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Paolo Donateo

Publications and source records attributed to Paolo Donateo.

11 recordsLinked to original sources
PubMed2006

Seven-year follow-up after catheter ablation of atrioventricular nodal re-entrant tachycardia.

BACKGROUND: Radiofrequency catheter ablation is considered to be a curative therapy for patients with atrioventricular nodal re-entrant tachycardia (AVNRT). Nevertheless, there is little information available with respect to long-term results and the consequences of catheter ablation. The present study aimed to assess the long-term results (a minimum of 5 years) and clinical events. PATIENTS AND METHODS: The recurrence rate of AVNRT, the development of late atrioventricular block and the presence of other arrhythmias (atrial flutter and fibrillation) were assessed in 131 consecutive patients who were undergoing catheter ablation between January 1992 and December 1998. RESULTS: During a mean follow-up of 7.2 +/- 2.5 years, tachycardia recurred in 13 patients (10%) after a median time of 6 months (interquartile range 4-24 months) and a second procedure was perfomed. Atrioventricular block occurred in two patients (1.5%) after 1 and 13 months. Atrial fibrillation recurred in seven (44%) of 16 patients in whom atrial fibrillation or flutter was present before ablation after a median of 12 months (interquartile range 9-15 months). Overall, all these events occurred after a median of 9 months (interquartile range 4-17 months). Subsequently, no event related to the arrhythmia or to the procedure was observed. A new onset atrial fibrillation, probably not related to AVNRT, occurred late in the follow-up in a further three patients. CONCLUSIONS: Arrhythmic events are not infrequent after catheter ablation of AVNRT during the early years after ablation, but they are unlikely during the subsequent long-term follow-up.

Adult↗
PubMed2006

[Comparative study of results of catheter ablation in ventricular tachycardia of different etiologies].

BACKGROUND: The aim of this study was to assess long-term results and adverse events in patients with ventricular tachycardia from different etiologies. METHODS: The recurrence rate of tachycardia, consequent further therapies (other catheter ablation procedures, drug therapy and implantable defibrillator) and clinical events have been assessed in 60 consecutive patients undergoing ventricular tachycardia catheter ablation between January 2000 and December 2004. RESULTS: During a median follow-up of 20 months (interquartile range 13-36 months), tachycardia recurred in 27 patients (45%) after a median of 3 months (interquartile range 1-12 months). A second procedure was performed in 11 patients; it was successful in 8 patients. Four patients underwent pharmacological therapy which was successful in all cases. Overall, after ablation (> or =1 procedures) and pharmacological therapy, tachycardia was cured in 75% of cases. All the 20 patients without structural heart disease were cured with ablation vs. 62% of patients with heart disease (p = 0.001). Patients with dilated cardiomyopathy reported worst results (33% success, p = 0.03). Recurrences were predicted by acute failure of procedure (p = 0.05), presence of heart disease (p = 0.006) and history of atrial arrhythmias (p = 0.02). On a multivariate analysis, only structural heart disease continued to be an independent predictor of ventricular tachycardia recurrence. CONCLUSIONS: Catheter ablation of ventricular tachycardia has a high percentage of recurrences in patients with heart disease, whereas is curative in subjects without structural heart disease.

Adult↗
PubMed2005

The usage and diagnostic yield of the implantable loop-recorder in detection of the mechanism of syncope and in guiding effective antiarrhythmic therapy in older people.

OBJECTIVES: To evaluate the usage and diagnostic yield of the implantable loop-recorder (ILR) in detection of the mechanism of syncope and in guiding therapy in patients aged >/=65 years and comparing them with those <65 years. DESIGN: This was a two-hospital, observational, prospective study in consecutive patients with unexplained syncope who underwent an ILR implantation. Between November 1997 and December 2002, a total of 2052 patients with syncope were evaluated (local population of 590,000 inhabitants). The diagnosis remained unexplained in 371 (18%). Of these, 103 patients (5% of the total, 28% of those with unexplained syncope) received an ILR. RESULTS: There were 70 (76%) patients aged >/=65 years and 25 (24%) <65 years. ILR implantation was 110 and 9 per million inhabitants per year, respectively. During a mean follow-up of 14+/-10 months, syncope was recorded in 52 patients. Compared with younger patients those older had a 2.7 higher syncope recurrence rate (56% vs 32%, P=0.03); arrhythmias were 3.1 times more likely to be responsible for syncope (44% vs 20%, P=0.03). More patients >/=65 years finally received ILR-guided therapy (42% vs 20%, P=0.04). Among the 29 patients (25 of those >/=65 years) who received specific antiarrhythmic therapy, only one (3%), had recurrence of syncope during the subsequent follow-up of 40+/-18 months. CONCLUSIONS: In patients referred for investigation of unexplained syncope, the older subjects are more likely to have an indication for ILR implantation than those younger, ILR has a higher diagnostic value, an arrhythmia is more likely to be detected and successfully treated.

Aged↗
PubMed2005

Two unusual cases of coincident atrioventricular nodal reentrant tachycardia and ventricular tachycardia.

The simultaneous occurrence of narrow and wide QRS complex tachycardias was observed in 2 patients evaluated at our electrophysiological centers. Electrophysiological testing revealed the coexistence of two types of arrhythmia (atrioventricular nodal reentrant tachycardia and verapamil-sensitive left ventricular tachycardia) in one patient and of three types of arrhythmia (atrioventricular nodal reentrant tachycardia, ventricular tachycardia originating from the right ventricular outflow tract, and left ventricular tachycardia) in the other. Both patients underwent successful radiofrequency ablation of all the types of tachycardia.

Aged↗
PubMed2004

Outcome after cavo-tricuspid isthmus ablation in patients with recurrent atrial fibrillation and drug-related typical atrial flutter.

This study evaluates the long-term clinical outcome of 56 consecutive patients affected by atrial fibrillation and drug-related typical atrial flutter who underwent cavo-tricuspid isthmus radiofrequency ablation. Symptomatic arrhythmic events recurred after ablation in 64% of the patients during follow-up of 19 +/- 9 months. Even in those who had recurrences, there was a substantial reduction in the incidence of episodes, quality of life was improved, and hospitalizations decreased.

Aged↗
PubMed2004

Incidence, diagnostic yield and safety of the implantable loop-recorder to detect the mechanism of syncope in patients with and without structural heart disease.

AIM: To evaluate the incidence, diagnostic yield and safety of implantable loop recorders (ILRs) in patients with or without structural heart disease (SHD). METHODS AND RESULTS: Two-hospitals, observational, prospective study in consecutive patients with unexplained syncope who underwent an ILR implantation. Between November 1997 and December 2002, a total of 2052 patients with syncope were evaluated (referral population of 590000 inhabitants). The diagnosis remained unexplained in 371 (18%). Of these, 103 patients (5% of total, 28% of unexplained syncope) received an ILR. SHD was present in 38 (37%), and absent in 65 (63%). During a median follow-up of 13 months, syncope was recorded in 52 patients. While patients with and without SHD had similar incidence of syncope recurrence, its mechanism was different. Patients with SHD more frequently had paroxysmal AV block and tachyarrhythmias and patients without SHD more frequently had sinus bradycardia/sinus arrest or no arrhythmia. More patients with SHD finally received an ILR-guided therapy. Sudden death occurred in one patient with SHD. Five syncope-related injuries were noted in 3 patients. CONCLUSION: The mechanism of syncope is different in patients with and without SHD; diagnostic yield and safety are similar in both groups. About 28% of patients with unexplained syncope have an indication to ILR implantation. The need for ILR implantation in the general population is 34 implants/million inhabitants/year.

Aged↗
PubMed2004

Efficacy and feasibility of isometric arm counter-pressure manoeuvres to abort impending vasovagal syncope during real life.

AIMS: Isometric arm exercises are able to increase blood pressure during the phase of impending vasovagal syncope. We evaluated their efficacy and feasibility during daily life in a group of 29 consecutive patients affected by vasovagal syncopes. METHODS: The patients were trained to use arm tensing and/or handgrip in case of occurrence of symptoms of impending syncope. RESULTS: During 14+/-6 months of follow-up, 260 episodes of impending syncope were reported by 19 patients; the manoeuvres were self-administered by these patients in 98% of cases and were able to abort syncope in 99.6% of cases. Overall, 5 episodes of syncope occurred in 5 patients (17%), in 4 cases without and in 1 with activation of the manoeuvres. Syncope recurred in 4 (40%) of 10 patients aged >65 years versus only 1 (5%) of 19 patients aged < or =65 years, p=0.03. The non-responders had more episodes of impending syncope than responders (37+/-32 vs 3+/-4, p=0.001). Among 19 clinical variables, age in years was the only significant predictor of syncopal recurrence. No patients had injury or other adverse morbidity related to the relapses. CONCLUSIONS: Isometric arm counter-pressure manoeuvres are able to abort impending vasovagal syncope in most patients aged < or =65 years. Arm counter-pressure manoeuvres are feasible, safe and well accepted by the patients in the daily life.

Adult↗
PubMed2003

Mechanism of syncope in patients with positive adenosine triphosphate tests.

OBJECTIVES: We prospectively evaluated the mechanism of syncope in patients with positive adenosine triphosphate (ATP) tests (defined as the induction of atrioventricular [AV] block with a ventricular pause >/=6 s after an intravenous bolus of 20 mg ATP). BACKGROUND: Patients with unexplained syncope tend to have more positive ATP tests results than those without syncope. METHODS: An implantable loop recorder (ILR) was inserted in 36 ATP-positive patients (69 +/- 10 years; 22 women; median of 6 syncopal episodes); 15 of them also had a positive response to tilt testing. RESULTS: During the follow-up of 18 +/- 9 months, 18 patients (50%) had syncopal recurrence and 16 (44%) had an electrocardiographically documented episode: AV block (n = 3: paroxysmal in 2 and permanent in 1), AV block followed by sinus arrest (n = 1), sinus arrest (n = 5), sinus bradycardia <40 beats/min (n = 2), normal sinus rhythm (n = 2), sinus tachycardia (n = 1), rapid atrial fibrillation (n = 1), and ectopic atrial tachycardia (n = 1). Bradycardia was documented in a total of 11 cases (69%), and a long ventricular pause (4 to 29 s) was present in eight cases (50%). All three patients with ILR-documented AV block had previously had a negative tilt test, whereas seven of eight with ILR-documented sinus bradycardia or sinus arrest had previously had a positive tilt test. CONCLUSIONS: In patients with adenosine-sensitive syncope, the mechanism of syncope is heterogeneous, although bradycardia is the most frequent finding. Adenosine triphosphate-induced AV block predicts AV block as the mechanism of spontaneous syncope in only a few tilt-negative patients.

Adenosine Triphosphate↗
PubMed2002

Isometric arm counter-pressure maneuvers to abort impending vasovagal syncope.

OBJECTIVES: We hypothesized that isometric arm exercises were able to increase blood pressure (BP) during the phase of impending vasovagal syncope and allow the patient to avoid losing consciousness. BACKGROUND: Hypotension is always present during the prodromal phase of vasovagal syncope. METHODS: We evaluated the effect of handgrip (HG) and arm-tensing in 19 patients affected by tilt-induced vasovagal syncope. The study consisted of an acute single-blind, placebo-controlled, randomized, cross-over tilt-table efficacy study and a clinical follow-up feasibility study. RESULTS: In the acute tilt study, HG was administered for 2 min, starting at the time of onset of symptoms of impending syncope. In the active arm, HG caused an increase in systolic blood pressure (SBP) from 92 +/- 10 mm Hg to 105 +/- 38 mm Hg, whereas in the placebo arm SBP decreased from 91 +/- 11 mm Hg to 73 +/- 21 mm Hg (p = 0.008). Heart rate behavior was similar in the two arms. In the active arm, 63% of patients became asymptomatic, versus 11% in the control arm (p = 0.02); conversely, only 5% of patients developed syncope, versus 47% in the control arm (p = 0.01). The patients were trained to self-administer arm-tensing treatment as soon as symptoms of impending syncope occurred. During 9 +/- 3 months of follow-up, the treatment was actually performed in 95/97 episodes of impending syncope (98%) and was successful in 94/95 (99%). No patients suffered injury or other adverse morbidity related to the relapses. CONCLUSIONS: Isometric arm contraction is able to abort impending vasovagal syncope by increasing systemic BP. Arm counter-pressure maneuvers can be proposed as a new, feasible, safe, and well accepted first-line treatment for vasovagal syncope.

Adolescent↗