Transcatheter Ablation of Atrial Fibrillation in Patients with Chronic Heart Failure

Atrial fibrillation (AF) is the most frequent of all cardiac arrhythmias and it is associated with an increased risk of stroke, systemic embolism and heart failure. Patients with AF have a twofold increased risk of death and fivefold increased risk of stroke compared with those without AF. In patients with heart failure (HF), AF ablation improves left ventricular (LV) function over short- and long-term follow-ups, especially compared with medical treatment. Furthermore, AF ablation in HF patients relates to a significant improvement in quality of life, functional class and exercise tolerance, possibly related to the improvement in LV function and hemodynamic status of the patients. Finally, data showed that restoration of sinus rhythm in this setting of patients reduced the incidence of stroke and death. In this review, we reported all the major data regarding atrial fibrillation therapy in patients with heart failure

Leukotrienes in Atherosclerosis: New Target Insights and Future Therapy Perspectives

Atherosclerosis represents an important chronic inflammatory process associated with several pathophysiological reactions in the vascular wall. The arachidonic acid, released by phospholipase A2, is an important substrate for the production of a group of lipid mediators known as leukotrienes, which induce proinflammatory signaling through the activation of specific BLT and CysLT receptors. The interaction of these substances in the vascular wall determines important morphological alterations like the early lipid retention and the accumulation of foam cells, the development of intimal hyperplasia, and advanced atherosclerotic lesions, and it plays an important role in the rupture of atherosclerotic plaque. Many studies regarding myocardial ischemia and reperfusion show that leukotriene signaling may be involved in the development of ischemic injury. For these, reasons both leukotriene synthesis inhibitors and leukotriene receptor antagonists have been suggested for inducing beneficial effects at different stages of the atherosclerosis process and may represent a new therapeutic target in the treatment of atherosclerotic vessel diseases, in particular in acute coronary syndrome

Atypical Presentation of Acute Coronary Syndrome-Not ST Elevation: A Case Report

We describe the unexpected case of a 70-year-old man, with medical history of ischemic heart disease and surgery for aneurysm of abdominal aorta, who comes to the emergency department complaining of low-back pain without other symptoms or signs of organic failure. After a few hours we see a deterioration of physical conditions with pulmonary oedema, increase of blood pressure, changing in the ECG pattern, and worsening of left ventricular function with progressive increase of biomarkers for myocardial necrosis. So this pain has revealed the premature symptom of an acute coronary syndrome (ACS). After a short time a subsequent cardiac arrest complicates the clinical situation. After resuscitation, the patient undergoes successfully to coronary angiography and performed a percutaneous transluminal coronary angioplasty (PTCA)

A novel integrated industrial approach with cobots in the age of industry 4.0 through conversational interaction and computer vision

From robots that replace workers to robots that serve as helpful colleagues, the field of robotic automation is experiencing a new trend that represents a huge challenge for component manufacturers. The contribution starts from an innovative vision that sees an ever closer collaboration between Cobot, able to do a specific physical job with precision, the AI world, able to analyze information and support the decision-making process, and the man able to have a strategic vision of the future

Obstructive sleep apnea and heart disease: the biomarkers point of view.

Obstructive sleep apnea syndrome (OSAS) is a highly prevalent disorder. Important risk factors for this disease are represented by obesity, male gender, smoking, some endocrinological disturbances, alcohol intake, use of benzodiazepines, and craniofacial alterations. It is well known that OSAS is a frequent comorbidity as well as a relevant risk factor for cardiovascular diseases (CVD), especially in patients with hypertension, coronary artery disease (CAD), arrhythmias, and heart failure. Furthermore, therapy with continuous positive airway pressure devices (CPAP) has been shown to significantly reduce the incidence of serious cardiovascular consequences. Interactions between OSAS and the cardiovascular system (CVS) can eventually result mainly in coronary atherosclerosis. These two conditions are connected by a complex biomarkers network. An extensive overview of these pathways could be helpful to better understand the causes of cardiovascular impairment in patients with OSAS

Zero Fluoroscopy Arrhythmias Catheter Ablation: A Trend Toward More Frequent Practice in a High-Volume Center

BACKGROUND: Awareness of radiation exposure risks associated to interventional cardiology procedures is growing. The availability of new technologies in electrophysiology laboratories has reduced fluoroscopy usage during arrhythmias ablations. The aim of this study was to describe procedures with and without X-Rays and to assess feasibility, safety, and short-term efficacy of zero fluoroscopy intervention in a high-volume center oriented to keep exposure to ionizing radiation as low as reasonably achievable. METHODS: Cardiac catheter ablations performed in our hospital since January 2017 to June 2021. RESULTS: A total of 1,853 procedures were performed with 1,957 arrhythmias treated. Rate of fluoroless procedures was 15.4% (285 interventions) with an increasing trend from 8.5% in 2017 to 22.9% of first semester 2021. The most frequent arrhythmia treated was atrial fibrillation (646; 3.6% fluoroless) followed by atrioventricular nodal reentrant tachycardia (644; 16.9% fluoroless), atrial flutter (215; 8.8% fluoroless), ventricular tachycardia (178; 17.4% fluoroless), premature ventricular contraction (162; 48.1% fluoroless), and accessory pathways (112; 31.3% fluoroless). Although characteristics of patients and operative details were heterogeneous among treated arrhythmias, use of fluoroscopy did not influence procedure duration. Moreover, feasibility and efficacy were 100% in fluoroless ablations while the rate of major complications was very low and no different with or without fluoroscopy (0.45 vs. 0.35%). CONCLUSION: Limiting the use of X-Rays is necessary, especially when the available technologies allow a zero-use approach. A lower radiation exposure may be reached, reducing fluoroscopy usage whenever possible during cardiac ablation procedures with high safety, full feasibility, and efficacy

The Heart Beats as It Breathes, or Is It the Other Way Around?

One third of human life is spent sleeping, thus the importance of sleep in the maintenance of correct homeostatic balance is well established [...

Pulsed Field Ablation to Treat Atrial Fibrillation: A Review of the Literature

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and catheter ablation, which can be used in symptomatic patients refractory to antiarrhythmic therapy. Pulmonary vein isolation (PVI) remains the cornerstone of any ablation procedure. A major limitation of current catheter ablation procedures is important to recognize because even when the PVI is performed in highly experienced centers, PVI reconnection was documented in about 20% of patients. Therefore, better technology is needed to improve ablation lesions. One of the novelties in recent years is pulsed filed ablation (PFA), a non-thermal energy that uses trains of high-voltage, very-short-duration pulses to kill the cells. The mechanism of action of this energy consists of creating pores in the myocardiocyte cell membrane in a highly selective and tissue-specific way; this leads to death of the target cells reducing the risk of damage to surrounding non-cardiac tissues. In particular during the animal studies, PVI and atrial lines were performed effectively without PV stenosis. Using PFA directly on coronary arteries, there was no luminal narrowing, there has been no evidence of incidental phrenic nerve injury, and finally, PFA has been shown not to injure esophageal tissue when directly applied to the esophagus or indirectly through ablation in the left atrium. The aim of this review is to report all published animal and clinical studies regarding this new technology to treat paroxysmal and persistent AF