707 Transvenous radiofrequency ablation of epicardial posterior-septal accessory pathways in children with WPW syndrome: can technology and imaging innovations improve the outcome?

Abstract Aims The aim of the study was to analyse our recent single-centre experience about epicardial posterior-septal accessory pathways transcatheter ablation in children and young patients using radiofrequency through the coronary sinus, in order to understand which mapping and ablation strategy is associated with higher success rate and safety. Methods and results We reviewed all the cases of ablation of overt accessory pathways (in Wolff–Parkinson–White syndrome) with epicardial posterior-septal localization performed in children or young patients at our institution in the last 5 years. Twenty-two paediatric patients (mean age: 13 ± 3 years) with epicardial posterior-septal accessory pathways (15 in coronary sinus and 7 in the Middle Cardiac Vein) underwent radiofrequency transcatheter ablation with CARTO 3TM. Acute success rate was 77%. No patient was lost to follow-up (mean time 14.4 ± 9 months). The recurrence rate was 18%. Two patients underwent a successful redo-procedure; the overall long-term success rate was 68%. NAVISTAR® catheter presented the highest acute success rate in the coronary sinus. NAVISTAR SMARTTOUCH® was the only catheter that did not present recurrences after the acute success and it was successfully used in two patients previously unsuccessfully treated with a NAVISTAR THERMOCOOL®. Integration with angio-CT of coronary sinus branches obtained with CARTOMERGE was associated with higher success rate in patients with a previous failed ablation attempt. Conclusions Epicardial posterior-septal accessory pathways can be successfully treated with transvenous radiofrequency ablation in more than half of the cases in children/young patients. Acute success rate does not seem to depend on catheters used but contact-force catheter seems to be useful in cases with recurrences. Image integration with cardiac-CT reconstruction of coronary sinus branches anatomy can be useful to better guide ablation in case of previously failed attempts

3D transvenous radiofrequency ablation of manifest epicardial posterior-septal accessory pathways in children: Can technology innovations improve the outcome?

AbstractIntroduction:The aim of the study was to revise our more recent experience about epicardial posterior-septal accessory pathways radiofrequency transcatheter ablation in children and young patients using a transvenous approach through the coronary sinus, to understand if new mapping and ablation technologies can increase success rate and safety.Methods and results:Twenty children (mean age 13 ± 3 years) with epicardial posterior-septal accessory pathways (14 in coronary sinus and 6 in the middle cardiac vein) underwent radiofrequency transcatheter ablation with CARTO-3® system with help of the CARTO-Univu® module. Acute success rate was 73%. No patient was lost to follow-up (mean time 11.4 ± 9 months). The recurrence rate was 19%. Two patients underwent a successful redo-procedure; the overall long-term success rate was 65%. Navistar® catheter presented the highest acute success rate in the coronary sinus. Navistar SmartTouch® was the only catheter that did not present recurrences after the acute success, and it was successfully used in two patients previously unsuccessfully treated with a Navistar ThermoCool®. Acute success rate was 79% without image integration with angio-CT, while it was 63% after the introduction of CARTO-Merge®.Conclusion:Epicardial posterior-septal accessory pathways can be definitively eliminated by transvenous radiofrequency transcatheter ablation in more than half of the cases in children. Acute success rate does not seem to depend on catheters used, but contact-force catheter seems to be useful in cases with recurrences. Image integration with cardiac-CT does not increase success rate, but it is useful to detect coronary sinus alterations to better guide ablation strategy

Clinical characteristics and risk of arrhythmic events in patients younger than 12 years diagnosed with Brugada syndrome

Background Brugada syndrome (BrS) is an inheritable disease with an increased risk of sudden cardiac death. Although several score systems have been proposed, the management of children with BrS has been inconsistently described. Objective The purpose of this study was to identify the characteristics, outcome, and risk factors associated with cardiovascular and arrhythmic events (AEs) in children younger than 12 years with BrS. Methods In this single-center case series, all children with spontaneous or drug/fever-induced type 1 Brugada electrocardiographic (ECG) pattern and younger than 12 years at the time of diagnosis were enrolled. Results Forty-three patients younger than 12 years at the time of diagnosis were included. The median follow-up was 3.97 years (interquartile range 2–12 years). In terms of first-degree atrioventricular block, premature beats, nonmalignant AEs, malignant AEs, and episodes of syncope, no significant differences were observed either between patients with spontaneous and drug/fever-induced type 1 Brugada ECG pattern or between female and male patients (except a significant difference between female and male patients for first-degree atrioventricular block). A higher incidence of malignant AEs was observed in patients with syncope (3 of 8 [37.5%] vs 0 of 35 [0%]; P = .005) than in patients without syncope. SCN5A mutations were associated with a higher occurrence of malignant AEs (3 of 14 [21.4%] vs 0 of 25 [0%]; P = .04) compared with no SCN5A mutations. Conclusion A spontaneous type 1 Brugada ECG pattern is not associated with a higher incidence of syncope, first-degree atrioventricular block, premature beats, nonmalignant AEs, and malignant AEs than the drug/fever-induced type 1 Brugada ECG pattern. Syncope events are correlated with an increased incidence of malignant AEs. Moreover, SCN5A mutations are associated with a higher occurrence of malignant AEs

Heart rate variability as possible marker of brain damage in neonates with hypoxic ischemic encephalopathy: a systematic review.

Heart rate variability (HRV) is currently considered the most valuable non-invasive test to investigate the autonomic nervous system function, based on the fact that fast fluctuations might specifically reflect changes of sympathetic and vagal activity. An association between abnormal values of HRV and brain impairment has been reported in the perinatal period, although data are still fragmentary. Considering such association, HRV has been suggested as a possible marker of brain damage also in case of hypoxic-ischemic encephalopathy following perinatal asphyxia. The aim of the present manuscript was to review systematically the current knowledge about the use of HRV as marker of cerebral injury in neonates suffering from hypoxic-ischemic encephalopathy. Findings reported in this paper were based on qualitative analysis of the reviewed data. Conclusion: A growing body of research supports the use of HRV as non-invasive, bedside tool for the monitoring of hypoxic-ischemic encephalopathy. The currently available data about the role of HRV as prognostic tool in case of hypoxic ischemic encephalopathy are promising but require further validation by future studies. What is Known: • Heart rate variability (HRV) is a non-invasive monitoring technique to assess the autonomic nervous system activity. • A correlation between abnormal HRV and cerebral injury has been reported in the perinatal period, and HRV has been suggested as possible marker of brain damage in case of hypoxic-ischemic encephalopathy. What is New: • HRV might provide precocious information about the entity of brain injury in asphyxiated neonates and be of help to design early, specific, and personalized treatments according to severity. • Further investigations are required to confirm these preliminary data

Correction to: Heart rate variability as possible marker of brain damage in neonates with hypoxic ischemic encephalopathy: a systematic review.

Correction to: European Journal of Pediatrics https://doi.org/10.1007/s00431-020-03882-

Prognostic impact of peripheral artery disease-related parameters in patients with acute coronary syndrome

Background: Lower extremity arterial disease (LEAD) and increased aortic stiffness are associated with higher mortality in patients with chronic coronary syndrome, while their prognostic significance after an acute coronary syndrome (ACS) is less known. Methods: We analyzed prevalence, clinical phenotypes and association of LEAD - assessed by the ankle-brachial index (ABI) - and increased aortic stiffness - assessed by the aortic pulse wave velocity (PWV) - with all-cause mortality and major adverse cardiovascular events (MACE) in patients admitted with an ACS. Results: Among 270 patients admitted for ACS (mean age 67 years, 80% males), 41 (15%) had an ABI ≤0.9, with 14 of them (34%) presenting with intermittent claudication (symptomatic LEAD). Patients with symptomatic LEAD, compared with those with asymptomatic LEAD or without LEAD, had higher prevalence of cardiovascular risk factors, lower estimated glomerular filtration rate and higher high-sensitivity C-reactive protein. Patients with LEAD, either symptomatic or asymptomatic, more frequently presented with non-ST-elevation myocardial infarction and more frequently had multivessel coronary artery disease. Both symptomatic and asymptomatic LEAD were significantly associated with all-cause mortality after adjustment for confounders, including multivessel disease or carotid artery disease (hazard ratio 4.03, 95% confidence interval 1.61-10.08, P < 0.01), whereas PWV was not associated with the outcome in the univariable model. LEAD and PWV were not associated with a higher risk of MACE (myocardial infarction or unstable angina, stroke, or transient ischemic attack). Conclusions: LEAD, either clinical or subclinical, but not increased aortic stiffness, is an independent predictor of all-cause mortality in patients admitted for ACS

Biventricular Tissue Tracking with Cardiovascular Magnetic Resonance: Reference Values of Left- and Right-Ventricular Strain

We derived reference values of left-ventricular (LV) and right-ventricular (RV) strain parameters in a cohort of 100 healthy subjects by feature tracking cardiac magnetic resonance (FT-CMR). Global and regional strain values were calculated for the LV; circumferential and radialSAX strain parameters were derived from the short-axis (SAX) stack, while longitudinal and radialLAX strain parameters were assessed in three long-axis (LAX) views. Only global longitudinal strain (GLS) was calculated for the RV. Peak global LV circumferential strain was −16.7% ± 2.1%, LV radialSAX strain was 26.4% ± 5.1%, LV radialLAX strain was 31.1% ± 5.2%, LV GLS was −17.7% ± 1.9%, and RV GLS was −23.9% ± 4.1%. Women presented higher global LV and RV strain values than men; all strain values presented a weak relationship with body surface area, while there was no association with age or heart rate. A significant association was detected between all LV global strain measures and LV ejection fraction, while RV GLS was correlated to RV end-diastolic volume. The intra- and inter-operator reproducibility was good for all global strain measures. In the regional analysis, circumferential and radial strain values resulted higher at the apical level, while longitudinal strain values were higher at the basal level. The assessment of cardiac deformation by FT-CMR is feasible and reproducible and gender-specific reference values should be used

Cronache meridionali. A. IX, Nuova serie, n.6-12 (1962)

N. 6 (giugno 1962): Risultati elettorali e politica comunista di Gerardo Chiaromonte, P. 3 ; Documenti (Dalla Relazione La Malfa: una polemica contro i «tempi lunghi » - Dalla terza Relazione Pastore: ancora emigrazione fino al 1970), P. 21 ; Fontani, A., L'immigrazione nel «triangolo industriale», P. 27 ; Cronache di emigrati, P. 48 ; Il Comune di Bologna per gli immigrati, P. 52 ; Un dibattito sull'energia, P. 56 ; Gomez, M., Appunti sull'approvazione del piano di rinascita sardo «Latifondo contadino» e riforma agraria, P. 59 ; Costantino, D., La situazione di Reggio Calabria ad un anno dalla visita di Fanfani, P. 78 ; Pinna, P.,La pastorizia in Sardegna, P.82 ; Quistelli, A.,Il nuovo piano regolatore per l'avvenire di Napoli, P. 87 ; Maglietta, C., La periferia napoletana, P. 104 ; De Jaco, A.,Indipendenza e impegno per una letteratura realistica, P. 115 ;Recensioni e segnalazioni, P. 126.N. 7-8 (luglio-agosto 1962): Rossitto, F., Il significato meridionale e nazionale della crisi siciliana, P. 3 ; Pirastu, L., Vecchio e nuovo nella legge del piano di rinascita della Sardegna, P. 15 ; Podda G., Il dibattito al Consiglio regionale sardo, P. 24 ; Granati, F., Una nuova politica dell'energia per lo sviluppo del Mezzogiorno, P. 29 ; Napolitano, G., Industria di Stato e programmazione, P. 48 ; D’Antonio, M., Appunti e considerazioni sulla terza relazione Pastore, P. 70 ; (Viviani, L.), Il Congresso di Mosca ; (Valenzi, M.), Il dissidio fra i capi della rivoluzione algerina, P. 80 : Tamborrino, L., La riscossa democratica e sindacale dei lavoratori della Cirio, P. 90 ; Mele, A., Della scelta letteraria e del parlar chiaro, P. 112 ; Daniele I., Prisco M. e M. D’Amico.,Immigrazione e industria ; Daniele A., Danilo Dolci, P. 120 ; La Conferenza nazionale del P.C.I. sull'immigrazione nel Nord, P. 130.N. 9 (settembre 1962): Politica comunista e questione meridionale, P. 3 ; Dalla formazione delle Giunte alla crisi siciliana Dopo il terremoto, P. 25 ; Documenti sul terremoto del 21 agosto, P. 31 ; Dalla diga sullo Jato all' inchiesta parlamentare sulla mafia, P. 39 ; Santarelli, E., Dalla Regione Friuli-Venezia Giulia all'attuazione dell'ordinamento regionale, P. 45 ; La posizione dei sindacati pugliesi sulle «aree» e sui « nuclei», P. 61 ; Grifone, P., L'attuazione degli impegni di governo in tema di politica agraria, P. 66 ; Capobianco, G., Il «Piano verde» in Campania, P. 82 ; Viviani, L., I riflessi dell'emigrazione sulla condizione della donna meridionale, P. 88 ; Di Stegano, G., Un Convegno regionale dei comunisti calabresi, P. 98 ; Una lettera al direttore P. 103 ; Rassegna della stampa , P. 108 ; Pomilio, M., Letteratura e fatti di moda di Mario Pomilio, P. 113 ; Piemontese, F., Realismo si, ma che significa realismo?, P. 117.N. 10-11 (ottobre-novembre 1962): Appello al governo e all'opinione pubblica, P. 3 ; Chiaromonte, G., Agricoltura, urbanistica e regioni, P. 5 D’Amico, M., I sindacati nei « poli di sviluppo», P. 8 ; Cardia, U., La Sardegna alla vigilia del Piano, P. 22 ; Spiga, E., Prospettive della lotta politica sarda, P. 33 ; Chiaromonte, G., Discutere sì, ma su quale terreno?, P. 38 ; Il P.c.i. e la battaglia meridionalistica, P. 43 ; Banfi, R., Cosa si intende per «unificazione capitalistica», P. 44 ; D’Antonio, M., Programmazione economica e questione meridionale, P.72 ; Vitale, G., La riforma agraria: una scelta obbligata per la programmazione, P. 90 ; Esposto, A., Il ruolo delle masse contadine per un nuovo blocco di potere, P. 106 ; La Torre, P., Il centro-sinistra nel Mezzogiorno e l'esperienza siciliana, P.118 ; Lettera al direttore, P. 131 ; Argiroffi, E., Le raccoglitrici di ulive in Calabria, P. 134 ; Jocca, P., L'emigrazione dal Molise, P. 139 ; Il Convegno di Palmi su «Università e scuola nel Mezzogiorno», P. 155 ; Recensioni e segnalazioni, P. 177.N. 12 (dicembre 1962): Il deterioramento del centro-sinistra, P. 3 ; Colajanni, N., Chiarificazione in Sicilia, P. 6 ; Chiaromonte, G., Alcuni punti fermi per la battaglia meridionalistica, P. 15 ; Reichlin, A., Appunti sul centro-sinistra nel Mezzogiorno, P. 27 ; Capobianco, G. Le leggi agrarie del governo, P. 43 ; Il censimento dell'agricoltura, P. 49 ; Un anno di azione sindacale a Napoli, P. 55 ; Problemi urbanistici nelle aree di sviluppo industriale (comunicazione presentata dal .Gruppo per l'architettura ed urbanistica siciliana al Congresso nazionale dell'I.n.u.), P. 60 ; Pinna, P., Cronache dalla Sardegna, P. 72 ; Lettera al direttore, P. 85 ; Recensioni e segnalazioni, P. 85