Biomedical subjects

Nicola Trevisi

Publications and source records attributed to Nicola Trevisi.

4 recordsLinked to original sources

PubMed2005

Long-term follow-up after radiofrequency catheter ablation of atrial fibrillation: role of the acute procedure outcome and of the clinical presentation.

AIMS: This study is a single centre long-term experience on a consecutive cohort of patients with paroxysmal or persistent atrial fibrillation (AF) undergoing electrical disconnection of pulmonary veins (PVs) by means of catheter ablation. Long-term outcome was analyzed in relation to acute procedure success and to the clinical presentation. METHODS AND RESULTS: Two hundred and thirty-four patients (182 males, mean age 55.9+/-10.6 years), affected by paroxysmal (78%) or persistent AF, underwent an electrophysiologically guided isolation of PVs. ECG, Holter and clinical follow-up were obtained at 1, 3, 6 and 12 months. At discharge an antiarrhythmic drug, Flecainide, was given only in cases with incomplete disconnection; Amiodarone was administered in all persistent AF pts. Successful disconnection of all PVs was achieved in 90% of cases. The rate of stable sinus rhythm maintenance was 85%, 74%, 72% and 65% at 1, 3, 6 and 12 months, respectively. The one-year arrhythmia free survival rates were higher among patients with paroxysmal AF (68% vs. 54%, P 0.008), those with complete disconnection of all PVs and in patients younger than 55 years. CONCLUSIONS: The electrical disconnection of all the pulmonary veins should be the minimal endpoint of radiofrequency catheter ablation in patients with either paroxysmal or persistent AF. Incomplete disconnection of the PVs is predictive of recurrence. Long-term results of the ablation procedure were significantly better in patients with paroxysmal AF.

Atrial Fibrillation↗

PubMed2005

Left mitral isthmus ablation associated with PV Isolation: long-term results of a prospective randomized study.

BACKGROUND: The deployment of an ablation line connecting the left inferior PV to the mitral annulus (mitral isthmus line [MIL]) enhances the efficacy of pulmonary vein disconnection (PVD) in preventing atrial fibrillation (AF) recurrences. OBJECTIVES: To investigate the long-term effect of the additional linear lesion in a prospective randomized study. METHODS: One hundred and eighty-seven patients (37 females, mean age: 55 +/- 11 years) with paroxysmal (126) or persistent (61 patients) AF, were prospectively randomized into two groups: PVD (group A, 92 patients) or PVD combined with MIL (group B, 95 patients), performed by means of an irrigated-tip ablation catheter. RESULTS: Successful disconnection of all PVs was achieved in all patients. A bidirectional block (BB) along the left atrial isthmus was obtained in 72 of 95 (76%) patients in group B, most of whom required additional RF pulses from within the distal CS. A transient ischemic attack occurred in 1 patient of group A, and a cardiac tamponade occurred in 1 patient of group B. At 1 year, 53 +/- 5% (group A) and 71 +/- 5% (group B) remained arrhythmia free (P = 0.01); subgroup analysis highlights a higher improvement among patients with persistent AF (74 +/- 9% vs 36 +/- 9%; P < 0.01) than what was observed in paroxysmal AF (76 +/- 6% vs 62 +/- 6%; P < 0.05); antiarrhythmic drugs were continued in 56% and 50%, respectively, in groups A and B (P = ns). CONCLUSIONS: The addition of mitral isthmus line to the PV disconnection allows a significant improvement of sinus rhythm maintenance rate, particularly in patients with persistent AF, without the risk for major complications.

Atrial Fibrillation↗

PubMed2005

Ventricular tachycardia ablation.

The role of catheter ablation in the treatment of ventricular arrhythmias has been changing in the last decade, and this form of therapy now aims at curing multiple ventricular tachycardia morphologies and complex substrates in patients with structural heart disease (post-infarction and idiopathic dilated cardiomyopathy). Under these circumstances, conventional mapping is not feasible and accurate, and the development of new diagnostic methods has become necessary. The non-contact mapping system has been introduced to study the activation pattern of any ventricular arrhythmia by a "single-cycle" analysis, and has brought to the characterization of unstable and of non-sustained forms of arrhythmia. The evaluation of the arrhythmogenic substrate has similarly become more precise by the more common use of the electroanatomic mapping (CARTO), which is being applied to identify areas of scarred tissue responsible for ventricular arrhythmias, to map stable tachycardias and to validate the creation of a line of block. By means of this technological advancement, the identification of critical isthmi and deep intramural circuits has also led to new ablation strategies, frequently simplifying the procedure and minimizing complications.

Body Surface Potential Mapping↗

PubMed2004

Incidence and significance of pleomorphism in patients with postmyocardial infarction ventricular tachycardia. Acute and long-term outcome of radiofrequency catheter ablation.

AIMS: The prognostic significance of multiple ventricular tachycardia (VT) morphologies, whether spontaneous or induced, was investigated in patients who underwent radiofrequency catheter ablation (RFCA) for postinfarction ventricular tachycardia. METHODS AND RESULTS: We studied 137 patients with postinfarction ventricular tachycardia. Catheter ablation of all induced ventricular tachycardias was attempted. A single ventricular tachycardia morphology was documented in 102/137 patients (MONO group); 35 patients had spontaneous pleomorphism (PLEO group). Multiple VT morphologies were induced in 58/102 (57%) MONO patients and in all PLEO patients. A higher rate of arrhythmia suppression was obtained in MONO as compared to PLEO patients (162/212 [76%] vs. 43/110 [39%]). Clinical presentation (VT pleomorphism) (OR: 0.22, CI: 0.08-0.62) and the induced VT cycle (mean PLEO/MONO: 338/385 ms, OR: 1.06) were independent predictors of acute RFCA success. Among MONO patients, the procedure was successful in 75% of the patients with a single induced ventricular tachycardia compared to 64% of those with multiple tachycardias. The acute success rate was lower in PLEO patients (23%). PLEO patients had a significantly higher 3- and 5-year arrhythmia recurrence rate than MONO patients. RFCA acute success was the only independent predictor of long-term outcome in multivariate analysis. CONCLUSIONS: Spontaneous, but not induced, VT pleomorphism in patients with prior myocardial infarction adversely affects the acute and long-term success rate of RFCA.

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