Papers by Valentina Ribatti
Pacing and Clinical Electrophysiology, Sep 13, 2023
Authorea (Authorea), Jun 19, 2023
Journal of Cardiovascular Electrophysiology, May 17, 2023
IntroductionBrugada syndrome (BrS) has a dynamic ECG pattern that might be revealed by certain co... more IntroductionBrugada syndrome (BrS) has a dynamic ECG pattern that might be revealed by certain conditions such as fever. We evaluated the incidence and management of ventricular arrhythmias (VAs) related to COVID‐19 infection and vaccination among BrS patients carriers of an implantable loop recorder (ILR) or implantable cardioverter‐defibrillator (ICD) and followed by remote monitoring.MethodsThis was a multicenter retrospective study. Patients were carriers of devices with remote monitoring follow‐up. We recorded VAs 6 months before COVID‐19 infection or vaccination, during infection, at each vaccination, and up to 6‐month post‐COVID‐19 or 1 month after the last vaccination. In ICD carriers, we documented any device intervention.ResultsWe included 326 patients, 202 with an ICD and 124 with an ILR. One hundred and nine patients (33.4%) had COVID‐19, 55% of whom developed fever. Hospitalization rate due to COVID‐19 infection was 2.76%. After infection, we recorded only two ventricular tachycardias (VTs). After the first, second, and third vaccines, the incidence of non‐sustained ventricular tachycardia (NSVT) was 1.5%, 2%, and 1%, respectively. The incidence of VT was 1% after the second dose. Six‐month post‐COVID‐19 healing or 1 month after the last vaccine, we documented NSVT in 3.4%, VT in 0.5%, and ventricular fibrillation in 0.5% of patients. Overall, one patient received anti‐tachycardia pacing and one a shock. ILR carriers had no VAs. No differences were found in VT before and after infection and before and after each vaccination.ConclusionsFrom this large multicenter study conducted in BrS patients, followed by remote monitoring, the overall incidence of sustained VAs after COVID‐19 infection and vaccination is relatively low.
European Heart Journal, Nov 1, 2020
Circulation
Introduction: Brugada syndrome (BrS) is an inherited channelopathy leading to an increased risk o... more Introduction: Brugada syndrome (BrS) is an inherited channelopathy leading to an increased risk of life-threatening arrhythmias. BrS patients have a dynamic ECG pattern that might be revealed by certain conditions such as fever. Covid infection/vaccination is associated with fever. Therefore, prompt treatment with antipyretic drugs is recommended. Hypothesis: We evaluated the incidence and management of fever-related arrhythmias from Covid infection/vaccination among BrS patients previously implanted with an implantable loop recorder (ILR) or an implantable cardioverter-defibrillator (ICD) and followed by remote monitoring. Methods: 326 patients were retrospectively analyzed in 9 Italian Centers with a dedicated inherited disease ambulatory. All patients had a previously implanted device (ICD/ILR) and remote monitoring. We recorded ventricular arrhythmias (non-sustained VT, VT, FVT, VF) 6-month before Covid infection/vaccination, during Covid infection, at each vaccination, and up t...
European Heart Journal Supplements, Dec 14, 2022
European Heart Journal Supplements, May 1, 2022
Background: The rate of post-vaccine myocarditis is being studied from the beginning of the massi... more Background: The rate of post-vaccine myocarditis is being studied from the beginning of the massive vaccination campaign against Sars-Cov-2, reporting a very low incidence. Although a direct cause-effect relationship has been described, in most cases the vaccine pathophysiological role is doubtful. Moreover, it is not quite as clear as having had a previous myocarditis could be a risk factor for a post-vaccine disease relapse. Case Presentation: A 27-year-old man presented to the ED for palpitations and pericardial chest pain radiated to the upper left limb, on the 4th day after the third dose of BNT162b2 vaccine. He experienced a previous myocarditis 3 years before, with full recovery and no other comorbidities. ECG showed a diffuse ST segment elevation and a cardiac echo showed lateral hypokinesia with preserved ejection fraction. Troponine-T was elevated (160ng/l), chest x-ray was normal, and the Sars-Cov-2 molecular buffer was negative. High-dose anti-inflammatory therapy with ibuprofen and colchicine was started; in the 3rd day high sensitivity Troponin I reached a peak (hsTnI) of 23000 ng/L. No heart failure or arrhythmias were observed. A cardiac MRI was performed showing normal biventricular systolic function, areas of LGE with non-ischemic subepicardial pattern at the level of the anterior wall with increased T2 signal, suggestive for a recurrence of myocarditis. A left ventricle electroanatomic voltage mapping was negative (both unipolar and bipolar), while the endomiocardial biopsy showed a picture consistent with active myocarditis. The patient was discharged in good shape, with normal hsTnI values on bisoprolol 1.25mg, ramipril 2.5mg, ibuprofen 600 mg three times a day, colchicine 0.5 mg twice a day. Discussion: We presented the case of a young man with history of previous myocarditis, admitted with a non-complicated acute myopericarditis relapse occurred 4 days after Sars-Cov-2 vaccination (3rd dose). Despite the observed very low incidence of cardiac complications following BNT162b2 administration, and the lack of a clear proof of a direct cause-effect relationship, we think that in our patient this link can be more than likely. In the probable need for additional Sars-Cov-2 vaccine doses in the next future, studies addressing the risk-benefit balance of this subset of patient are warranted. Conclusion: We described a multidisciplinary management of a case of myocarditis recurrence after the third dose of Sars-Cov-2 BNT162b2 vaccine.
European Heart Journal Supplements
Background Acute myocarditis (AM) is a heart inflammatory disease that may also rarely occur as a... more Background Acute myocarditis (AM) is a heart inflammatory disease that may also rarely occur as a complication of COVID-19 vaccines. Inflammation is involved in arrhythmogenic cardiomyopathy (ACM) pathogenesis. Little is known regarding the COVID-19 vaccines influence on ACM relapses. We present two cases of vaccine related AM revealing a pre-existent (silent) ACM. Cases presentation Table shows a summary of the patients’ main clinical characteristics. Discussion We presented 2 cases of arrhythmic myocarditis-like clinical presentation in patients without previous cardiovascular history, whose timing was temporally related to a dose of vaccine against COVID-19. Subsequent diagnostic workup suggested the possible presence of an underlying silent ACM. In our case series, tissue characterization provided by CMR played a fundamental role as a diagnostic tool, showing in all cases a prominent left ventricle involvement and identifying both the underlying ACM disease and the superimposed ...
European Heart Journal Supplements, May 1, 2022
With a Cox regression model, considering the absence of risk factor as a reference, we confirmed ... more With a Cox regression model, considering the absence of risk factor as a reference, we confirmed that having 2 or 3 risk factors was significantly associated with death before hospital discharge [HR 1.9 (95%IC 1-3.5), p ¼ 0.037 e HR 5.1(95%IC 2.6-10.1), p < 0.001 respectively]. Conclusions: Our study confirms the central role of ECG in STEMI patients resuscitated after an OHCA and proves that post-ROSC ECG features can be used for both the selection of patients who may benefit from urgent coronary angiography as well as for prognostic stratifications.
European Heart Journal Supplements
Background The rate of post–vaccine myocarditis is being studied from the beginning of the massiv... more Background The rate of post–vaccine myocarditis is being studied from the beginning of the massive vaccination campaign against Sars–Cov–2, reporting a very low incidence. Although a direct cause–effect relationship has been described, in most cases the vaccine pathophysiological role is doubtful. Moreover, it is not quite as clear as having had a previous myocarditis could be a risk factor for a post–vaccine disease relapse. Case Presentation A 27–year–old man presented to the ED for palpitations and pericardial chest pain radiated to the upper left limb, on the 4th day after the third dose of BNT162b2 vaccine. He experienced a previous myocarditis 3 years before, with full recovery and no other comorbidities. ECG showed a diffuse ST segment elevation and a cardiac echo showed lateral hypokinesia with preserved ejection fraction. Troponine–T was elevated (160ng/l), chest x–ray was normal, and the Sars–Cov–2 molecular buffer was negative. High–dose anti–inflammatory therapy with ibu...
Europace, May 24, 2023
Funding Acknowledgements: Type of funding sources: None. Introduction: Pulsed-field ablation (PFA... more Funding Acknowledgements: Type of funding sources: None. Introduction: Pulsed-field ablation (PFA) is a new non-thermal, tissue-specific ablation technique. Through the application of a local electric field, it is possible to induce a selective electroporation of cardiomyocytes membranes, resulting in myocytic apoptosis and sparing of non-myocardial structures (nerves, connective tissue, esophagus, vessels). Purpose: A new PFA system for atrial fibrillation (AF) ablation has recently been introduced in our hospital. The aim of this retrospective review is to share the initial results of our experience in terms of acute efficacy and safety. Methods: A total of 41 adult patients suitable for AF percutaneous ablation underwent PFA between April and November 2022 in our Institute. PFA system consisted of a current generator, a deflectable sheath and a multielectrode PFA catheter. Once inside the left atrium (LA), the PFA catheter was directed to the pulmonary veins (PVs) ostia through an over-the-wire system. Then, 8 electric impulses were applied for each PV to achieve electrical isolation; in some cases, applications to the posterior left atrium wall (LAPW) were delivered to obtain LAPW isolation (LAPWI). A moderate-to-deep sedation was provided by an anesthesiologist during all the procedures. Acute ablation efficacy was defined as absence of intracavitary signals at the electroanatomic mapping and local capture failure at the pacing maneuvers. Intra and peri-procedural safety was defined as the absence of major complications (pericardial effusion/ tamponade, stroke, vascular complications, death) during the procedure and the hospitalization period. Results: Of the 41 patients included, 24 (58.5%) were treated for paroxysmal AF and 17 (41.5%) for persistent AF. In almost all cases (n=40, 97.6%) pulmonary veins isolation (PVI) was performed; in 14 cases (34.1%, almost all persistent AF patients) a LAPWI was performed with the application of a variable number of pulses (mean value = 13). In most of the cases (n=28, 68.3%) an electroanatomic mapping was acquired before and after the ablation. Acute efficacy was observed in all PVI cases (n=40, 100%) and in all LAPWI cases (n=14, 100%). No periprocedural major complications were observed (n=0, 0%). Conclusions: PFA is a promising ablation technique capable of inducing selective myocytic apoptosis through electroporation, causing a thick damage across the muscle with no injury of other tissues, and could become a game changer in electrophysiology in the next future. Our initial data report a combination of ease of use and high efficacy and safety profiles.
European Heart Journal, 2020
Background A myocardial substrate assessment through percutaneous endomyocardial biopsy (EMB) rep... more Background A myocardial substrate assessment through percutaneous endomyocardial biopsy (EMB) represents an important additional diagnostic test for cardiomyopathies when uncertainties remain after non-invasive evaluation. Yet, extensive application of EMB has been limited by the low sensitivity of biopsies. Electroanatomic voltage mapping (EVM) is a promising modality for guiding Endomyocardial biopsies (EMB). Aim The aim of our study is to evaluate the diagnostic yield of EVM-guided EMB and the role of histological analysis in the diagnosis of patients with suspected cardiomyopathies and arrhythmic presentation. Methods One-hundred and sixty-two consecutive patients undergoing EMB at our Institution from 2010 to 2019 were included. Demographics, clinical data, CMR data and peri-procedural complications were retrospectively retrieved. All procedures were guided by endo-cavitary EVM. According to non-invasive data collected before proceeding with EMB a suspected clinical diagnosis w...
European Heart Journal, Aug 1, 2017
Background: Cardiovascular (CV) disease remains a significant public health concern in the Japane... more Background: Cardiovascular (CV) disease remains a significant public health concern in the Japanese population. Evidence from clinical practice (real-world evidence) describing treatment patterns in patients with CV disease can help identify gaps and guide efforts to improve patient outcomes. Purpose: To describe statin use and low density lipoprotein cholesterol (LDL-C) levels across three cohorts in Japan. Methods: We conducted a retrospective cohort study of three adult (≥18 years) patient groups in the JMDC medical and pharmacy claims database: (1) patients with diagnosed hypercholesterolemia, (2) patients with a recent myocardial infarction (MI) or stroke, and (3) statin users. The first date a patient met the inclusion criteria for any of the cohorts in 2014 was assigned as the index date; cohorts were not mutually exclusive. We used one-year baseline and follow-up periods. Statin use was defined as having at 1+ prescription with ≥14 days' supply during baseline. Statin intensity dosage categories were adapted from the U.S. AHA/ACC 2013 Guidelines as maximum tolerated, greater than moderate, moderate, and low intensity. The highest dose was used if multiple prescription claims were found. Results: We identified 51,226 patients with diagnosed hypercholesterolemia, 10,673 patients with an MI/stroke, and 59,399 statin users. The majority were male (62% hypercholesterolemia 68% MI/stroke, and 63% statin users, respectively), and the average ages were 54, 58, and 56 years, respectively. Statin use was less prevalent in the MI/stroke cohort (47%) than among hypercholesterolemia patients (72%), with only 3% of patients taking statin and ezetimibe concomitantly (all cohorts). Overall, moderate intensity statin use was most prevalent. Use of maximally tolerated statin dose was very low (1-2%). When considered within ACC/AHA guideline definition, many (55-62%) would be categorized as taking low intensity statins and <1% of all patients would be considered as taking high intensity or maximally tolerated statins. Among patients with an LDL-C lab value during baseline (53-64%), 79%, 68%, 77% had LDL-C levels ≥100 mg/dL (2.6 mmol/L), respectively. In all cohorts, LDL-C levels were lower among patients receiving higher intensity statin dose. Among the small number of patients taking concomitant statin+ezetimibe, fewer patients had LDL ≥100mg/dL (43-62%). Conclusions: Japanese guidelines recommend treating patients with lipidlowering medications to LDL-C levels <100 mg/dL but in clinical practice fewer than 50% of patients achieve that, identifying an area for potential improvement. Future research will describe rates of cardiovascular events in these real-world Japanese patient populations.
Journal of Allergy and Clinical Immunology, 2006
Background: Tissue hyperreactivity of target organs to nonspecific stimuli is known to be an impo... more Background: Tissue hyperreactivity of target organs to nonspecific stimuli is known to be an important factor in influencing the clinical picture of allergic disease. Objective: To identify the sensitivity and specificity of a hyperosmolar conjunctival provocation test in predicting conjunctival hyperreactivity and to relate this reactivity to the presence of ocular discomfort in subjects with and without allergy. Methods: In 50 healthy patients and 19 patients with allergic conjunctivitis during remission phase, symptoms of ocular discomfort triggered by nonspecific stimuli were identified and graded with a discomfort score. Subjects were then challenged with a glucose solution at increasing concentrations (from 10% to 50%). The glucose concentration that elicited 21 conjunctival hyperemia was considered the provoking dose. The response to this hyperosmolar provocation in subjects with ocular discomfort was compared with that of asymptomatic subjects. Sensitivity and specificity of the test in predicting conjunctival hyperreactivity were analyzed. Results: Six of 50 healthy subjects and 12 of 19 subjects with allergy complained of ocular discomfort after exposure to nonspecific stimuli. The hyperosmolar provocation test discriminated between subjects with and without ocular discomfort (mean provoking dose: 39.5% 6 5% and 47.5% 6 5% glucose, respectively; P < .001). Forty percent glucose was the optimal threshold dose that demonstrated the highest sensitivity and specificity for prediction of conjunctival hyperreactivity. Discomfort scores were significantly related to provoking dose values (P < .05). Conclusion: This study provides a standardized procedure to detect nonspecific conjunctival hyperreactivity independent of underlying atopy. Clinical implications: Hyperosmolar provocation test may be useful for identifying conjunctival hyperreactivity in subjects with and without allergy with a history of ocular discomfort.
European Heart Journal Supplements
The rate of post-vaccine myocarditis is being studied from the beginning of the massive vaccinati... more The rate of post-vaccine myocarditis is being studied from the beginning of the massive vaccination campaign against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although a direct cause–effect relationship has been described, in most cases, the vaccine pathophysiological role is doubtful. Moreover, it is not quite as clear as having had a previous myocarditis could be a risk factor for a post-vaccine disease relapse. A 27-year-old man presented to the emergency department for palpitations and pericardial chest pain radiated to the upper left limb, on the 4th day after the third dose of BNT162b2 vaccine. He experienced a previous myocarditis 3 years before, with full recovery and no other comorbidities. Electrocardiogram showed normal atrioventricular conduction, incomplete right bundle branch block, and diffuse ST-segment elevation. A cardiac echo showed lateral wall hypokinesis with preserved ejection fraction. Troponin-T was elevated (160 ng/L), chest X-ray was no...
This record contains raw data related to the article "Cardiac arrhythmia catheter ablation p... more This record contains raw data related to the article "Cardiac arrhythmia catheter ablation procedures guided by x-ray imaging: N-acetylcysteine protection against radiation-induced cellular damage (CARAPACE study): study design." Abstract <strong>Purpose: </strong>Catheter ablation (CA) procedures are characterized by exposure to ionizing radiations (IR). IR can cause DNA damage and may lead to carcinogenesis if not efficiently repaired. The primary endpoint of this study is to investigate whether intravenous administration of N-acetylcysteine prior to CA procedure may prevent systemic oxidative stress and genomic DNA damage induced by exposure to IR. <strong>Methods: </strong>The "Cardiac Arrhythmia catheter ablation procedures guided by x-Ray imaging: N-Acetylcysteine Protection Against radiation induced Cellular damagE" (CARAPACE) study is a prospective, randomized, single-blinded, parallel-arm monocenter study enrolling 550 consecutive...
JACC: Clinical Electrophysiology, 2021
OBJECTIVES This study aimed to assess the long-term outcomes of minimally fluoroscopic approach (... more OBJECTIVES This study aimed to assess the long-term outcomes of minimally fluoroscopic approach (MFA) compared with conventional fluoroscopic ablation (ConvA) in terms of recurrences of arrhythmia and long-term complications. BACKGROUND Catheter ablation (CA) of supraventricular tachycardia (SVT) with an MFA, under the guidance of electroanatomic mapping (EAM) systems, results in a significant reduction in exposure to ionizing radiations without impairing acute procedural success and complication rate. However, data regarding long-term outcomes of MFA compared with ConvA are lacking. METHODS This is a retrospective observational study. All patients undergoing MFA CA of SVT (atrioventricular nodal re-entrant tachycardia and atrioventricular re-entrant tachycardia) between 2010 and 2015 were enrolled and were compared with matched subjects (1 MFA: 2 ConvA) undergoing ConvA during the same period. The 2 co-primary outcomes were recurrence of arrhythmias and long-term complications. RESULTS Six-hundred eighteen patients (mean age 38 ± 15 years, 60% female) were enrolled. MFA included 206 patients, whereas 412 were treated with ConvA. Acute success (99% vs. 97%; p = 0.10) and acute complications (2.4% vs. 5.3%; p = 0.14) were similar in the 2 groups. During a median follow-up of 4.4 years, 5.9% of patients experienced recurrence of arrhythmias. At multivariate analysis, ConvA (hazard ratio [HR]: 3.03) and procedural success (HR: 0.10) were independently associated with recurrence of arrhythmias. Late complications (i.e., advance atrioventricular block and need for pacemaker implantation) occurred more frequently in ConvA (3.4% vs. 0.5%; p = 0.03) compared with MFA. CONCLUSIONS CA guided by EAM systems with MFA provided better long-term results and reduced risk of complications compared with ConvA.
Journal of Interventional Cardiac Electrophysiology, 2020
Catheter ablation (CA) procedures are characterized by exposure to ionizing radiations (IR). IR c... more Catheter ablation (CA) procedures are characterized by exposure to ionizing radiations (IR). IR can cause DNA damage and may lead to carcinogenesis if not efficiently repaired. The primary endpoint of this study is to investigate whether intravenous administration of N-acetylcysteine prior to CA procedure may prevent systemic oxidative stress and genomic DNA damage induced by exposure to IR. The “Cardiac Arrhythmia catheter ablation procedures guided by x-Ray imaging: N-Acetylcysteine Protection Against radiation induced Cellular damagE” (CARAPACE) study is a prospective, randomized, single-blinded, parallel-arm monocenter study enrolling 550 consecutive patients undergoing CA at the Arrhythmology Unit of Centro Cardiologico Monzino (CCM). Inclusion criteria are age ≥ 18, indication for CA procedure guided by IR imaging, and written informed consent. IR levels will be measured via fluoroscopy time, effective dose, and dose area product. Glutathione and glutathione disulfide concentrations will be measured, and urinary levels of 8-iso-prostaglandin-F2α and 8-hydroxy-2-deoxyguanosine will be quantified. The enrolled patients will be randomized 1:1 to the N-acetylcysteine group or to the control group. We expect that pre-operative administration of N-acetylcysteine will prevent IR-induced systemic oxidative stress. The study will provide data on oxidative DNA damage assessed by urinary 8-hydroxy-2-deoxyguanosine levels and direct evidence of genomic DNA damage in blood cells by comet assay. Catheter ablation procedures can lead to IR exposure and subsequent DNA damage. N-acetylcysteine administration prior to the procedure may prevent them and therefore lead to less possible complications. www.clinicaltrials.gov (NCT04154982)
European Heart Journal, 2020
Background Electroanatomic voltage mapping (EVM) is a promising modality for guiding Endomyocardi... more Background Electroanatomic voltage mapping (EVM) is a promising modality for guiding Endomyocardial biopsies (EMB). Previous experiences on this techniques have reported safety and feasibility of this approach. These reports however, resulted limited by sample size or imperfect designs, preventing reliable comparisons of the effectiveness of this new methods with a conventional or a cardiac magnetic resonance (CMR) imaging guided approach. Aim We now report the largest cohort of patients undergoing EVM-guided EMB in order to show its diagnostic yield and comparing it with a cardiac magnetic resonance (CMR) guided approach. Methods One-hundred and sixty-two consecutive patients undergoing EMB at our Institution from 2010 to 2019 were included. Pathological areas identified at EVM and CMR underwent EMB. According to EMB results, CMR and EVM sensitivity and specificity regarding the identification of pathological substrates of myocardium were evaluated. Results A gadolinium-enhanced CM...
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Papers by Valentina Ribatti