To my beloved wife Luisa Someone said “Love, pleasant folly…”, I say “Love, lunatic happiness...”
True love doesn’t know how to speak!
1 3
Current News in Cardiology
Proceedings of the
Mediterranean Cardiology Meeting (Taormina, May 20-22, 2007)
Michele M. Gulizia (Editor)
Michele M. Gulizia, MD Chief of Cardiology Division
“Garibaldi-Nesima” Hospital Catania, Italy
Library of Congress Control Number: 2007927712
ISBN 13: 978-88-470-0635-5 Springer Milan Berlin Heidelberg New York e-ISBN 13: 978-88-470-0636-2
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It is said that the true essence of the progress is the constant verification of that which is certain.
Clinical practice is evolving at a rapid pace, nowhere more so than in the field of cardiology.
Acute Coronary Syndromes, Sudden Cardiac Death, Heart Failure, Atrial Fibrillation, Syncope, and Prevention of Global Cardiovascular Risk are the main emerging pathologies, on which many investigators are focusing their research. Less than 10 years ago, some of them were considered of relevance only to internists, and some others as common benign arrhythmias or ineluc- table illnesses. Today, their prevalence amongst the population represents a major public health problem at the beginning of the third millennium.
The need for a state-of-the-art overview of the epidemiology, physiopatho- logical and electrogenetic mechanisms, diagnosis, pharmacological or electri- cal treatment, prognosis, patient management in and out of hospital, organisa- tional and economical implications of these emerging pathologies, and the great success of the previous editions, inspired us to organise the third edition of this biannual International Meeting, to give you the “Current News in Cardiology”.
This book contains the Proceedings of the Mediterranean Cardiology Meeting held in Taormina, Italy, 20-22 May 2007. Like the previous volumes, it boasts the participation of many nationally and internationally renowned speakers in the field of clinical and interventional cardiology who will interact actively with delegates.
The exceptional novelty of this edition is that all participants to the Meeting will receive a password for a free pdf download of all chapters of the book, which can, be found on the website of the Mediterranean Cardiology Meeting (www.mcmweb.it) via SpringerLink.
The book is divided into 8 sections, 11 sub-sections, and a total of 54 chap- ters, each devoted to a different topic: Atrial Fibrillation and Atrial Flutter;
Hear t Failure; Sy ncope; Sudden Cardiac Death; Cardiac Pacing;
Electrocardiography; Acute Coronary Syndromes; Global Cardiovascular Risk Prevention.
Preface
It aims to provide the latest information on the most recent and modern aspects of the above mentioned pathologies. It is intended not only for cardio- logists, but also for those who are actively interested in the evidence-based approach to clinical care, such as internists, emergency and critical care clini- cians, physicians of general medicine, fellows, students, nurses, and techni- cians. It may also be helpful for individuals engaged in the development and coordination of research strategies in biological engineering, industry, and regulatory affairs, who have a strong interest in the overall management of these cardiac pathologies.
A Faculty selected from leading Italian and International experts ensures the highest quality of this volume: the publications of many of them have con- tributed to the scientific progress in cardiology and influenced many of our professional considerations and decisions. I am most indebted to all these authors, who have devoted the invaluable time and effort without which this book would not have been completed.
I also wish to thank the staff of Springer, and in particular Donatella Rizza, Executive Editor, who has facilitated the publication of this book since the first edition of the Mediterranean Cardiology Meeting, and who has kindly assisted me throughout this project together with her staff member Eleonora.
Special and deep thanks are addressed to Rita Reggiani, professional, tireless, and wonderful Project Leader of Adria Congrex, who has helped and suppor- ted me in achieving the best possible organisation of this International Meeting, together with her staff members Silvana, Sara and Elisa.
I cannot forget to acknowledge the role of my two teachers, Antonio Circo and Salvatore Mangiameli, who encouraged my passion for cardiology and particularly for arrhythmology and clinical management.
In addition, I would like to thank my co-workers Cacia, Cardillo, Francese, Mangiameli, Portale, Raciti, Ragusa, the chief of nursing Salpietro and the entire staff of my Cardiology Division at the “Garibaldi-Nesima” Hospital of Catania for their active collaboration and support during these years of work and for the organisation of this Meeting.
Finally, a special mention goes to my dear wife Luisa, my daughters Alice and Raffaella, and my parents Raffaele and Cettina. I am especially and deeply grateful to them. Without their love and patience I could not have spent so many nights and weekends preparing the Meeting and this volume.
Michele M. Gulizia
VI Preface
Table of Contents
ATRIAL FIBRILLATION AND ATRIAL FLUTTER PHARMACOLOGICALTHERAPY
Anti-arrhythmic Drugs in Atrial Fibrillation: Historical Perspectives
and New Developments . . . . 3 Berndt Lüderitz
“Pill-in-the-Pocket” Approach . . . 11 Paolo Alboni
Lone Atrial Fibrillation: Prophylactic Anti-arrhythmic Treatment . . . 17 Gianluca Botto, Mario Luzi, Giovanni Russo, Barbara Mariconti
RADIOFREQUENCYABLATION
Radiofrequency Ablation of Atrial Fibrillation and Atrial Flutter:
Who and When? . . . 23 Josef Kautzner, Dan Wichterle
Cryocatheter Ablation for Atrial Flutter . . . 29 Peter Andrew, Annibale Sandro Montenero
Clinical Profile, Electrophysiological Characteristics, and Outcome after
Radiofrequency Catheter Ablation of Atypical Atrial Flutter . . . 41 Golmehr Ashrafpoor, Amir-Ali Fassa, Henri Sunthorn, Haran Burri,
Pascale Gentil-Baron, Dipen Shah
The Impact of New Imaging, Mapping and Energy Delivery Technology
on the Current Approach to Ablation of Atrial Fibrillation . . . 43 Andrea Colella, Marzia Giaccardi, Luigi Padeletti, Gian Franco Gensini
Trigger vs Substrate Ablation for the Treatment of Atrial Fibrillation . . . 49 Atul Verma
Complications of Atrial Fibrillation Ablation: How To Prevent Them . . . 57 Giuseppe De Martino, Giovanna Rodio, Carmine Mancusi, Stefano De Vivo
PACING IN THEPREVENTION ANDTHERAPY OFATRIALARRHYTHMIAS
Pacing in Atrial Fibrillation: Is It Still Viable? . . . 63 Oscar Oseroff, Gustavo Iralde, Enrique Retyk
Traditional or Device Approach for the Management of Atrial Fibrillation in Patients with Heart Failure . . . 75 Aurelio Quesada, Mónica Giménez, Victor Palanca, Javier Jiménez, José Roda
PRACTICALISSUES INMANAGINGATRIALFIBRILLATIONPATIENTS Conversion of Persistent Atrial Fibrillation to Sinus Rhythm by DC Shock:
Is It Still in Use Two Years After AFFIRM? . . . 87 Valeria Calvi, Salvatore Timineri
Lone Atrial Fibrillation and Sports Activities . . . 93 Francesco Furlanello, Giuseppe Inama, Claudio Pedrinazzi,
Luigi De Ambroggi, Riccardo Cappato
HEART FAILURE
Heart-Failure Management: Focus on Heart-Failure Practice Guidelines . . . . 101 Eugene Crystal, Rajneesh Calton
MANAGINGPATIENTS WITHIMPLANTABLECRT DEVICES FORHEARTFAILURE Determination of Left Ventricular Contractile Reserve by Dobutamine
Stress Echocardiography To Predict the Response to CRT . . . 117 Carmine Muto, Bernardino Tuccillo
Focus on Optimization of Cardiac Resynchronization
Therapy Techniques . . . 119 Maurizio Lunati, Yann Poezevara, Andrea Boncompagni
Evaluation of the Clinical State of Cardiac Resynchronization Therapy
Patients by Continuous Heart-Failure Monitoring . . . 125 Henri Benkemoun, Bertrand Colombo, Jean Sacrez, Philippe Lagrange,
Philippe Cabrol, Gabriel Robert, Marc Moulichon
VIII Table of Contents
Predicting Heart Failure Events in CRT Patients: Future Challenges . . . 129 Roberto Mantovan, Danilo Contardi, Vittorio Calzolari,
Martino Crosato, Zoran Olivari
Use of Fluid Accumulation Monitoring in HF Patients . . . 137 Saverio Iacopino, Rossella Alemanni, Antonella Talerico,
Gennaro Fabiano, Sergio Canonaco, Francesco Borrello
SYNCOPE
DIAGNOSTICEVALUATION OFPATIENTS WITHRECURRENTSYNCOPALEPISODES Performing Carotid Sinus Massage . . . 145 Roberto Maggi, Michele Brignole
Performing Tilt Testing and Physical Countermaneuvers Training . . . 153 Giuseppina M. Francese, Michele M. Gulizia
Implanting a Loop Recorder . . . 159 Michele Brignole
SUDDEN DEATH
NONINVASIVESUDDENDEATHRISKSTRATIFICATION Noninvasive Sudden Death Risk Stratification: Heart Rate
Variability and Turbulence, and QT Dynamicity . . . 167 Antonio Vincenti, Stefano Pedretti
Noninvasive Risk Stratification of Sudden Death: T-Wave Alternans . . . 179 Roberto F.E. Pedretti, Simona Sarzi Braga, Raffaella Vaninetti,
Antonio Laporta, Sergio Masnaghetti, Rossella Raimondo, Mario Salerno, Francesco Santoro
Risk Stratification for Sudden Death in Hypertrophic Cardiomyopathy . . . 191 Domenico Catanzariti, Massimiliano Maines, Giuseppe Vergara
Managing Hypertrophic Cardiomyopathy: Screening in Young Subjects . . . . 197 Maurizio Santomauro on Behalf of the AIAC Task Force of Risk Management, Gianluca Botto, Corrado Diaco, Michele M. Gulizia, Giuseppe Marceca, Francesco Melandri, Franco Naccarella, Carla Riganti, Massimo Santini Table of Contents IX
PHARMACOLOGICALTHERAPY
The Prevention of Sudden Death: New Perspectives . . . 205 Savina Nodari, Marco Metra, Alessandra Manerba, Silvia Frattini,
Giuseppe Seresini, Livio Dei Cas
CURRENTNEWS INPREVENTION OFSUDDENDEATH BYIMPLANTABLE
CARDIACDEFIBRILLATORS
Which Patient and when Should Receive an ICD? Evolving
New Indications on the Horizon . . . 215 Roberto Verlato, Maria Stella Baccillieri, Pietro Turrini
Implantable Cardiac Defibrillators: Is Defibrillation Threshold
Testing Still Necessary in all Patients? . . . 221 Franco Naccarella, Fabio Iachetti, Angela Wang, Cristina Felicani,
Giovannina Lepera, Elvira Moccia, Leilei Sun, Luca Casari, Giorgio Morselli, Patrizia Capogreco, Gerald Naccarelli
Current Practice in Italy of VF Testing at Implant:
What Do We Know and Where Do We Go From Here? . . . 231 Michele Brignole, Giovanni Raciti, Maria Grazia Bongiorni,
Giuseppe De Martino, Stefano Favale, Maurizio Gasparini, Raffaele Luise, Eraldo Occhetta, Alessandro Proclemer
How To Choose Between Single-Chamber and Dual-Chamber ICD . . . 239 Maurizio Del Greco, Lorena Gramegna, Massimiliano Marini,
Marcello Disertori
Which Patients Should Receive Dual Defibrillators? Results of DATAS . . . 245 Aurelio Quesada, Mónica Giménez, Victor Palanca, Javier Jiménez,
Alfonso Valle, José Roda
Prevention of Sudden Death in Patients with Genetic Arrhythmias . . . 255 Pietro Delise
Cost-Effectiveness of ICD Therapy in the Prevention of Sudden
Death in CAD and/or HF Patients . . . 263 Andrea Pozzolini
X Table of Contents
CARDIAC PACING
HEMODYNAMICISSUES ANDPRACTICALAPPLICATIONS INCARDIACPACING Hemodynamic Impact of Right Ventricular Pacing . . . 279 Raúl Chirife, G. Aurora Ruiz, M. Cristina Tentori
Hemodynamics in Standard Cardiac Pacing . . . 293 Milos Taborsky
Hemodynamic Assessment with an Implanted Pacing Device . . . 303 Maria Grazia Bongiorni, Ezio Soldati, Giuseppe Arena, Giulio Zucchelli,
Andrea Di Cori, Alberto Barbetta, Franco Di Gregorio
Hemodynamic Optimization of Pacing Configuration
in Bradyarrhythmias . . . 309 Gianfilippo Neri, Rolando Zamprogno, Diego Vaccari,
Giuliano Masaro, Alberto Barbetta, Franco Di Gregorio
Applications of TVI Sensing in Cardiac Stimulation . . . 317 Eraldo Occhetta, Miriam Bortnik, Franco Di Gregorio,
Alberto Barbetta, Paolo Marino
The Ideal Pacemaker for Complete AV Block . . . 325 I. Eli Ovsyshcher
The Ideal Pacemaker for Elderly Patients . . . 331 Gulmira Kudaiberdieva, Bulent Gorenek
ELECTROCARDIOGRAPHY
WHATISNEW IN12-LEADELECTROCARDIOGRAPHY?
Update on ACC/ESC Criteria for Acute ST Elevation
Myocardial Infarction . . . 341 Peter W. Macfarlane
ECG-MRI based Localization of Myocardial Infarction . . . 347 Henrik Engblom, Olle Pahlm
Table of Contents XI
Electrocardiographic Predictors of Arrhythmias In CCU Patients . . . 355 Afshin Parspour, Alparslan Birdane, Bulent Gorenek
The Routine ECG as a Marker of Sudden Cardiac Death . . . 365 Luigi De Ambroggi
ACUTE CORONARY SYNDROMES
International Guidelines on Acute Coronary Syndrome:
Practical Application and Current News in Cardiology . . . 375 Giacomo Chiarandà, Giuseppa Strano, Angela Lazzaro, Marta Chiarandà
Is There a Limit to PTCA in Elderly Patients? . . . 383 Francesco Bovenzi, Roberto Lorenzoni, Mauro Lazzari,
Andrea Boni, Cristina Gemignani
When Should Patients with Ischemic Mitral Regurgitation
Undergo Cardiac Surgery? . . . 391 Scipione Carerj, Concetta Zito, Giuseppe Dattilo, Grazia Di Bella,
Carmelo Nipote, Annalisa Lamari, Rossella Garufi, Salvatore Micciulla, Francesco Arrigo
Minimally Invasive Techniques in Cardiac Surgery:
An Opportunity for All Patients? . . . 395 Leonardo Patanè, Alfio Cavallaro
GLOBAL CARDIOVASCULAR RISK PREVENTION
Cardiovascular Risk Management: An Overview . . . 407 Andrea Boni, Roberto Lorenzoni, Mauro Lazzari,
Cristina Gemignani, Francesco Bovenzi
Is Arterial Pressure Self-Measurement Better Than Ambulatory
24-Hour Pressure Monitoring? . . . 417 Carlo Fernandez
Role of Angiotensin-Receptor Blockers in the Prevention
of Cardiovascular Risk: Clinical Guidelines . . . 425 Pasquale Perrone-Filardi, Pierluigi Costanzo, Antonio Marzano,
Paolo Cesarano, Paola Gargiulo, Enrico Vassallo, Caterina Marciano, Teresa Losco, Massimo Chiariello
XII Table of Contents
New Evidence about the Beneficial Effects of Angiotensin-Receptor
Blockers on the Heart and the Kidney . . . 433 Claudio Borghi, Marco Manca
Lercanidipine, Enalapril, and Their Combination in the Treatment
of Elderly Hypertensive Patients . . . 441 Juan Garcia Puig, Carlos Calvo, Olavi Luurila, Harri Luurila,
Sakari Sulosaari, Arto Strandberg, Cristina Ghezzi
Subject Index . . . 445 Table of Contents XIII
List of Contributors
ALBONIP., 11 ALEMANNIR., 137 ANDREWP., 29 ARENAG., 303 ARRIGOF., 391 ASHRAFPOORG., 41 BACCILLIERIM.S., 215 BARBETTAA., 303, 309, 317 BENKEMOUNH., 125 BIRDANEA., 355 BONCOMPAGNIA., 119 BONGIORNIM.G., 231, 303 BONIA., 383, 407
BORGHIC., 433 BORRELLOF., 137 BORTNIKM., 317 BOTTOG., 17, 197 BOVENZIF., 383, 407 BRIGNOLEM., 145, 159, 231 BURRIH., 41
CABROLP., 125 CALTONR., 101 CALVIV., 87 CALVOC., 441 CALZOLARIV., 129 CANONACOS., 137 CAPOGRECOP., 221 CAPPATOR., 93 CARERJS., 391 CASARIL., 221 CATANZARITID., 191 CAVALLAROA., 395 CESARANOP., 425 CHIARANDÀG., 375 CHIARANDÀM., 375
CHIARIELLOM., 425 CHIRIFER., 279 COLELLAA., 43 COLOMBOB., 125 CONTARDID., 129 COSTANZOP., 425 CROSATOM., 129 CRYSTALE., 101 DATTILOG., 391
DEAMBROGGIL., 93, 365 DEMARTINOG., 57, 231 DEVIVOS., 57
DEICASL., 205 DELGRECOM., 239 DELISEP., 255 DIBELLAG., 391 DICORIA., 303
DIGREGORIOF., 303, 309, 317 DIACOC., 197
DISERTORIM., 239 ENGBLOMH., 347 FABIANOG., 137 FASSAA-A., 41 FAVALES., 231 FELICANIC., 221 FERNANDEZC., 417 FRANCESEG.M., 153 FRATTINIS., 205 FURLANELLOF., 93 GARGIULOP., 425 GARUFIR., 391 GASPARINIM., 231 GEMIGNANIC., 383, 407 GENSINIG.F., 43 GENTIL-BARONP., 41
GHEZZIC., 441 GIACCARDIM., 43 GIMÉNEZM., 75, 245 GORENEKB., 331, 355 GRAMEGNAL., 239 GULIZIAM.M., 153, 197 IACHETTIF., 221 IACOPINOS., 137 INAMAG., 93 IRALDEG., 63 JIMÉNEZJ., 75, 245 KAUTZNERJ., 23 KUDAIBERDIEVAG., 331 LAGRANGEP., 125 LAMARIA., 391 LAPORTAA., 179 LAZZARIM., 383, 407 LAZZAROA., 375 LEPERAG., 221 LORENZONIR., 383, 407 LOSCOT., 425
LÜDERITZB., 3 LUISER., 231 LUNATIM., 119 LUURILAH., 441 LUURILAO., 441 LUZIM., 17
MACFARLANEP.W., 341 MAGGIR., 145 MAINESM., 191 MANCAM., 433 MANCUSIC., 57 MANERBAA., 205 MANTOVANR., 129 MARCECAG., 197 MARCIANOC., 425 MARICONTIB., 17 MARINIM., 239 MARINOP., 317 MARZANOA., 425 MASAROG., 309 MASNAGHETTIS., 179 MELANDRIF., 197 METRAM., 205 MICCIULLAS., 391
MOCCIAE., 221 MONTENEROA.S., 29 MORSELLIG., 221 MOULICHONM., 125 MUTOC., 117
NACCARELLAF., 197, 221 NACCARELLIG., 221 NERIG., 309 NIPOTEC., 391 NODARIS., 205 OCCHETTAE., 231, 317 OLIVARIZ., 129 OSEROFFO., 63 OVSYSHCHERI.E, 325 PADELETTIL., 43 PAHLMO., 347 PALANCAV., 75, 245 PARSPOURA., 355 PATANÈL., 395 PEDRETTIR.F.E., 179 PEDRETTIS., 167 PEDRINAZZIC., 93 PERRONE-FILARDIP., 425 POEZEVARAY., 119 POZZOLINIA., 263 PROCLEMERA., 231 PUIGJ.G., 441 QUESADAA., 75, 245 RACITIG., 231 RAIMONDOR., 179 RETYKE., 63 RIGANTIC., 197 ROBERTG., 125 RODAJ., 75, 245 RODIOG., 57 RUIZG.A., 279 RUSSOG., 17 SACREZJ., 125 SALERNOM., 179 SANTINIM., 197 SANTOMAUROM., 197 SANTOROF., 179 SARZIBRAGAS., 179 SERESINIG., 205 SHAHD., 41
XVI List of Contributors
SOLDATIE., 303 STRANDBERGA., 441 STRANOG., 375 SULOSAARIS., 441 SUNL., 221 SUNTHORNH., 41 TABORSKYM., 293 TALERICOA., 137 TENTORIM.C., 279 TIMINERIS., 87 TUCCILLOB., 117 TURRINIP., 215 VACCARID., 309
VALLEA., 245 VANINETTIR., 179 VASSALLOE., 425 VERGARAG., 191 VERLATOR., 215 VERMAA., 49 VINCENTIA., 167 WANGA., 221 WICHTERLED., 23 ZAMPROGNOR., 309 ZITOC., 391 ZUCCHELLIG., 303 List of Contributors XVII
