21 results on '"D'Ambrosio, Gabriele"'
Search Results
2. Prognostic value of chronic kidney disease in patients undergoing left atrial appendage occlusion.
- Author
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Rocca, Domenico G Della, Magnocavallo, Michele, Niekerk, Christoffel J Van, Gilhofer, Thomas, Ha, Grace, D'Ambrosio, Gabriele, Mohanty, Sanghamitra, Gianni, Carola, Galvin, Jennifer, Vetta, Giampaolo, Lavalle, Carlo, Biase, Luigi Di, Sorgente, Antonio, Chierchia, Gian-Battista, Asmundis, Carlo de, Urbanek, Lukas, Schmidt, Boris, Geller, J Christoph, Lakkireddy, Dhanunjaya R, and Mansour, Moussa
- Abstract
Aims Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist and share an increased risk of thrombo-embolism (TE). CKD concomitantly predisposes towards a pro-haemorrhagic state. Our aim was to evaluate the prognostic value of CKD in patients undergoing percutaneous left atrial appendage occlusion (LAAO). Methods and results A total of 2124 consecutive AF patients undergoing LAAO were categorized into CKD stage 1+2 (n = 1089), CKD stage 3 (n = 796), CKD stage 4 (n = 170), and CKD stage 5 (n = 69) based on the estimated glomerular filtration rate at baseline. The primary endpoint included cardiovascular (CV) mortality, TE, and major bleeding. The expected annual TE and major bleeding risks were estimated based on the CHA
2 DS2 -VASc and HAS-BLED scores. A non-significant higher incidence of major peri-procedural adverse events (1.7 vs. 2.3 vs. 4.1 vs. 4.3) was observed with worsening CKD (P = 0.14). The mean follow-up period was 13 ± 7 months (2226 patient–years). In comparison to CKD stage 1+2 as a reference, the incidence of the primary endpoint was significantly higher in CKD stage 3 (log-rank P -value = 0.04), CKD stage 4 (log-rank P -value = 0.01), and CKD stage 5 (log-rank P -value = 0.001). Left atrial appendage occlusion led to a TE risk reduction (RR) of 72, 66, 62, and 41% in each group. The relative RR of major bleeding was 58, 44, 51, and 52%, respectively. Conclusion Patients with moderate-to-severe CKD had a higher incidence of the primary composite endpoint. The relative RR in the incidence of TE and major bleeding was consistent across CKD groups. [ABSTRACT FROM AUTHOR]- Published
- 2023
- Full Text
- View/download PDF
3. Prognostic value of chronic kidney disease in patients undergoing left atrial appendage occlusion
- Author
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Della Rocca, Domenico G; https://orcid.org/0000-0003-3837-3462, Magnocavallo, Michele; https://orcid.org/0000-0001-9883-0114, Van Niekerk, Christoffel J; https://orcid.org/0000-0001-9897-3553, Gilhofer, Thomas; https://orcid.org/0000-0002-1708-156X, Ha, Grace; https://orcid.org/0009-0009-7173-8399, D'Ambrosio, Gabriele; https://orcid.org/0000-0002-1804-0022, Mohanty, Sanghamitra, Gianni, Carola; https://orcid.org/0000-0002-8174-7207, Galvin, Jennifer, Vetta, Giampaolo; https://orcid.org/0000-0002-1120-0492, Lavalle, Carlo; https://orcid.org/0000-0002-0794-4296, Di Biase, Luigi; https://orcid.org/0000-0001-6508-4047, Sorgente, Antonio; https://orcid.org/0000-0002-0078-9393, Chierchia, Gian-Battista; https://orcid.org/0000-0003-2967-1345, de Asmundis, Carlo; https://orcid.org/0000-0001-9351-0760, Urbanek, Lukas; https://orcid.org/0000-0002-5234-744X, Schmidt, Boris; https://orcid.org/0000-0001-5347-9906, Geller, J Christoph; https://orcid.org/0000-0002-9033-8173, Lakkireddy, Dhanunjaya R; https://orcid.org/0000-0002-1492-2693, Mansour, Moussa, Saw, Jacqueline; https://orcid.org/0000-0002-7027-984X, Horton, Rodney P; https://orcid.org/0000-0001-9958-2941, Gibson, Douglas; https://orcid.org/0000-0002-8248-5827, Natale, Andrea; https://orcid.org/0000-0002-5487-0728, Della Rocca, Domenico G; https://orcid.org/0000-0003-3837-3462, Magnocavallo, Michele; https://orcid.org/0000-0001-9883-0114, Van Niekerk, Christoffel J; https://orcid.org/0000-0001-9897-3553, Gilhofer, Thomas; https://orcid.org/0000-0002-1708-156X, Ha, Grace; https://orcid.org/0009-0009-7173-8399, D'Ambrosio, Gabriele; https://orcid.org/0000-0002-1804-0022, Mohanty, Sanghamitra, Gianni, Carola; https://orcid.org/0000-0002-8174-7207, Galvin, Jennifer, Vetta, Giampaolo; https://orcid.org/0000-0002-1120-0492, Lavalle, Carlo; https://orcid.org/0000-0002-0794-4296, Di Biase, Luigi; https://orcid.org/0000-0001-6508-4047, Sorgente, Antonio; https://orcid.org/0000-0002-0078-9393, Chierchia, Gian-Battista; https://orcid.org/0000-0003-2967-1345, de Asmundis, Carlo; https://orcid.org/0000-0001-9351-0760, Urbanek, Lukas; https://orcid.org/0000-0002-5234-744X, Schmidt, Boris; https://orcid.org/0000-0001-5347-9906, Geller, J Christoph; https://orcid.org/0000-0002-9033-8173, Lakkireddy, Dhanunjaya R; https://orcid.org/0000-0002-1492-2693, Mansour, Moussa, Saw, Jacqueline; https://orcid.org/0000-0002-7027-984X, Horton, Rodney P; https://orcid.org/0000-0001-9958-2941, Gibson, Douglas; https://orcid.org/0000-0002-8248-5827, and Natale, Andrea; https://orcid.org/0000-0002-5487-0728
- Abstract
AIMS Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist and share an increased risk of thrombo-embolism (TE). CKD concomitantly predisposes towards a pro-haemorrhagic state. Our aim was to evaluate the prognostic value of CKD in patients undergoing percutaneous left atrial appendage occlusion (LAAO). METHODS AND RESULTS A total of 2124 consecutive AF patients undergoing LAAO were categorized into CKD stage 1+2 (n = 1089), CKD stage 3 (n = 796), CKD stage 4 (n = 170), and CKD stage 5 (n = 69) based on the estimated glomerular filtration rate at baseline. The primary endpoint included cardiovascular (CV) mortality, TE, and major bleeding. The expected annual TE and major bleeding risks were estimated based on the CHA2DS2-VASc and HAS-BLED scores. A non-significant higher incidence of major peri-procedural adverse events (1.7 vs. 2.3 vs. 4.1 vs. 4.3) was observed with worsening CKD (P = 0.14). The mean follow-up period was 13 ± 7 months (2226 patient-years). In comparison to CKD stage 1+2 as a reference, the incidence of the primary endpoint was significantly higher in CKD stage 3 (log-rank P-value = 0.04), CKD stage 4 (log-rank P-value = 0.01), and CKD stage 5 (log-rank P-value = 0.001). Left atrial appendage occlusion led to a TE risk reduction (RR) of 72, 66, 62, and 41% in each group. The relative RR of major bleeding was 58, 44, 51, and 52%, respectively. CONCLUSION Patients with moderate-to-severe CKD had a higher incidence of the primary composite endpoint. The relative RR in the incidence of TE and major bleeding was consistent across CKD groups.
- Published
- 2023
4. 1108 PERI-PROCEDURAL COMPLICATIONS AND LONG-TERM OUTCOMES IN ATRIAL FIBRILLATION PATIENTS STRATIFIED FOR CHRONIC KIDNEY DISEASE SEVERITY UNDERGOING LEFT ATRIAL APPENDAGE OCCLUSION: RESULTS FROM AN INTERNATIONAL, MULTICENTRE REGISTRY
- Author
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Magnocavallo, Michele, primary, Della Rocca, Domenico Giovanni, additional, Van Niekerk, Christoffel J, additional, Gilhofer, Thomas, additional, Ha, Grace, additional, D´ambrosio, Gabriele, additional, Galvin, Jennifer, additional, Urbanek, Lukas, additional, Schmidt, Boris, additional, Christoph Geller, J, additional, Lakkireddy, Dhanunaja, additional, Di Biase, Luigi, additional, Price, Matthew, additional, Mansour, Moussa, additional, Saw, Jacqueline, additional, Horton, Rodney P, additional, Gibson, Douglas, additional, and Natale, Andrea, additional
- Published
- 2022
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5. Individualized or fixed approach to pulmonary vein isolation utilizing the fourth-generation cryoballoon in patients with paroxysmal atrial fibrillation: the randomized INDI-FREEZE trial
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Heeger, Christian Hendrik, primary, Popescu, Sorin Stefan, additional, Saraei, Roza, additional, Kirstein, Bettina, additional, Hatahet, Sascha, additional, Samara, Omar, additional, Traub, Anna, additional, Fehe, Marcel, additional, D’Ambrosio, Gabriele, additional, Keelani, Ahmad, additional, Schlüter, Michael, additional, Eitel, Charlotte, additional, Vogler, Julia, additional, Kuck, Karl Heinz, additional, and Tilz, Roland Richard, additional
- Published
- 2021
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6. 76 Right mini-thoracotomy surgical Cox-maze (left atrial lesion) vs. catheter ablation using contact force-sensing technology in patients with persistent atrial fibrillation
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D'Ambrosio, Gabriele, primary, Raffa, Santi, additional, Romano, Silvio, additional, Alothman, Obaida, additional, Borisov, Georgi, additional, Karam, Issa, additional, Thomas, Kuntze, additional, and Geller, J. Christoph, additional
- Published
- 2021
- Full Text
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7. Individualized or fixed approach to pulmonary vein isolation utilizing the fourth-generation cryoballoon in patients with paroxysmal atrial fibrillation: the randomized INDI-FREEZE trial.
- Author
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Heeger, Christian Hendrik, Popescu, Sorin Stefan, Saraei, Roza, Kirstein, Bettina, Hatahet, Sascha, Samara, Omar, Traub, Anna, Fehe, Marcel, D'Ambrosio, Gabriele, Keelani, Ahmad, Schlüter, Michael, Eitel, Charlotte, Vogler, Julia, Kuck, Karl Heinz, and Tilz, Roland Richard
- Subjects
ATRIAL fibrillation diagnosis ,FREEZING ,RESEARCH ,TIME ,RESEARCH methodology ,ARTHRITIS Impact Measurement Scales ,CATHETER ablation ,ATRIAL fibrillation ,CRYOSURGERY ,EVALUATION research ,TREATMENT effectiveness ,DISEASE relapse ,COMPARATIVE studies ,RANDOMIZED controlled trials ,PULMONARY veins - Abstract
Aims: Cryoballoon (CB) based pulmonary vein isolation (PVI) is a widely used technique for treatment of atrial fibrillation (AF); however the ideal energy dosing has not yet been standardized. This was a single-centre randomized clinical trial aiming at assessing the safety, acute efficacy, and clinical outcome of an individualized vs. a fixed CB ablation protocol using the fourth-generation CB (CB4) guided by pulmonary vein (PV) potential recordings and CB temperature.Methods and Results: Patients were randomized in a 1:1 fashion to two different dosing protocols: INDI-FREEZE group (individualized protocol): freeze-cycle duration of time to effect plus 90 s or interruption of the freeze-cycle and repositioning CB if a CB temperature of -30°C was not within 40 s. Control group (fixed protocol): freeze-cycle duration of 180 s. No-bonus freeze-cycle was applied in either patient group. The primary endpoint was freedom from atrial tachyarrhythmia at 12 months. Secondary end points included procedural parameters and complications. A total of 100 patients with paroxysmal AF were prospectively enrolled. No difference was seen in the primary endpoint [INDI-FREEZE group: 38/47 (81%) vs. control group: 40/47, (85%), P = 0.583]. The total freezing time was significantly shorter in the INDI-FREEZE group (157 ± 56 s vs. 212 ± 83 s, P < 0.001), while procedure duration (57.9 ± 17.9 min vs. 63.2 ± 20.2 min, P = 0.172) was similar. No differences were seen in the minimum CB and oesophageal temperatures as well as in periprocedural complications.Conclusion: Compared to the fixed protocol, the individualized approach provides a similar safety profile and clinical outcome, while reducing the total freezing time. [ABSTRACT FROM AUTHOR]- Published
- 2022
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8. A Novel Score using Left Atrial Volume Index, Gender, and Age to Predict the Presence of Left Atrial Low Voltage Zones in Patients with Atrial Fibrillation: the ZAQ score
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D'Ambrosio, Gabriele
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Settore MED/11 - Malattie dell'Apparato Cardiovascolare - Published
- 2020
9. Colaboração premiada : o questionamento sobre a moralidade e a efetividade do instituto
- Author
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Ambrosio, Gabriele da Costa Frias and Dias, Augusto Silva
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Crime organizado ,Política criminal ,Direito penal ,Teses de mestrado - 2019 ,Direito - Abstract
Submitted by Maria João Antunes (mariajoao@fd.ul.pt) on 2019-10-07T17:14:02Z No. of bitstreams: 1 ulfd138205_tese.pdf: 954893 bytes, checksum: 831c1918a228f072a1fca4a73e3adf21 (MD5) Made available in DSpace on 2019-10-07T17:14:53Z (GMT). No. of bitstreams: 1 ulfd138205_tese.pdf: 954893 bytes, checksum: 831c1918a228f072a1fca4a73e3adf21 (MD5) Previous issue date: 2019-04-09
- Published
- 2019
10. The definition of left bundle branch block influences the response to cardiac resynchronization therapy
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Caputo, Maria Luce, Caputo, Maria Luce, van Stipdonk, Antonius, Illner, Annekatrin, D'Ambrosio, Gabriele, Regoli, Francois, Conte, Giulio, Moccetti, Tiziano, Klersy, Catherine, Prinzen, Frits W., Vernooy, Kevin, Auricchio, Angelo, Caputo, Maria Luce, Caputo, Maria Luce, van Stipdonk, Antonius, Illner, Annekatrin, D'Ambrosio, Gabriele, Regoli, Francois, Conte, Giulio, Moccetti, Tiziano, Klersy, Catherine, Prinzen, Frits W., Vernooy, Kevin, and Auricchio, Angelo
- Abstract
Background: CRT has been proven to achieve most benefit in patients with left bundle branch block morphology (LBBB). However, ECG criteria to define LBBB significantly differ from each other. Objective of the study was to evaluate the impact of different ECG criteria for LBBB definition on survival, hospitalization for heart failure and reverse remodelling in patients who received cardiac resynchronization therapy (CRT). Methods and results: Three-hundred-sixteen consecutive patients were included in the analysis. Six different classifications were assessed in baseline ECGs of patients who received a CRT device: a QRS duration of >= 150 ms and LBBB according to AHA/ACC/HRS, ESC 2006, ESC 2009, ESC 2013 and the classification proposed by Strauss and colleagues. In univariate analysis, the ESC 2009 and 2013 and the Strauss classifications were significantly associated with a reduction in cumulative probability for heart failure (HF) andmortality (HR 0.60, 95% CI 0.42-0.86, HR 0.61, 95% CI 0.43-0.87 and HR 0.57, 95% CI 0.40-0.80, respectively). Inmultivariate analysis, the association with the combined endpoint was confirmed only for ESC 2009 and 2013 classifications and for Strauss. Moreover, the cumulative probability of all-cause death and HF hospitalizations was higher in patients who were negative for all the 5 LBBB classifications. Conclusions: This study shows that the strength of the association of LBBB to outcome in CRT depends on the ECG classifications used to define LBBB, the simplest criteria (ESC 2009 and 2013) providing the best association with clinical endpoints in CRT. (c) 2018 Elsevier B.V. All rights reserved.
- Published
- 2018
11. A embriaguez alcóolica e a teoria da actio libera in causa
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Ambrosio, Gabriele da Costa Frias
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Responsabilidade penal ,Imputabilidade (direito penal) ,Embriaguez ,Punibilidade ,Política criminal ,Culpabilidade ,Responsabilidade objetiva ,Responsabilidade criminal - Abstract
Submitted by Patrícia Rabello (rabello@stj.jus.br) on 2017-09-14T20:16:54Z No. of bitstreams: 2 embriaguez_alcoolica_teoria_ambrosio.pdf: 344225 bytes, checksum: 2871c120613a82598ca67f16fdc2d3d0 (MD5) license.txt: 1239 bytes, checksum: c9b4c351324448672315a00808efb725 (MD5) Approved for entry into archive by Roberta Marins (rmarins@stj.jus.br) on 2017-09-15T20:05:55Z (GMT) No. of bitstreams: 2 embriaguez_alcoolica_teoria_ambrosio.pdf: 344225 bytes, checksum: 2871c120613a82598ca67f16fdc2d3d0 (MD5) license.txt: 1239 bytes, checksum: c9b4c351324448672315a00808efb725 (MD5) Made available in DSpace on 2017-09-15T20:05:55Z (GMT). No. of bitstreams: 2 embriaguez_alcoolica_teoria_ambrosio.pdf: 344225 bytes, checksum: 2871c120613a82598ca67f16fdc2d3d0 (MD5) license.txt: 1239 bytes, checksum: c9b4c351324448672315a00808efb725 (MD5) Previous issue date: 2017
- Published
- 2017
12. 216-64: Slow Septal Conduction Is Key In LBBB Patient-Specifc Models
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Sánchez, Carlos, primary, Potse, Mark, additional, D'ambrosio, Gabriele, additional, Illner, Annekatrin, additional, Regoli, François, additional, Moccetti, Tiziano, additional, Conte, Giulio, additional, Caputo, Maria Luce, additional, Caiani, Enrico, additional, Prinzen, Frits, additional, Krause, Rolf, additional, and Auricchio, Angelo, additional
- Published
- 2016
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13. 89-05: Validation of NOGA-derived assessment of left ventricular function against MRI
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Tiziano Moccetti, Maria Luce Caputo, François Regoli, D'ambrosio Gabriele, Francesco Maffessanti, Frits W. Prinzen, Mark Potse, Angelo Auricchio, Rolf Krause, and Giulio Conte
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Ejection fraction ,medicine.diagnostic_test ,Cardiac cycle ,business.industry ,Diastole ,Magnetic resonance imaging ,Gold standard (test) ,Physiology (medical) ,medicine ,Medical imaging ,Bland–Altman plot ,Systole ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business - Published
- 2016
14. 136-55: Pericardial effusion during transvenous lead extraction: not always the same story
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Angelo Auricchio, Stefano Svab, Tiziano Moccetti, Catherine Klersy, D'ambrosio Gabriele, Maria Luce Caputo, Giulio Conte, and François Regoli
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medicine.medical_specialty ,business.industry ,Physiology (medical) ,Extraction (chemistry) ,medicine ,Radiology ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Pericardial effusion ,Transvenous lead - Published
- 2016
15. Bilateral internal mammary artery for multi-territory myocardial revascularization: long-term follow-up of pedicled versus skeletonized conduits†
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Di Mauro, Michele, primary, Iacò, Angela L., additional, Acitelli, Angelo, additional, D'Ambrosio, Gabriele, additional, Filipponi, Laura, additional, Salustri, Elisa, additional, De Luca, Chiara, additional, Romano, Silvio, additional, Penco, Maria, additional, and Calafiore, Antonio M., additional
- Published
- 2014
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16. Bilateral internal mammary artery for multi-territory myocardial revascularization: long-term follow-up of pedicled versus skeletonized conduits.
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Di Mauro, Michele, Iacò, Angela L., Acitelli, Angelo, D'Ambrosio, Gabriele, Filipponi, Laura, Salustri, Elisa, De Luca, Chiara, Romano, Silvio, Penco, Maria, and Calafiore, Antonio M.
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INTERNAL thoracic artery ,MYOCARDIAL revascularization ,CORONARY artery bypass ,MYOCARDIAL infarction ,SURGICAL anastomosis ,FOLLOW-up studies (Medicine) ,PATIENTS - Abstract
OBJECTIVES: The aim of this study was to evaluate 17-year actual clinical outcomes of patients undergoing coronary artery bypass graft (CABG) using skeletonized versus pedicled bilateral internal mammary arteries (BIMAs). METHODS: FromSeptember 1991 to June 1996, 548 consecutive patients underwent CABG formultivessel disease using BIMA. After propensity matching, 350 patients were enrolled: 175 patients with skeletonized BIMA (Group S) and 175 with pedicled BIMA (Group P). The two groups were adequately comparable. Composite end-point: deaths, new revascularization and new myocardial infarctions were defined as 'events'. RESULTS: Group S provided a higher rate of total arterial myocardial revascularization (94.3 vs 82.9%, P 0.001) with a higher average number of arterial anastomoses (3.1 ± 0.8 vs 2.7 ± 0.8, P < 0.001) and BIMA anastomoses (2.5 ± 0.3 vs 2.1 ± 0.3, P < 0.001). In Group S, the incidence of sequential grafts was higher (37.7 vs 17.7%, P < 0.001). The rate of sternal wound healing problems was lower (1.7 vs 7.4%, P = 0.010). Thirty-day mortality and morbidity were similar. The median survival time of survivors was 17.8 years (min-max = 17.0-21.5); 17.3 (17.0-18.0) in Group S vs 19.1 (18.1-21.5) in Group P, P < 0.001. Seventeen-year actual outcomes were better in Group S: deaths (8.7 vs 27.9%, P < 0.001), cardiac deaths (4.7 vs 13.4%, P = 0.005), cardiac events (10.5 vs 22.1%, P = 0.003), new revascularization (2.9 vs 8.7%, P = 0.021) and events (15.1 vs 36.1%, P < 0.001). CONCLUSIONS: Skeletonization of BIMA allows one to achieve a higher rate of arterial grafting and better outcome if compared with pedicled BIMA. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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17. 76Right mini-thoracotomy surgical Cox-maze (left atrial lesion) vs. catheter ablation using contact force-sensing technology in patients with persistent atrial fibrillation
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D'Ambrosio, Gabriele, Raffa, Santi, Romano, Silvio, Alothman, Obaida, Borisov, Georgi, Karam, Issa, Thomas, Kuntze, and Geller, J. Christoph
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- 2021
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18. Abstract 9684: In the Presence of Low Voltage Areas, Substrate Modification Using Contact Force Sensing Adds Efficacy in Patients With Persistent Atrial Fibrillation
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D?Ambrosio, Gabriele, Raffa, Santi, Romano, Silvio, Frommhold, Markus, Alothman, Obaida, Borisov, Georgi, Issa, Karam, Patti, Giuseppe, Penco, Maria, and Geller, Johann Christoph
- Abstract
Introduction:Although pulmonary vein (PV) isolation (PVI) is very effective in paroxysmal atrial fibrillation (AF), in patients (pts) with persistent AF, PVI often is not sufficient, and the ideal ablation strategy is still debated. A number of studies suggest that low voltage areas (LVA, i.e. >3 adjacent low-voltage points <0.5 mV during electrophysiology study) outside of the PV might be involved in the complex mechanisms perpetuating AF. However, so far substrate modification (SM) ablation strategies did not show additional benefit in persistent AF. However, these studies were performed without force sensing technology, and the explanation for these results may be the inability to achieve transmural lesions.Hypothesis:Therefore, we hypothesized that the use of contact force sensing technology would improve ablation efficacy and long-term outcome both in pts with and without evidence of LVA in the left atrium.Methods:Depending on the location of the LVA, mainly linear ablation was performed in addition to PVI, using ablation catheters with contact force sensing technology (CF) aiming at contact values ?10g <20g and FTI >400g/s. Ablation was performed in a temperature-controlled fashion with energy of 30W except at the posterior wall (20-25W).Results:78 consecutive pts with persistent AF (48 men, mean age 64?9 years, mean duration of AF 44?56 months, LV-EF 0.55?7, LA diameter 41?4mm, CT derived LA volume index 66?14 ml/m2) were included: pts without LVA (n=45) underwent PVI, in pts with LVA (n=33), PVI + SM was performed (mitral Isthmus line in 7, supero-septal line in 22 and roof line in 33; bidirectional block was achieved in 86%, 91%, and 100%, respectively). Additional SM required longer procedure and X-ray times (283?63 vs 231?57 and 12?6 vs 10?6 min, p<0.05). After a mean follow-up of 12 months, 89% of pts without and 70% with LVA were in sinus rhythm (p=0.044) mainly without antiarrhythmic drugs (91% PVI, 82% PVI + SM).Conclusion:In patients with persistent AF without LVA, PVI leads to excellent 1-year freedom from AF. In pts with LVA, ablation results are not (quite) as good but additional substrate modification with CF is associated with improved success rates compared to previous studies.
- Published
- 2019
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19. Abstract 9683: Indexed Left Atrial Volume Predicts the Presence of Low Voltage Areas. The ZAQ Score
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D?Ambrosio, Gabriele, Romano, Silvio, Alothman, Obaida, Frommhold, Markus, Borisov, Georgi, Patti, Giuseppe, Issa, Karam, Penco, Maria, Geller, Johann Christoph, and Raffa, Santi
- Abstract
Introduction:Pulmonary vein isolation (PVI) is the most efficient therapy for patients (pts) with paroxysmal atrial fibrillation (AF) and is the primary endpoint for almost all AF ablation procedures. In pts with advanced structural changes (both paroxysmal and persistent AF), substrate modification may be required although the ideal ablation strategy is still debated. Therefore, it would be helpful to assess the presence of substrate in the left atrium (LA) before the ablation. Late gadolinium enhancement MRI and electroanatomic voltage mapping (EVM) have been used for substrate characterization. Whereas the former is difficult to reproduce using standard MRI software, the latter does not allow to plan an ablation strategy before the procedure. Clinical parameters (combined in a score, e.g. DRFLASH) have been proposed as a way to predict the presence of atrial substrate, and increased LA volume is associated with higher rates of AF recurrence both with drug and ablation.Hypothesis:We hypothesized that (1) indexed LA volume (LAVI) is associated with the presence of low voltage areas (LVA) identified by EVMin the left atrium and (2) that it would be helpful in developing a score that would predict the need for additional substrate modification during ablation.Methods:We defined the cut-off value of LAVI and age which had the best accuracy to detect LVA in receiver operating characteristic curve (ROC). Clinical predictors for the presence of LVA were identified with regression analysis. These parameters were used to build a risk score (Zentralklinik Bad Berka and University of L?Aquila [ZAQ] Score: age>65 years, female gender and LAVI>57ml/m2).Results:374 patients (age 62?10 years, 149 female, 222 paroxysmal AF, EF 0.56?7, LA diameter 40?5mm) were studied. The mean LA volume was 117?29ml, LAVI 58?14ml/m2. In our study court, the ZAQ score correctly identified the 75 pts with LVA (AUC 0.81; CI 0.76-0.86; P<0.001 - OR 4.1; CI 2.9-5.9; P<0.001) and was more accurate than DRFLASH score (AUC 0.75; CI 0.69-0.81; P<0.001 - OR 2.0; CI 1.7-2.6; P<0.001).Conclusion:ZAQ score is able to identify pts with LVA and may be helpful in planning the ablation strategy (i.e. Cryo balloon PVI vs RF PVI + substrate modification).
- Published
- 2019
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20. Individualized or fixed approach to pulmonary vein isolation utilizing the fourth-generation cryoballoon in patients with paroxysmal atrial fibrillation: the randomized INDI-FREEZE trial.
- Author
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Heeger CH, Popescu SS, Saraei R, Kirstein B, Hatahet S, Samara O, Traub A, Fehe M, D'Ambrosio G, Keelani A, Schlüter M, Eitel C, Vogler J, Kuck KH, and Tilz RR
- Subjects
- Freezing, Humans, Recurrence, Time Factors, Treatment Outcome, Atrial Fibrillation diagnosis, Atrial Fibrillation surgery, Catheter Ablation adverse effects, Catheter Ablation methods, Cryosurgery adverse effects, Cryosurgery methods, Pulmonary Veins surgery
- Abstract
Aims: Cryoballoon (CB) based pulmonary vein isolation (PVI) is a widely used technique for treatment of atrial fibrillation (AF); however the ideal energy dosing has not yet been standardized. This was a single-centre randomized clinical trial aiming at assessing the safety, acute efficacy, and clinical outcome of an individualized vs. a fixed CB ablation protocol using the fourth-generation CB (CB4) guided by pulmonary vein (PV) potential recordings and CB temperature., Methods and Results: Patients were randomized in a 1:1 fashion to two different dosing protocols: INDI-FREEZE group (individualized protocol): freeze-cycle duration of time to effect plus 90 s or interruption of the freeze-cycle and repositioning CB if a CB temperature of -30°C was not within 40 s. Control group (fixed protocol): freeze-cycle duration of 180 s. No-bonus freeze-cycle was applied in either patient group. The primary endpoint was freedom from atrial tachyarrhythmia at 12 months. Secondary end points included procedural parameters and complications. A total of 100 patients with paroxysmal AF were prospectively enrolled. No difference was seen in the primary endpoint [INDI-FREEZE group: 38/47 (81%) vs. control group: 40/47, (85%), P = 0.583]. The total freezing time was significantly shorter in the INDI-FREEZE group (157 ± 56 s vs. 212 ± 83 s, P < 0.001), while procedure duration (57.9 ± 17.9 min vs. 63.2 ± 20.2 min, P = 0.172) was similar. No differences were seen in the minimum CB and oesophageal temperatures as well as in periprocedural complications., Conclusion: Compared to the fixed protocol, the individualized approach provides a similar safety profile and clinical outcome, while reducing the total freezing time., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)
- Published
- 2022
- Full Text
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21. Very-high-power short-duration ablation for treatment of premature ventricular contractions - The FAST-AND-FURIOUS PVC study.
- Author
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Heeger CH, Popescu SS, Kirstein B, Hatahet S, Traub A, Phan HL, Feher M, D Ambrosio G, Keelani A, Schlüter M, Vogler J, Eitel C, Kuck KH, and Tilz RR
- Abstract
Objectives: We sought to assess the efficacy, safety and short-term clinical outcome of very high-power short-duration (vHP-SD) radiofrequency (RF) catheter ablation for the treatment of idiopathic PVCs originating from the cardiac outflow tract (OT)., Background: Power-controlled RF ablation is a widely used technique for the treatment of premature ventricular contractions (PVCs). A novel ablation catheter offers three microelectrodes and six thermocouples at its tip and provides temperature-controlled vHP-SD (90 Watts/4 s,) with the opportunity to switch to moderate-power mode., Methods: In this pilot study, twenty-four consecutive, prospectively enrolled patients underwent PVC ablation utilizing the vHP-SD ablation (study group) and were compared with 24 consecutive patients previously treated with power-controlled ablation (control group). Each group included 12 patients with PVCs originating from the right ventricular OT (RVOT) and 12 patients with PVCs originating from the left ventricular OT (LVOT). The acute endpoint was PVC elimination and was achieved in all patients., Results: In 16/24 (67%) patients (study group) it was achieved by using vHP-SD only. The median RF delivery time was 52 (interquartile range [IQR] 16, 156) seconds (study group) and 350 (IQR 240, 442) seconds (control group, p < 0.0001). No difference was observed regarding procedure duration (p = 0.489) as well as 6-months follow-up (p = 0.712). One (4%, study group) and 2 (8%, control group) severe adverse events occured (p = 0.551)., Conclusion: In this study , vHP-SD PVC ablation was similarly effective and safe as compared to conventional power-controlled ablation. The RF time was significantly shorter., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: CHH received travel grants and research grants from Boston Scientific, Biosense Webster and Cardiofocus and speaker honoraria from Boston Scientific, Biosense Webster and Cardiofocus. CE received travel grants and research grants from Boston Scientific and Biosense Webster and speaker honoraria from Biosense Webster, Medtronic, Boston Scientific and Abbott Medical. RRT is a consultant for Boston Scientific, Biotronik and Biosense Webster and received speaker honoraria from Biosense Webster, Medtronic, Boston Scientific and Abbot Medical. KHK reports grants and personal fees from Abbott Vascular, Medtronic, Biosense Webster outside the submitted work. All other authors have no relevant disclosures., (© 2022 The Author(s).)
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- 2022
- Full Text
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