Editorial

3 pages, 207 KiB

Open AccessEditorial

Special Issue: “Biophysics, Arrhythmias and Pacing”

by Matteo Bertini

Biology 2023, 12(4), 569; https://0-doi-org.brum.beds.ac.uk/10.3390/biology12040569 - 08 Apr 2023

Viewed by 988

Cardiac pacing technologies have been implemented during the last few decades, including leadless pacemakers and pacing of the conduction system, such as His bundle pacing and left bundle branch area pacing [...] Full article

(This article belongs to the Special Issue Biophysics Arrhythmias and Pacing)

Research

Jump to: Editorial, Review, Other

8 pages, 523 KiB

Open AccessCommunication

Non-Vitamin K Antagonist Oral Anticoagulants in Patients with β-Thalassemia

by Michele Malagù, Filomena Longo, Federico Marchini, Paolo Sirugo, Andrea Capanni, Stefano Clò, Elisa Mari, Martina Culcasi and Matteo Bertini

Biology 2023, 12(4), 491; https://0-doi-org.brum.beds.ac.uk/10.3390/biology12040491 - 23 Mar 2023

Cited by 1 | Viewed by 1541

Abstract

Background. Patients with β-thalassemia have a high incidence of atrial fibrillation (AF) and other supraventricular arrhythmias. The use of non-vitamin K antagonist oral anticoagulants (NOACs) for thromboembolic prophylaxis in patients with β-thalassemia has not been systematically evaluated. Methods. We enrolled patients with [...] Read more.

Background. Patients with β-thalassemia have a high incidence of atrial fibrillation (AF) and other supraventricular arrhythmias. The use of non-vitamin K antagonist oral anticoagulants (NOACs) for thromboembolic prophylaxis in patients with β-thalassemia has not been systematically evaluated. Methods. We enrolled patients with transfusion-dependent β-thalassemia, who were on treatment with NOACs for thromboembolic prophylaxis of supraventricular arrhythmias. Data on thromboembolic and bleeding events were collected. Results. Eighteen patients were enrolled. The patients had a history of AF (sixteen), typical atrial flutter (five), and atypical atrial flutter (four). The patients were treated with dabigatran (seven), apixaban (five), rivaroxaban (four) or edoxaban (two). The mean follow-up duration was 22 ± 15 months. No thromboembolic events were reported. No major bleedings were observed. Three patients had non-major bleeding events. Two patients reported dyspepsia during treatment with dabigatran and were shifted to a different NOAC. Conclusions. Our study suggests the efficacy and safety of NOACs in patients affected by transfusion-dependent β-thalassemia. Full article

(This article belongs to the Special Issue Biophysics Arrhythmias and Pacing)

► Show Figures

Figure 1

13 pages, 697 KiB

Open AccessArticle

Transvenous Lead Extraction in Patients with Cardiac Implantable Device: The Impact of Systemic and Local Infection on Clinical Outcomes—An ESC-EHRA ELECTRa (European Lead Extraction Controlled) Registry Substudy

by Igor Diemberger, Luca Segreti, Christopher A. Rinaldi, Jesper Hastrup Svendsen, Andrzej Kutarski, Arwa Younis, Cécile Laroche, Christophe Leclercq, Barbara Małecka, Przemyslaw Mitkowski, Maria Grazia Bongiorni and On behalf of the ELECTRa Investigators

Biology 2022, 11(4), 615; https://0-doi-org.brum.beds.ac.uk/10.3390/biology11040615 - 18 Apr 2022

Cited by 6 | Viewed by 2161

Abstract

Background: Infections of cardiac implantable devices (CIEDI) have poor outcomes despite improvement in lead extraction (TLE) procedures. Methods: To explore the influence of CIEDI on the outcomes of TLE and the differences between patients with systemic (Sy) vs. local (Lo) CIEDI, we performed [...] Read more.

Background: Infections of cardiac implantable devices (CIEDI) have poor outcomes despite improvement in lead extraction (TLE) procedures. Methods: To explore the influence of CIEDI on the outcomes of TLE and the differences between patients with systemic (Sy) vs. local (Lo) CIEDI, we performed a sub-analysis of the EORP ELECTRa (European Lead Extraction ConTRolled) Registry. Results: Among 3555 patients enrolled by 73 centers in 19 Countries, the indication for TLE was CIEDI in 1850: 1170 with Lo-CIEDI and 680 with Sy-CIEDI. Patients with CIEDI had a worse in-hospital prognosis in terms of major complications (3.57% vs. 1.71%; p = 0.0007) and mortality (2.27% vs. 0.49%; p < 0.0001). Sy-CIEDI was an independent predictor of in-hospital death (H.R. 2.14; 95%CI 1.06–4.33. p = 0.0345). Patients with Sy-CIEDI more frequently had an initial CIED implant and a higher prevalence of comorbidities, while subjects with Lo-CIEDI had a higher prevalence of previous CIED procedures. Time from signs of CIEDI and TLE was longer for Lo-CIEDI despite a shorter pre-TLE antibiotic treatment. Conclusions: Patients with CIEDI have a worse in-hospital prognosis after TLE, especially for patients with Sy-CIEDI. These results raise the suspicion that in a relevant group of patients CIEDI can be systemic from the beginning without progression from Lo-CIEDI. Future research is needed to characterize this subgroup of patients. Full article

(This article belongs to the Special Issue Biophysics Arrhythmias and Pacing)

► Show Figures

Figure 1

10 pages, 829 KiB

Open AccessArticle

Atrial High-Rate Episodes Detected by Cardiac Implantable Electronic Devices: Dynamic Changes in Episodes and Predictors of Incident Atrial Fibrillation

by Jacopo Francesco Imberti, Niccolò Bonini, Alberto Tosetti, Davide Antonio Mei, Luigi Gerra, Vincenzo Livio Malavasi, Andrea Mazza, Gregory Y. H. Lip and Giuseppe Boriani

Biology 2022, 11(3), 443; https://0-doi-org.brum.beds.ac.uk/10.3390/biology11030443 - 15 Mar 2022

Cited by 20 | Viewed by 2605

Abstract

Background. Atrial high rate episodes (AHRE) detected by cardiac implantable electronic devices (CIEDs) may be associated with a risk of progression towards long-lasting episodes (≥24 h) and clinical atrial fibrillation (AF). Methods. Consecutive CIED patients presenting AHRE (with confirmation of an arrhythmia lasting [...] Read more.

Background. Atrial high rate episodes (AHRE) detected by cardiac implantable electronic devices (CIEDs) may be associated with a risk of progression towards long-lasting episodes (≥24 h) and clinical atrial fibrillation (AF). Methods. Consecutive CIED patients presenting AHRE (with confirmation of an arrhythmia lasting 5 min–23 h 59 min, atrial rate ≥175/min, with no AF at 12-lead ECG and no prior clinical AF) were retrospectively enrolled. The aims of this study were to describe patients’ characteristics and the incidence of adverse events, and second, to identify potential predictors of the composite outcome of clinical AF and/or AHRE episodes lasting ≥24 h. Results. 104/107 (97.2%) patients (median age 79.7 (74.0–84.2), 33.7% female) had available follow-up data. Over a median follow-up of 24.3 (10.6–40.3) months, 31/104 (29.8%) patients experienced the composite outcome of clinical AF or AHRE episodes lasting ≥24 h. Baseline CHA₂DS₂-VASc score and the longest AHRE episode at enrollment lasting 12 h–23 h 59 min were independently associated with the composite outcome (Hazard ratio (HR); 95% CI: 1.40; 1.07–1.83 and HR: 8.15; 95% CI 2.32–28.65, respectively). Baseline CHA₂DS₂-VASc score and the longest AHRE episode at enrollment lasting 12 h–23 h 59 min were the only independent predictors of incident clinical AF (HR: 1.45; 95% CI 1.06–2.00 and HR: 4.25; 95% CI 1.05–17.20, respectively). Conclusions. In patients with AHRE, the incidence of clinical AF or AHRE episodes lasting ≥24 h is high in a two-year follow-up. Baseline patients’ characteristics (CHA₂DS₂-VASc score) and AHRE duration may help to intensify monitoring and decision-making, being independently associated with clinical AF at follow-up. Full article

(This article belongs to the Special Issue Biophysics Arrhythmias and Pacing)

► Show Figures

Figure 1

10 pages, 557 KiB

Open AccessArticle

Implantable Cardioverter Defibrillator Multisensor Monitoring during Home Confinement Caused by the COVID-19 Pandemic

by Matteo Ziacchi, Leonardo Calò, Antonio D’Onofrio, Michele Manzo, Antonio Dello Russo, Luca Santini, Giovanna Giubilato, Cosimo Carriere, Vincenzo Ezio Santobuono, Gianluca Savarese, Carmelo La Greca, Giuseppe Arena, Antonello Talarico, Ennio Pisanò, Massimo Giammaria, Antonio Pangallo, Monica Campari, Sergio Valsecchi and Igor Diemberger

Biology 2022, 11(1), 120; https://0-doi-org.brum.beds.ac.uk/10.3390/biology11010120 - 12 Jan 2022

Cited by 5 | Viewed by 1814

Abstract

Aims: The utilization of remote monitoring platforms was recommended amidst the COVID-19 pandemic. The HeartLogic index combines multiple implantable cardioverter defibrillator (ICD) sensors and has proved to be a predictor of impending heart failure (HF) decompensation. We examined how multiple ICD sensors behave [...] Read more.

Aims: The utilization of remote monitoring platforms was recommended amidst the COVID-19 pandemic. The HeartLogic index combines multiple implantable cardioverter defibrillator (ICD) sensors and has proved to be a predictor of impending heart failure (HF) decompensation. We examined how multiple ICD sensors behave in the periods of anticipated restrictions pertaining to physical activity. Methods: The HeartLogic feature was active in 349 ICD and cardiac resynchronization therapy ICD patients at 20 Italian centers. The period from 1 January to 19 July 2020, was divided into three phases: pre-lockdown (weeks 1–11), lockdown (weeks 12–20), post-lockdown (weeks 21–29). Results: Immediately after the implementation of stay-at-home orders (week 12), we observed a significant drop in median activity level whereas there was no difference in the other contributing parameters. The median composite HeartLogic index increased at the end of the Lockdown. The weekly rate of alerts was significantly higher during the lockdown (1.56 alerts/week/100 pts, 95%CI: 1.15–2.06; IRR = 1.71, p = 0.014) and post-lockdown (1.37 alerts/week/100 pts, 95%CI: 0.99–1.84; IRR = 1.50, p = 0.072) than that reported in pre-lockdown (0.91 alerts/week/100 pts, 95%CI: 0.64–1.27). However, the median duration of alert state and the maximum index value did not change among phases, as well as the proportion of alerts followed by clinical actions at the centers and the proportion of alerts fully managed remotely. Conclusions: During the lockdown, the system detected a significant drop in the median activity level and generated a higher rate of alerts suggestive of worsening of the HF status. Full article

(This article belongs to the Special Issue Biophysics Arrhythmias and Pacing)

► Show Figures

Figure 1

Review

Jump to: Editorial, Research, Other

12 pages, 975 KiB

Open AccessReview

Atrial Fibrillation in β-Thalassemia: Overview of Mechanism, Significance and Clinical Management

by Michele Malagù, Federico Marchini, Alessio Fiorio, Paolo Sirugo, Stefano Clò, Elisa Mari, Maria Rita Gamberini, Claudio Rapezzi and Matteo Bertini

Biology 2022, 11(1), 148; https://0-doi-org.brum.beds.ac.uk/10.3390/biology11010148 - 17 Jan 2022

Cited by 9 | Viewed by 3037

Abstract

Thalassemia is an inherited blood disorder with worldwide distribution. Transfusion and chelation therapy have radically improved the prognosis of β-thalassemic patients in the developed world, but this has led to the development of new chronic cardiac complications like atrial fibrillation (AF). Prevalence of [...] Read more.

Thalassemia is an inherited blood disorder with worldwide distribution. Transfusion and chelation therapy have radically improved the prognosis of β-thalassemic patients in the developed world, but this has led to the development of new chronic cardiac complications like atrial fibrillation (AF). Prevalence of AF in patients with β-thalassemia is higher than in the general population, ranging from 2 to 33%. Studies are lacking, and the little evidence available comes from a small number of observational studies. The pathophysiology is not well understood but, while iron overload seems to be the principal mechanism, AF could develop even in the absence of iron deposition. Furthermore, the clinical presentation is mainly paroxysmal, and patients are highly symptomatic. The underlying disease, the pathophysiology, and the clinical presentation require a different management of AF in β-thalassemia than in the general population. Rhythm control should be preferred over rate control, and the most important antiarrhythmic therapy is represented by chelation drugs. Thromboembolic risk is high, but the available risk scores are not validated in β-thalassemia, and the choice of anticoagulation therapy should be considered early. The main purpose of this review is to summarize the actual knowledge about AF in β-thalassemia, with a specific focus on the clinical management of these complex patients. Full article

(This article belongs to the Special Issue Biophysics Arrhythmias and Pacing)

► Show Figures

Figure 1

Other

Jump to: Editorial, Research, Review

20 pages, 1141 KiB

Open AccessSystematic Review

Clinical Profile, Arrhythmias, and Adverse Cardiac Outcomes in Emery–Dreifuss Muscular Dystrophies: A Systematic Review of the Literature

by Anna Chiara Valenti, Alessandro Albini, Jacopo Francesco Imberti, Marco Vitolo, Niccolò Bonini, Giovanna Lattanzi, Renate B. Schnabel and Giuseppe Boriani

Biology 2022, 11(4), 530; https://0-doi-org.brum.beds.ac.uk/10.3390/biology11040530 - 30 Mar 2022

Cited by 6 | Viewed by 2359

Abstract

Cardiolaminopathies are a heterogeneous group of disorders which are due to mutations in the genes encoding for nuclear lamins or their binding proteins. The whole spectrum of cardiac manifestations encompasses atrial arrhythmias, conduction disturbances, progressive systolic dysfunction, and malignant ventricular arrhythmias. Despite the [...] Read more.

Cardiolaminopathies are a heterogeneous group of disorders which are due to mutations in the genes encoding for nuclear lamins or their binding proteins. The whole spectrum of cardiac manifestations encompasses atrial arrhythmias, conduction disturbances, progressive systolic dysfunction, and malignant ventricular arrhythmias. Despite the prognostic significance of cardiac involvement in this setting, the current recommendations lack strong evidence. The aim of our work was to systematically review the current data on the main cardiovascular outcomes in cardiolaminopathies. We searched PubMed/Embase for studies focusing on cardiovascular outcomes in LMNA mutation carriers (atrial arrhythmias, ventricular arrhythmias, sudden cardiac death, conduction disturbances, thromboembolic events, systolic dysfunction, heart transplantation, and all-cause and cardiovascular mortality). In total, 11 studies were included (1070 patients, mean age between 26–45 years, with follow-up periods ranging from 2.5 years up to 45 ± 12). When available, data on the EMD-mutated population were separately reported (40 patients). The incidence rates (IR) were individually assessed for the outcomes of interest. The IR for atrial fibrillation/atrial flutter/atrial tachycardia ranged between 6.1 and 13.9 events/100 pts–year. The IR of atrial standstill ranged between 0 and 2 events/100 pts-year. The IR for malignant ventricular arrhythmias reached 10.2 events/100 pts–year and 15.6 events/100 pts–year for appropriate implantable cardioverter–defibrillator (ICD) interventions. The IR for advanced conduction disturbances ranged between 3.2 and 7.7 events/100 pts–year. The IR of thromboembolic events reached up to 8.9 events/100 pts–year. Our results strengthen the need for periodic cardiological evaluation focusing on the early recognition of atrial arrhythmias, and possibly for the choice of preventive strategies for thromboembolic events. The frequent need for cardiac pacing due to advanced conduction disturbances should be counterbalanced with the high risk of malignant ventricular arrhythmias that would justify ICD over pacemaker implantation. Full article

(This article belongs to the Special Issue Biophysics Arrhythmias and Pacing)

► Show Figures

Figure 1

8 pages, 898 KiB

Open AccessProject Report

Vascular Accesses in Cardiac Stimulation and Electrophysiology: An Italian Survey Promoted by AIAC (Italian Association of Arrhythmias and Cardiac Pacing)

by Matteo Ziacchi, Angelo Placci, Andrea Angeletti, Fabio Quartieri, Cristina Balla, Santo Virzi, Matteo Bertini, Roberto De Ponti, Mauro Biffi, Giuseppe Boriani and for AIAC Ricerca Investigators’ Network

Biology 2022, 11(2), 265; https://0-doi-org.brum.beds.ac.uk/10.3390/biology11020265 - 08 Feb 2022

Cited by 3 | Viewed by 1650

Abstract

Cardiac implantable electronic device (CIED) implants and electrophysiological procedures share a common step: vascular access. On behalf of the AIAC Ricerca Investigators’ Network, we conducted a survey to outline Italian common practice regarding vascular access in EP-lab. All Italian physicians with experience in [...] Read more.

Cardiac implantable electronic device (CIED) implants and electrophysiological procedures share a common step: vascular access. On behalf of the AIAC Ricerca Investigators’ Network, we conducted a survey to outline Italian common practice regarding vascular access in EP-lab. All Italian physicians with experience in CIED implantation and electrophysiology were invited to answer an online questionnaire (from May 2020 to November 2020) featuring 20 questions. In total, 103 cardiologists (from 92 Italian hospitals) answered the survey. Vascular access during CIED implants was considered the most complex step following lead placement by 54 (52.4%) respondents and the most complex for 35 (33.9%). In total, 54 (52.4%) and 49 (47.6%) respondents considered the cephalic and subclavian vein the first option, respectively (intrathoracic and extrathoracic subclavian/axillary vein by 22 and 27, respectively). In total, 45 (43.7%) respondents performed close arterial femoral accesses manually; only 12 (11.7%) respondents made extensive use of vascular closure devices. A total of 46 out of 103 respondents had experience in ultrasound-guided vascular accesses, but only 10 (22%) used it for more than 50% of the accesses. In total, 81 (78.6%) respondents wanted to increase their ultrasound-guided vascular access skills. Reducing complications is a goal to reach in cardiac stimulation and electrophysiological procedures. Our survey shows the heterogeneity of the vascular approaches used in Italian centres. Some vascular accesses were proved to be superior to others in terms of complications, with ultrasound-guided puncture as an emerging technique. More effort to produce the standardization of vascular accesses could be made by scientific societies. Full article

(This article belongs to the Special Issue Biophysics Arrhythmias and Pacing)

► Show Figures

Figure 1

9 pages, 2044 KiB

Open AccessBrief Report

Zero-Fluoroscopy Cardiac Ablation: Technology Is Moving Forward in Complex Procedures—A Novel Workflow for Atrial Fibrillation

by Matteo Bertini, Graziella Pompei, Paolo Tolomeo, Michele Malagù, Alessio Fiorio, Cristina Balla, Francesco Vitali and Claudio Rapezzi

Biology 2021, 10(12), 1333; https://0-doi-org.brum.beds.ac.uk/10.3390/biology10121333 - 15 Dec 2021

Cited by 6 | Viewed by 4249

Abstract

Background and Rationale. A fluoroscopy-based approach to an electrophysiological procedure is widely validated and has been recognized as the gold standard for a long time. The use of fluoroscopy exposes both the healthcare staff and the patient to a non-negligible dose of radiation. [...] Read more.

Background and Rationale. A fluoroscopy-based approach to an electrophysiological procedure is widely validated and has been recognized as the gold standard for a long time. The use of fluoroscopy exposes both the healthcare staff and the patient to a non-negligible dose of radiation. To minimize the risks associated with the use of fluoroscopy, it would be reasonable to perform ablation procedures with zero fluoroscopy. This approach is widely used in simple ablation procedures, but not in complex procedures. In atrial fibrillation (AF) ablation procedures, fluoroscopy remains the main technology used, in particular to guide the transseptal puncture. Main results and Implications. We present a workflow to perform a complete zero-fluoroscopy ablation for AF ablation procedures using a 3D electro-anatomical mapping system, intracardiac echocardiography and a novel steerable guiding sheath that can be visualized on the mapping system. We present two cases, one with paroxysmal AF and the other one with persistent AF during which we applied this novel workflow achieving a successful pulmonary vein isolation without complications and complete zero-fluoroscopy exposure. Full article

(This article belongs to the Special Issue Biophysics Arrhythmias and Pacing)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Biophysics Arrhythmias and Pacing

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Published Papers (9 papers)

Editorial

Research

Review

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI