1: -0.0186, group 2: -0.0126) and TS (group 1: 10.844, group 2: 7.870) values in comparison with controls (TO -0.0256, TS 19.829); P < 0.001 for both comparisons. In conclusion, HRT data may be useful in the electrocardiographic analysis of autonomic heart control in Chagas disease. Its prognostic value remains to be determined.

Adult↗
PubMed2003

Hypertension and concurrent arrhythmias.

Hypertension and cardiac arrhythmias commonly coexist in many patients. In this review, we will initially discuss arrhythmogenesis in hypertension, with particular emphasis on atrial and ventricular tachyarrhythmias and sudden cardiac death, whilst in the final part, we will focus our attention on the effects of anti-hypertensive therapies on supra-ventricular and ventricular arrhythmias and on sudden cardiac death prevention. Many patients with atrial fibrillation or frequent premature ventricular contractions have hypertension, and both need to be managed appropriately. Furthermore, hypertensive left ventricular hypertrophy could cause a wide variety of ventricular arrhythmias, which could end in sudden cardiac arrest. Most anti-hypertensive therapies, such as the beta blockers or ACE inhibitors, by slowing or interrupting the progression towards atrial and ventricular remodelling might exert some anti-arrhythmic effect, thus reducing the risk of sudden cardiac death in these patients.

Adrenergic alpha-Antagonists↗
PubMed2002

Power-law behavior of heart rate variability in Chagas' disease.

Beta slope is a nonlinear index derived from the power-law analysis of 24-hour heart rate variability (HRV); in healthy subjects, the beta index is typically near -1, suggesting a fractal behavior of HRV. There is scarce data on HRV in Chagas' disease. This transversal study intends to describe power-law and linear HRV patterns in different forms of Chagas' disease. Patients and healthy controls (n = 26) without other diseases were submitted to a standardized protocol, including electrocardiography, echocardiography, and 24-hour Holter monitoring. Patients with Chagas' disease were divided into groups according to their left ventricular (LV) systolic function: normal (group 1, n = 85), segmental abnormalities (group 2, n = 49), and reduced ejection fraction (group 3, n = 26). The temporal series were carefully processed to obtain the HRV indexes and beta slope. Despite the differences in the LV systolic function, the 3 groups were comparable in terms of long-term HRV index values. After adjustment for covariates, short-term HRV index values were consistently reduced in the Chagas' disease groups. The beta-index values were also diminished in Chagas' disease groups (group 1: -1.09 +/- 0.03, group 2: -1.11 +/- 0.06; group 3: -1.14 +/- 0.03; and controls: 0.95 +/- 0.03, p <0.001). This breakdown of fractal long-range correlation of RR interval dynamics, a strong predictor of mortality in other cardiomyopathies, may reflect cardiac dysautonomia that may have gone undetected in long-term time-domain analysis. This abnormality may explain the increased risk for arrhythmic sudden death found in Chagas' disease even in the absence of signs of LV dysfunction.

Adult↗
PubMed2002

Clinical implications of present physiological understanding of HRV components.

Time and frequency domain analysis of heart rate variability (HRV) is a non invasive technique capable of providing information on autonomic modulation of the sinus node and of stratifying risk after myocardial infarction and in heart failure. One of the basic assumptions used to explain the negative predictive value of reduced HRV was the concept that overall HRV was largely dependent on vagal mechanisms and that a reduction in HRV could reflect an increased sympathetic and a reduced vagal modulation of sinus node; i.e., an autonomic imbalance favouring cardiac electrical instability. This initial interpretation was challenged by several findings indicating a greater complexity of the relationship between neural input and sinus node responsiveness as well as the possible interference with non neural mechanisms.Nevertheless, the prognostic value of time and geometric parameters of HRV has been consistently confirmed. More complex is the interpretation of spectral parameters particularly when they are computed on 24-hour recordings. Under controlled conditions, instead, the computation of low and high frequency components and of their ratio seems to provide information on sympatho-vagal balance in normal subjects as well as in most patients with preserved left ventricular function, thus providing an unique tool to investigate neural control mechanisms. More recently, analysis on nonlinear dynamics of HRV has been utilized to describe the fractal-like characteristics of the variability signal and has been shown to identify patients at risk for sudden cardiac death. In conclusion, in spite of an incomplete understanding of the physiological significance of HRV parameters, this non invasive methodology is of substantial utility to evaluate autonomic control mechanisms and to identify patients with an increased cardiac mortality.

Autonomic Nervous System↗