Paolucci Dott. Marco
Pubblicazioni su PubMed
Subcutaneous ICD implantation in a patient with hypertrophic cardiomyopathy after transvenous ICD failure: A case report.
J Arrhythm2018 Feb;34(1):81-83. doi: 10.1002/joa3.12011.
Baroni Matteo, Cattafi Giuseppe, Arupi Michele, Paolucci Marco, Pelenghi Stefano, Lunati Maurizio
We describe the case of a patient with hypertrophic cardiomyopathy who experienced the failure of a transvenous implantable cardioverter defibrillator (T-ICD) lead and the following inability of a second T-ICD to convert a ventricular fibrillation. A subcutaneous ICD (S-ICD) was finally implanted and was effective at defibrillation test.
Guarda su PubMed
A case of premature ventricular contractions, ventricular tachycardia, and arrhythmic storm induced by right ventricular pacing during cardiac resynchronization therapy: Electrophysiological mechanism and catheter ablation.
J Arrhythm2015 Dec;31(6):401-5. doi: 10.1016/j.joa.2015.06.002.
Pedretti Stefano, Vargiu Sara, Paolucci Marco, Lunati Maurizio
A 77-year-old man with ischemic cardiomyopathy and a cardiac resynchronization therapy-defibrillator (CRT-D) device came to our attention due to incessant ventricular tachycardia and multiple implantable cardioverter defibrillator (ICD) shocks. An electrocardiogram showed non-sustained monomorphic ventricular tachycardias (NSVTs) constantly occurring after each biventricular stimulation. During an electrophysiological study, NSVTs reproducibly recurred only after right ventricular (RV) pacing; LV pacing did not induce any NSVTs. The activation map was consistent with a localized reentry at the interventricular septum, and a double exit; at the LV exit site, a single radiofrequency energy application immediately interrupted the occurrence of the NSVTs. Current evidence supports LV pacing to be pro-arrhythmogenic in few CRT patients. This unusual case shows that RV pacing during CRT could produce frequent ventricular arrhythmias and arrhythmic storm. Catheter ablation can be considered an effective therapeutic option, especially when CRT maintenance is highly advisable.
Guarda su PubMed
Evaluation of remote monitoring of parturition in dairy cattle as a new tool for calving management.
BMC Vet Res2013 Oct;9():191. doi: 10.1186/1746-6148-9-191.
Palombi Claudio, Paolucci Marco, Stradaioli Giuseppe, Corubolo Mario, Pascolo Paolo B, Monaci Maurizio
Proper calving management of dairy herds is a crucial aspect of the bovine life cycle, as it has profound effects on calf viability and on the post-partum course of the dam. The objectives of this study were to monitor the calving process through the use of a remote alarm system and to determine the impact of prompt emergency obstetric procedures in case of dystocia for the prevention of stillbirths and post-partum reproductive pathologies, and for improving herd fertility. Six groups of experimental animals were studied: monitored heifers (n = 60) and multiparous cows (n = 60) were compared with non-observed animals (n = 60 heifers and n = 60 multiparous) giving birth during the same time period and housed in the calving barn, and with unmonitored animals placed in a dry zone (n = 240 heifers and n = 112 multiparous cows).
The incidence of dystocia ranged from a minimum of 23.4% (monitored multiparous cows) to a maximum of 33.3% (monitored heifers), and there were no differences compared with control groups. However, the rate of stillbirth was higher in control groups than in the monitored groups (P
The remote alarm system used to monitor the calving process assured the prompt presence of personnel, improving both the cow's reproductive efficiency and neonatal viability.
Guarda su PubMed
[Risk stratification for sudden cardiac death: should we juist consider ejection fraction?].
G Ital Cardiol (Rome)2008 Oct;9(10 Suppl 1):27S-32S.
Paolucci Marco, Cattafi Giuseppe, Magenta Giovanni, Vecchi Maria Rita, Schirru Milena, Lunati Maurizio
Sudden cardiac arrest is a leading cause of death in industrialized countries. There is solid clinical evidence for implantable cardioverter-defibrillators as the only effective means of preventing sudden cardiac arrest and reducing mortality in high-risk patients. The therapeutic strategy has definitively been validated, but we have not yet identified with the same effectiveness the patients who most likely will benefit from such therapy. Risk stratification of sudden death is therefore one of the major unresolved issues of modern cardiology. Current guidelines identify ejection fraction as the only instrumental parameter for risk stratification of sudden cardiac death. It is strongly consolidated from "old and new" clinical trials that ejection fraction reduction is the real powerful predictor of total mortality and sudden death regardless of its etiology; however it cannot be considered as an indisputable gold standard predictor of risk because it lacks of sensitivity and specificity in the prediction of sudden death. It is reasonable that many factors besides ejection fraction influence patient prognosis; there are different aspects suggesting that a reduction in ejection fraction is a risk factor only in combination with other risk factors. The implantable cardioverter-defibrillator therapy is expensive and associated with possible complications. We therefore need better methods for risk stratification of our patients in order to increase the real cost-effectiveness of current and future treatment options.
Guarda su PubMed
Surgical ablation of arrhythmias.
Ital Heart J2005 Mar;6(3):231-40.
Lunati Maurizio, Paolucci Marco, Cattafi Giuseppe, Magenta Giovanni, Vecchi Maria Rita, Schirru Milena, Lanfranconi Marco, Vitali Ettore
The surgical approach was the earliest therapeutic ablation of hyperkinetic arrhythmias. Following the progressive improvements in electrophysiological mapping and operative techniques, new surgical approaches have been developed for the treatment of those arrhythmias related to ectopic phenomena or reentry mechanisms. These procedures have been proven to be highly effective but the associated morbidity and mortality were unacceptably high. More recent and advanced techniques of transcatheter ablation have revolutionized the treatment of these arrhythmias and now represent the treatment of choice in the majority of cases. However, the significant reduction in the operative risk and the improvement in patient outcome with respect to the past, thanks to a better patient selection and to advances in the surgical and myocardial protection techniques, make do that the surgical approach to some forms of arrhythmias is still valid, especially in those cases requiring associated surgery: atrial tachyarrhythmias in patients with congenital heart disease, post-ischemic ventricular tachycardias in patients who necessitate myocardial revascularization, and/or ventricular remodeling and chronic or paroxysmal atrial fibrillation in patients who require cardiac surgery. New techniques such as radiofrequency, microwaves and cryoablation guarantee the creation of linear and transmural lesions with minimum damage to the cardiac structures and appear very interesting as they are surgically simple and associated with shorter procedure times and less complications. The possibility of performing the ablative procedure completely on the epicardial surface may open the way for atrial fibrillation surgery on a totally beating heart and for procedures that are ever less invasive thus enabling treatment of patients without associated surgical indications.
Guarda su PubMed
Patient selection for biventricular pacing.
J Cardiovasc Electrophysiol2002 Jan;13(1 Suppl):S63-7.
Lunati Maurizio, Paolucci Marco, Oliva Fabrizio, Frigerio Maria, Magenta Giovanni, Cattafi Giuseppe, Vecchi Rita, Vicini Ilaria, Cavaglià Sergio
Biventricular pacing improves functional status in the majority of patients with drug-refractory heart failure, dilated cardiomyopathy, and interventricular conduction delay. The aim of this study was to analyze the baseline clinical and functional data of a cohort of patients implanted with a biventricular stimulation system in a single-center experience, to verify if the pathophysiologic characteristics of patients affect outcome, and to determine if preliminary identification of the right candidates for the new therapy is possible with noninvasive parameters.
METHODS AND RESULTS:
Since March 1999, 52 patients with advanced heart failure (idiopathic cardiomyopathy 50%, ischemic cardiomyopathy 35%, other etiology 15%) and left bundle branch block underwent cardiac resynchronization and were followed prospectively. Paired analysis over mean (+/- SD) follow-up of 348 +/- 154 days showed an overall significant decrease of QRS width (baseline 194 +/- 33.2 msec vs follow-up 159.6 +/- 20.1 msec), New York Heart Association (NYHA) functional class (baseline 3.2 +/- 0.5 vs follow-up 2.3 +/- 0.5), quality-of-life score (baseline 54 +/- 25 vs follow-up 25 +/- 16), and increase of maximal VO2 (baseline 12.6 +/- 2.5 mL/kg/min vs follow-up 15.0 +/- 3.3 mL/kg/min). There were 80% responders (documented, persistent decrease > or = 1 NYHA class) and 20% nonresponders (same NYHA class or decline of status; need for heart transplant; death due to progressive pump failure). No significant differences in baseline clinical and functional variables between the two subgroups were observed. In responders, there was a highly significant global improvement of all variables; in nonresponders, no parameters changed between baseline and follow-up.
These data confirm the role of biventricular pacing in improving the functional status of the great majority of a selected patient population having advanced heart failure and left bundle branch block with wide QRS complex. Basal demographic, clinical, and functional characteristics are not helpful in preliminary selection of responders. Simple evaluation of NYHA class confirms favorable outcome (improvement of functional and hemodynamic status).
Guarda su PubMed