Biomedical subjects

M Vincenzi

Publications and source records attributed to M Vincenzi.

At least 19 recordsLinked to original sources

PubMed2000

Procedural results, in-hospital course and six-month follow-up after rescue compared to primary stenting in acute myocardial infarction.

BACKGROUND: Although many previous reports showed a worse outcome after rescue compared to primary coronary angioplasty, a direct comparison of these two strategies in the era of stenting is lacking. METHODS: Fifty patients treated with rescue stenting were retrospectively compared to 61 patients treated with primary stenting during acute myocardial infarction over a 4-year period in our Laboratory. RESULTS: Baseline demographic and angiographic parameters were not significantly different in the two groups. Despite a significantly longer time-to-reperfusion in rescue stenting (4.7 +/- 2.7 vs 2.8 +/- 2.1 hours, p < 0.0001), procedural success rate (98 vs 97%), in-hospital mortality (6 vs 11%) and target vessel revascularization at 6 months (8 vs 10%) were similar in rescue compared to primary stenting. CONCLUSIONS: These data suggest that stenting may help improve results of rescue angioplasty, and support the concept that aggressive treatment after failed thrombolysis can be pursued with satisfactory results.

Adult↗

PubMed1999

Left ventricular versus biventricular dysfunction in idiopathic dilated cardiomyopathy.

Eighty-five consecutive patients with idiopathic dilated cardiomyopathy were categorized according to the presence (biventricular dysfunction) or absence (left ventricular [LV] dysfunction) of reduced right ventricular ejection fraction (<35%) along with reduced LV ejection fraction (<50%). Compared with the 36 patients with LV dysfunction, the 49 patients with biventricular dysfunction had significantly worse New York Heart Association functional class (2.7+/-0.6 vs 1.9+/-0.5; p <0.001), LV ejection fraction (26+/-10% vs 34+/-8%; p <0.0001), and outcome (transplant-free survival, 55% vs 89%; p <0.001). Thus, dilated cardiomyopathy is frequently characterized by biventricular involvement, which identifies a more severe disease and a worse long-term prognosis.

Adult↗

PubMed1999

Subacute thrombosis after stenting in acute myocardial infarction: four-year experience in a low-volume center.

BACKGROUND: Despite substantial technical and therapeutic improvements, subacute stent thrombosis (SST) remains a feared complication of stenting, especially in acute coronary syndromes. Results of large interventional trials obtained in selected highly skilled centers may underestimate the incidence of SST in the real world of interventional cardiology. OBJECTIVE: To analyze the incidence of SST after stenting in acute myocardial infarction (AMI) and to identify clinical or procedural parameters associated with its occurrence in a center performing < 40 interventional procedures in AMI per year. MATERIALS AND METHODS: The authors examined their catheterization laboratory database and analyzed a series of 80 consecutive patients treated with stenting for AMI from 1995 to 1998. The incidence of SST among these patients (AMI group) was compared with that observed among 389 elective patients treated during the same period (non-AMI group). Then, results obtained for AMI patients treated during the first half of the study period (1995-1996) were compared with those obtained for patients treated during 1997-1998. RESULTS: The incidence of SST in AMI group was 6.3%, significantly higher (P < 0.0001) than the 0.5% which occurred in non-AMI group. However, all cases of SST were concentrated during the first half of the experience, whereas no case was reported among the 47 patients treated during 1997-1998 (P = 0.016). Although most clinical and angiographic baseline data for the two study periods were comparable, less bail-out stenting (17 versus 42%; P = 0.024) and higher maximal inflation pressure (15 +/- 4 versus 13 +/- 5; P = 0.031) were found during the latter period. CONCLUSION: The authors conclude that SST after stenting in AMI was significantly decreased. Relatively low-volume centers should not be denied the possibility of performing interventional procedures in the clinical setting of AMI, provided that results and complication rates are within pre-defined standards of adequacy.

Acute Disease↗

PubMed1999

Torsade de pointes ventricular tachycardia during low dose intermittent dobutamine treatment in a patient with dilated cardiomyopathy and congestive heart failure.

The authors describe the case of a 56-year-old woman with chronic, severe heart failure secondary to dilated cardiomyopathy and absence of significant ventricular arrhythmias who developed QT prolongation and torsade de pointes ventricular tachycardia during one cycle of intermittent low dose (2.5 mcg/kg per min) dobutamine. This report of torsade de pointes ventricular tachycardia during intermittent dobutamine supports the hypothesis that unpredictable fatal arrhythmias may occur even with low doses and in patients with no history of significant rhythm disturbances. The mechanisms of proarrhythmic effects of Dubutamine are discussed.

Adrenergic beta-Agonists↗

PubMed1999

Incessant ventricular tachycardia early after acute myocardial infarction: efficacy of radiofrequency catheter ablation but not of optimal coronary revascularization.

Incessant ventricular tachycardia is an arrhythmia refractory to conventional antiarrhythmic treatment. We describe the case of 55-year-old man who presented incessant ventricular tachycardia in the early post-acute phase of myocardial infarction. Optimal coronary revascularization was not effective, but radiofrequency catheter ablation was able to eliminate the anatomic substrate and clinical arrhythmic recurrence.

Catheter Ablation↗

PubMed1998

Ventricular late potentials, interstitial fibrosis, and right ventricular function in patients with ventricular tachycardia and normal left ventricular function.

We examined 40 patients with ventricular tachycardia (VT) and no evidence of heart disease, and found a 50% prevalence of ventricular late potentials (VLPs) on the signal-averaged electrocardiogram. This finding was associated with a significantly higher content of fibrous tissue on endomyocardial biopsy and a lower right ventricular ejection fraction. Thus, VLPs are frequently found in idiopathic VT, are a marker for subclinical anatomic and functional abnormalities of the right ventricle, and may be associated with a worse outcome.

Adult↗

PubMed1998

Arrhythmic profile, ventricular function, and histomorphometric findings in patients with idiopathic ventricular tachycardia and mitral valve prolapse: clinical and prognostic evaluation.

BACKGROUND: In patients with ventricular tachycardia (VT) and apparently normal hearts, mitral valve prolapse (MVP) is discovered fairly often, raising the question of whether or not it is an occasional finding. HYPOTHESIS: This issue was analyzed in a series of patients with VT and apparently normal hearts in order to define the prevalence of MVP in this condition, the existence of specific diagnostic features suggesting a nonrandom association between idiopathic VT and MVP, and the prognostic implications of this finding. METHODS: We studied 28 consecutive patients with documented VT and no history of heart disease. Two-dimensional (2-D) echocardiogram, cardiac catheterization, morphometric examination of endomyocardial biopsy and arrhythmologic evaluation (24-h Holter monitoring, electrophysiologic study, and signal-averaged electrocardiogram) were performed. Inclusion criteria for all patients were angiographically normal coronary arteries, normal biventricular function, and absence of histologic evidence of myocarditis. Data obtained in patients found to have MVP at 2-D echo were compared with those of the remaining patients. Long-term follow-up data were also collected. RESULTS: The prevalence of MVP in our study group was 25% (7 patients). It was not associated with leaflet dysplasia or significant regurgitation. Biventricular function (ventricular volumes and ejection fraction) was comparable in patients with and without MVP. Patients with MVP had a significantly higher prevalence of ventricular late potentials at signal-averaged electrocardiogram (86 vs. 29%, p = 0.027), more interstitial fibrosis at morphometry (8.5 +/- 3.7 vs. 5.4 +/- 2.7% p = 0.028), and VT of right bundle-branch block morphology (100 vs. 48%; p = 0.044). Other arrhythmologic findings were similar in the two groups. After a mean follow-up of > 5 years, no patient in either group died, and none developed heart failure or severe mitral regurgitation. CONCLUSIONS: Mitral valve prolapse is frequently detected in idiopathic VT. The distinguishing features of this association are (1) VT of right bundle-branch block morphology, (2) high prevalence of ventricular late potentials, and (3) increased fibrosis on endomyocardial biopsy. Ventricular function and other arrhythmologic findings are not specific of this association. Prognosis remains substantially benign, as is true for most cases of idiopathic VT.

Adolescent↗

PubMed1998

Subacute stent thrombosis occurring more than one month after implantation for acute myocardial infarction. Description of two cases successfully treated with angioplasty and further stenting.

Two patients are described with anterior acute myocardial infarction who had a successful recanalization of a totally occluded left anterior descending coronary artery by means of primary angioplasty and stenting. Reinfarction occurred more than 1 month after implantation. At angiography, a totally occluded left anterior descending coronary artery at the site of stenting was observed and was effectively reopened with angioplasty and stenting in both cases. This report aims to emphasize that acute myocardial infarction still represents a major risk factor for subacute stent thrombosis and that this potentially catastrophic event may occur late after implantation. Potential implications for revascularization strategies and medical treatment are discussed.

Adult↗

PubMed1998

Assessment of right ventricular function and interstitial fibrosis in idiopathic dilated cardiomyopathy: hemodynamic correlates and prognostic value.

BACKGROUND: Right ventricular (RV) function and morphometric quantitation of interstitial fibrosis in idiopathic dilated cardiomyopathy (IDC) have not been the subject of specifically designed clinical observations. In particular, their role in routine assessment and prognostic evaluation of patients (pts) with IDC remains to be settled. METHODS: Eighty-one consecutive IDC patients (63 M, 18 F; mean age 52 +/- 11 yrs) with left ventricular (LV) systolic dysfunction (angiographic ejection fraction - EF - < 55%), normal coronary arteries and no histologic evidence of myocarditis were studied. Cardiac catheterization and endomyocardial biopsy (EMB) were routinely performed in all cases. RV volumes and EF were obtained by angiography according to Ferlinz' method and interstitial fibrosis was quantitated by computer-assisted morphometric analysis. These data were analyzed in order to study correlations with hemodynamic parameters and to assess their prognostic value in a long-term follow-up. RESULTS: In the study population, right ventricular EF was significantly lower than in normal controls (35 +/- 11% vs 53 +/- 6%, p < 0.0001) and showed a significant positive correlation with LV EF (r = 0.54; p < 0.0001), and a weak but significant negative correlation with fibrosis (r = -0.29; p = 0.03). RV volumes, but not EF, were significantly related to mean pulmonary pressure. At multivariate analysis, RV end-diastolic volume (EDV) and EF were the two independent predictors of severe heart failure (NYHA class III-IV). After a mean follow-up of 64 +/- 36 months, 20 pts died and 9 had heart transplantation, for a 63% transplant-free survival rate (TFS). Multivariate analysis identified three independent predictors of TFS: LV stroke work index (p < 0.0001), RV stroke work index (p = 0.02) and RV EDV (p = 0.03). Fibrosis was predictive of survival only in the subgroup with LV EF < 20%. CONCLUSIONS: Assessment of RV function provides useful information in the evaluation of hemodynamic profile and prognosis of pts with IDC. Quantitation of interstitial fibrosis by morphometry provides little additional data.

Adult↗

PubMed1998

Hemodynamic correlates of atrial natriuretic peptide concentration in unselected patients with heart disease of different etiologies.

BACKGROUND: Although a large number of studies have investigated the relationship between atrial natriuretic peptide (ANP) concentrations and circulatory abnormalities, it is presently unsettled as to whether this parameter provides valuable information in unselected patients with heart disease of different etiologies regardless of the presence of left ventricular dysfunction or heart failure. AIM OF THE STUDY: The aim was to evaluate the correlation between ANP, hemodynamics and parameters of ventricular function in a large series of consecutive patients and to define the predictive value of ANP for the identification of specific circulatory abnormalities. METHODS: Cardiac catheterization was performed in 167 consecutive patients (62% males; mean age 62 yrs; range 18-85) and ANP serum levels were determined concomitantly by single antibody immune assay. Underlying etiology was: ischemic (67), valvular (72), idiopathic (12) and miscellaneous (16). Data management included: comparison of patients according to ANP values > or < 50% percentile of the cumulative distribution curve (i.e. 140 pg/ml); analysis of ANP concentrations according to the presence of normal or abnormal ventricular filling pressures; correlation between hemodynamic parameters and ANP concentrations; correlation of ANP with ventricular function in the whole population and in subgroups; calculation of sensitivity and specificity of ANP for the identification of abnormal filling pressures. RESULTS: Mean ANP concentration was 181 +/- 139 pg/ml. Patients with ANP < 140 had significantly lower right-sided pressures but similar ventricular volumes and ejection fractions. By multivariate analysis, the single independent predictor of ANP was wedge pressure (p < 0.0001). Regarding etiology, severe mitral regurgitation was associated with the highest ANP levels (259 +/- 122 pg/ml), although the difference was not significant. The presence of abnormal left and right ventricular filling pressures was associated with significantly higher levels of ANP (p < 0.0001). A level of 125 pg/ml proved to be fairly sensitive (79%) but poorly specific (66%) for the detection of an abnormal wedge pressure. ANP was related to ventricular function only in the small subgroup of patients with dilated cardiomyopathy, where a significant negative correlation was found with both left ventricular (r = -0.72; p = 0.008) and right ventricular ejection fraction (-0.71; p = 0.01). CONCLUSIONS: In unselected cardiac patients, ANP is confirmed to be a marker of left ventricular filling pressure in spite of poor specificity. Ventricular function appears to be related to ANP concentrations only in the subgroup of patients with pure heart-muscle disease.

Adolescent↗

PubMed1997

Detectable serum troponin I in patients with heart failure of nonmyocardial ischemic origin.

Cardiac troponin I, a specific and sensitive marker of myocardial damage, was detected in the blood of 6 of 26 patients studied in our Heart Failure Clinic. In these patients functional class, ventricular function, and prognosis were significantly worse than in those without detectable troponin I. This study suggests that troponin I may represent the biochemical marker of myocardial damage occurring in severe heart failure.

Aged↗

PubMed1997

Screening of European coffee final products for occurrence of ochratoxin A (OTA).

Samples (633) of final coffee products were drawn from the markets of different European countries relative to the market share of each product type and brand. These samples were analysed in a cooperative action with nine different laboratories. With low limits of detection (mean detection limit approximately 0.5 ng/g) no OTA was found in over half of the samples (334 negatives). In the remaining samples occurrence of OTA at a rather low level was seen. Only four samples (all instants) exceeded a level of 10 ng/g, whereas for both instants, and roast and grounds (R & G), over three-quarters of the samples were in the range from nondetectable to 1 ng/g. The overall mean for all R & Gs was 0.8 ng/g and for all instant 1.3 ng/g (for samples in which no OTA was detected, half of the detection limit was included in this calculation). In the brewing methods frequently used in Europe the OTA is essentially fully extracted. Consumption of four cups of coffee per day (approximately 24 g R & G or approximately 8 g instant coffee) contributes on average 19 or 10 ng/day respectively. Four cups/day is above the per caput consumption level in most European contries. Compared with the Provisional Tolerable Weekly Intake (PTWI) recently set by the Joint FAO/WHO Expert Committee on Food Additives at 100 ng/kg bodyweight/week, consumption of 28 cups/week contributes up to 2% to the PTWI.

Carcinogens↗

PubMed1997

[Troponin T, Troponin I and CK-MB (mass) in the detection of periprocedural myocardial damage after coronary angioplasty].

The development of methods for the detection of circulating CK-MB mass, cardiac troponin T (cTn-T) and troponin I (cTn-I) has increased the diagnostic potential in the identification of myocardial damage. Coronary angioplasty (PTCA) represents a widely accepted revascularization procedure and a clinical model of induced ischemia. Using these new biochemical markers, we evaluated the incidence and the clinico-procedural correlates of minor myocardial damage (MMD) in a series of patients treated with PTCA in our Department. In 57 consecutive patients (75% males; mean age 58 years; range 35-80) undergoing elective PTCA from March 1 to June 30, 1995, serum levels of CK-MB mass, cTn-T and cTn-I were measured at baseline and at 6, 12 and 24 hours after the procedure. Seventy-eight coronary stenoses were dilated (mean 1.4 lesion/patient), 17 of these were in infarct-related vessels; 8 were total occlusions and 2 were located in saphenous vein grafts. Twenty-two procedures were completed by coronary stenting (17 elective). cTn-T and cTn-I were considered abnormal when serum levels were > 0.2 ng/ml and > 0.6 ng/ml, respectively. CK-MB mass was also determined in all patients (abnormal > 5 ng/ml). No patients had clinical or electrocardiographic evidence of myocardial infarction after the procedure. Overall, 16 patients (28%) developed biochemical evidence of post-procedural MMD (defined as the presence of at least one abnormal sample of any among the three markers tested). Four (7%) had abnormal CK-MB mass (at least one sample), 9 (16%) abnormal cTn-T, and 15 (26%) abnormal cTn-I. When CK-MB mass was elevated, both cardiac troponins were also elevated. In patients positive for MMD and abnormal CK-MB mass, peak cTn-I was significantly higher than in patients with normal CK-MB (3.02 +/- 1.07 vs 1.02 +/- 0.11 ng/ml; p = 0.009). The difference was not evident when comparing the same groups of patients for cTn-T (0.26 +/- 0.04 vs 0.18 +/- 0.10 ng/ml; p = 0.16). Also, peak cTn-I but not peak cTn-T had a positive correlation with peak CK-MB mass (r = 0.89; p < 0.0001 and r = 0.23; p = 0.40). The elevation of either marker of MMD was not related to clinical, angiographic or procedural variables. A possible interpretation for MMD was found in 2/3 of cases: bail-out (2); late occlusion (1); minor side branch occlusion (3); distal embolization from saphenous vein grafts (2) or total occlusions (2). In our series, MMD after PTCA occurs in 28% of cases and is unrelated to clinical, angiographic and procedural variables. Both cTn-T and cTn-I increase the sensitivity of CK-MB mass in the detection of MMD after PTCA, cTn-I being the most sensitive marker. In about 1/3 of cases, the presence of MMD remains unexplained. The prognostic implications of MMD are as yet undefined.

Adult↗

PubMed1996

Prediction of recovery after abstinence in alcoholic cardiomyopathy: role of hemodynamic and morphometric parameters.

The aim of the study is to describe the hemodynamic and morphometric characteristics of patients with alcoholic cardiomyopathy (ACM) and to evaluate whether these parameters can identify the subgroup of patients in whom recovery of cardiac function after abstinence will occur. Nineteen male patients (mean age 52.4 years, range 39-64 years) with symptomatic left ventricular dysfunction (LVD) [ejection fraction (EF) <50%] and a history of chronic heavy alcohol intake were submitted to a full invasive work-up including right ventricular endomyocardial biopsy (EMB). Counseling aimed at obtaining abstention and clinical follow-up were regularly performed in all patients. The two requisites necessary to define recovery were (1) an increase in left ventricular EF, and (2) improvement of symptoms. The former was defined as a gain in left ventricular EF > 15% from baseline; the latter, as a gain of at least one New York Heart Association (NYHA) functional class. Using these criteria, 9 alcoholic patients (48%) (Group A) improved significantly, while 10 (52%) (Group B) either stabilized or deteriorated at 2 years' follow-up. Group A patients had significantly lower pulmonary artery mean pressure (27.8 mmHg +/- 13.3 vs. 40.3 mmHg +/- 12.4; p < 0.05) and pulmonary capillary wedge pressure (18.4 mmHg +/- 8.9 vs. 26.5 mmHg +/- 7.7; p < 0.05) compared with Group B. All other hemodynamic data did not show statistically significant differences in the two groups. Quantitative evaluation of myocardial hypertrophy and interstitial fibrosis performed on EMB tissue samples using the morphometric approach was not predictive of recovery. Improvement in cardiac performance and functional class was detected in about one-half of patients with ACM who abstained from alcohol, and occurred even in cases presenting with severe LVD. Recovery is associated with significantly lower pulmonary artery and pulmonary wedge pressures. The morphometric evaluation of EMB does not provide adjunctive prognostic information in these patients.

Adult↗

PubMed1996

Troponin T, troponin I and creatine kinase-MB mass after elective coronary stenting.

OBJECTIVE: To assess whether and to what extent elective coronary stenting is associated with biochemical evidence of minor myocardial damage (MMD), as defined by the detection of abnormal post-procedural serum levels of one more among the following markers of ischaemic injury: creatine kinase (CK)-MB mass, troponin T (Tn-T) and troponin I (Tn-I). METHODS: Nineteen elective procedure of coronary stenting were compared with a matched group of 25 conventional percutaneous transluminal coronary angioplasty (PTCA) procedures performed in our laboratory from March to June 1995. Cases with evolving or recent (< 2 weeks) myocardial infarction, chronic total occlusions and dilation of saphenous vein grafts were excluded. By definition, all of the patients had undergone uneventful deployment of a single palmaz-Schatz stent, with no chest pain and no persistent ECG changes after the procedure. Serum levels of CK-MB mass, Tn-T and Tn-I were determined at baseline and 6, 12 and 24 h after the procedure. The frequency of abnormal results was determined for each marker. Baseline and peak post-procedural levels in the two groups were compared and related to procedural variables. RESULTS: Baseline values were normal in all cases. The quantitative analysis showed that post-procedural levels of each marker (including total CK) were significantly higher with respect to baseline in both groups. In the stent group, two patients had positive CK-MB mass, four positive Tn-T and seven positive Tn-I. Absolute changes in Tn-T and Tn-I were closely related to changes in CK-MB mass (r = 0.76, P < 0.0001; r = 0.90, P < 0.0001), respectively). Three of these patients developed clinically silent side-branch occlusion. All of them were positive for troponins and two were positive for CK-MB. No correlation was found between procedural variables and the results of biochemical assays. In the PTCA group, three patients were positive for Tn-I, whereas the CK-MB mass and Tn-T remained constantly normal. No side-branch occlusion was observed. The peak CK-MB mass and Tn-I were significantly higher in the stent group than they were in the PTCA group (3.04 +/- 4.1 versus 1.27 +/- 1.3 ng/ml, P = 0.046; 0.78 +/- 1.17 versus 0.28 +/- 0.3 ng/ml, P = 0.046, respectively). This difference was no longer apparent when patients with side-branch occlusion were excluded. CONCLUSIONS: In our series, Tn-I measurement shows the highest ability to detect MMD, being positive in 37% of stent and 14% of PTCA cases. Elective coronary stenting associated with greater release of CK-MB mass and Tn-I than is conventional PTCA. This finding is mainly determined by cases of side branch occlusion, which account for most, but not all, periprocedural MMD in the stent group.

Adult↗

PubMed1994

[The prognostic indicators of a favorable clinical evolution in dilated cardiomyopathy].

Improvement in cardiac function and clinical status has been described in subgroups of patients with dilated cardiomyopathy (DCM), but predictors of favourable outcome have not been unequivocally established. In 33 patients with DCM followed up for a mean of 23 months (range 3-68) a full non-invasive and invasive diagnostic work-up, including endomyocardial biopsy, was performed. At the end of the follow-up, 13 patients (39%; Group A) showed a significant improvement in their clinical status (> or = 1 gain in NYHA functional class) and cardiac function (> 0.10 increase in echocardiographic ejection fraction), while 20 (61%; Group B) either stabilized or deteriorated (5 died and 4 underwent successful heart transplantation). Clinical, hemodynamic and morphometric data of the 2 groups were compared. Only lower systemic vascular resistance (Group A 2,836 +/- 637 versus Group B 3,637 +/- 1113; p = 0.025) and higher prevalence of alcohol intake > 80 g/day (Group A 85% versus Group B 40%; p = 0.03) were significantly associated with improvement. Discriminant analysis utilizing these 2 variables along with cardiac index, mitral regurgitation, pulmonary resistance and cardiothoracic ratio reached a discriminant power of 72% (p = 0.0014). The above results suggest that, in our series, relatively simple data provide the most accurate assessment of prognosis. Yet, prediction of favourable versus unfavourable outcome remains uncertain, since an incorrect prognosis will be made in 28% of cases. Morphometric analysis of endomyocardial bioptic specimens does not provide significant prognostic information. The identification of a high alcohol intake has a clinical relevance, since abstention from alcoholic beverages is significantly associated with a favourable outcome in our patients.

Adult↗

PubMed1993

Aneurysm of the left main coronary artery without obstructive disease: report of a case presenting with severe unstable angina and treated with systemic thrombolysis.

A fusiform aneurysm of the left main coronary artery without associated obstructive disease was detected in a 77-year-old patient with severe unstable angina treated with systemic thrombolysis. The authors emphasize the following features: (1) unusual location of the aneurysm, (2) absence of concomitant obstruction in this age group, and (3) clinical efficacy of thrombolysis and subsequent long-term oral anticoagulation.

Aged↗

PubMed1993

Radiofrequency catheter ablation of the slow reentrant pathway of sustained ventricular tachycardia.

The article reports the cases of two patients with severe coronary artery disease and associated recurrent sustained ventricular tachycardia successfully treated with radiofrequency catheter ablation. In the first patient, two different types of ventricular tachycardia (one incessant) were eliminated. In all procedures, an area of slow conduction critical for tachycardia maintenance was localized by endocardial mapping techniques. Radiofrequency energy delivered to this area could permanently modify the anatomical substrate of the arrhythmia. After single follow-ups of 19, 14, and 13 months regarding the arrhythmic entities, the patients are well and free from spontaneous recurrences.

Aged↗