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| 1 | Ticagrelor therapy and atrioventricular block:Do we need to worry?显示文摘Ticagrelor is a potent,direct P2Y12 antagonist with rapid onset of action and intense platelet inhibition,indicated in patients with acute coronary syndromes(ACS).This drug is usually well tolerated,but some patients experience serious adverse effects:Major bleeding;gastrointestinal disturbances;dyspnoea;ventricular pauses > 3 s.Given the unexpected high incidence of bradyarrhythmias,a PLATO substudy monitored this side effect,showing that ticagrelor was associated with an increase in the rate of sinus bradycardia and sinus arrest compared to clopidogrel.This side effect was usually transient,asymptomatic and not associated with higher incidence of severe atrioventricular(AV) block or pacemaker needs.A panel of experts from Food and Drug Administration did not consider bradyarrhythmias a serious problem in clinical practice and,accordingly,current labeling of the drug does not give any precaution or contraindication regarding this issue.However,recently some articles have described ACS patients with high-degree,life-threatening,AV block requiring drug discontinuation and,in some cases,pacemaker implantation.In this paper,we describe and discuss five published case reports of severe AV block following ticagrelor therapy and two other cases managed in our Hospital.The analysis of literature suggests that,although rarely,ticagrelor can be associated with lifethreatening AV block.Caution and careful monitoring are required especially in patients with already compromised conduction system and/or treated with AV blocking agents.Future studies,with long-term rhythm monitoring,would help to define the outcome of patients at higher risk of developing this complication. | Elia De Maria Ambra Borghi Letizia Modonesi Stefano Cappelli | 2017 | World Journal of Clinical Cases2017，5，5： | 5 |
| 2 | 程序升温汽化大体积进样气相色谱法同时测定空气中的甲醛及其他10种羰基污染物(英文)显示文摘Long-term indoor-air limit for formaldehyde stipulated by the European Commission is 1 μg/m3,while the World Health Organization has set a threshold of 100 μg/m3 that should not be exceeded for more than 30 min. To date,however,only a few analytical techniques have been developed that can be used to detect formaldehyde at these very restrictive limits. Thus,there is a need to develop for comprehensive methods for analyzing airborne formaldehyde and other carbonyl pollutants in the ambient environment. The aim of this study is to develop a highly sensitive online automated preconcentration gas chromatographic method using large-volume injection with a programmed temperature vaporization injector for the analysis of airborne formaldehyde and ten other carbonyl compounds. The influence of several parameters,such as the maximum volume injected,programmed temperature vaporization transfer time and temperature,carrier gas flow rate,and type of packing material was investigated. After optimization,highly satisfactory results in terms of the absolute and methodological detection limits were achieved,i. e. as low as the μg/m3 level for all the carbonyl pollutants studied. A commercially available sampler,originally designed for active sampling,was evaluated as a passive sampling device;this optimized technique was applied to monitor the concentrations of carbonyl pollutants in the indoor air of ten public buildings in Florence. The strength of this methodology lies both in the low detection limits reached in the simultaneous analysis of a wide group of 2,4-dinitrophenylhydrazine derivatives,and the potential adaptability of this method to other gas chromatographic applications to achieve lower sensitivity. | Stefano DUGHERI Nicola MUCCI Ilenia POMPILIO Giovanni CAPPELLI Costanza BOSSI AlessANDro BONARI Giulio ARCANGELI | 2018 | 色谱2018，36，12： | 3 |
| 3 | Cardiac magnetic resonance imaging:Which information is useful for the arrhythmologist?显示文摘Cardiac magnetic resonance(CMR) is a non-invasive,nonionizing,diagnostic technique that uses magnetic fields,radio waves and field gradients to generate images with high spatial and temporal resolution.After administration of contrast media(e.g.,gadolinium chelate),it is also possible to acquire late images,which make possible the identification and quantification of myocardial areas with scar/fibrosis(late gadolinium enhancement,LGE).CMR is currently a useful instrument in clinical cardiovascular practice for the assessment of several pathological conditions,including ischemic and nonischemic cardiomyopathies and congenital heart disease.In recent years,its field of application has also extended to arrhythmology,both in diagnostic and prognostic evaluation of arrhythmic risk and in therapeutic decisionmaking.In this review,we discuss the possible useful applications of CMR for the arrhythmologist.It is possible to identify three main fields of application of CMR in this context:(1) arrhythmic and sudden cardiac death risk stratification in different heart diseases;(2) decisionmaking in cardiac resynchronization therapy device implantation,presence and extent of myocardial fibrosis for left ventricular lead placement and cardiac venous anatomy; and(3) substrate identification for guiding ablation of complex arrhythmias(atrial fibrillation and ventricular tachycardias). | Elia De Maria Annachiara Aldrovandi Ambra Borghi Letizia Modonesi Stefano Cappelli | 2017 | World Journal of Cardiology2017，9，10： | 2 |
| 4 | Prognostic implications of tumor invasion or adhesion to peripancreatic vessels in resected pancreatic cancer显示文摘 | Ugo Boggi Marco Del Chiaro Chiara Croce Fabio Vistoli Stefano Signori Carlo Moretto Gabriella Amorese Salvatore Mazzeo Carla Cappelli Daniela Campani Franco Mosca | 2009 | Surgery2009，，： | 1 |
| 5 | Riata silicone defibrillation lead with normal electrical measures at routine ambulatory check:The role of highvoltage shock testing显示文摘AIM To describe our experience with shock testing for the evaluation of patients with Riata? leads.METHODS Among 51 patients with normal baseline electrical parameters, 20 died during follow-up. Of the remaining 31 patients, 15 underwent the test: In 10 cases a defibrillation testing with ventricular fibrillation(VF) induction and in 5 cases a R-wave-synchronized shock(> 20 J, without inducing VF). The test was performed under sedation with Midazolam. RESULTS Twelve patients(80%) had a normal behavior during shock testing: In 8 cases induced VF was correctly detected and treated; in 4 cases of R-wave-synchronized shock electrical parameters remained stable and normal. Three patients(20%) failed the test. One patient with externalized conductors showed a sudden drop of high-voltage impedance(< 10 Ohm) after a 25 J R-wave-synchronized shock. Two other patients with externalized conductors, undergoing defibrillation testing, showed a short-circuit during shock delivery and the implantable cardioverter defibrillator was unable to interrupt VF.CONCLUSION In Riata? leads the delivery of a low current during routine measurement of high-voltage impedance may not reveal a small short circuit, that can only be evident by attempting to deliver a true shock, either for spontaneous arrhythmias or in the context of a shock testing. | Elia De Maria Ambra Borghi Lorenzo Bonetti Pier Luigi Fontana Stefano Cappelli | 2016 | World Journal of Cardiology2016，8，11： | 1 |
| 6 | Central pancreatectomy with inframesocolic pancreatojejunostomy显示文摘 | Ugo Boggi Gabriella Amorese Nelide Lio Vittorio Perrone Simone D'Imporzano Chiara Croce Fabio Vistoli Stefano Signori Carla Cappelli Franco Mosca | 2012 | Langenbeck’s Archives of Surgery2012，，6： | 1 |
| 7 | Externalized conductors and insulation failure in Biotronik defibrillator leads: History repeating or a false alarm?显示文摘Conductor externalization and insulation failure are frequent complications with the recalled St. Jude Medical Riata implantable cardioverter-defibrillator(ICD) leads. Conductor externalization is a 'unique' failure mechanism: Cables externalize through the insulation('inside-out' abrasion) and appear outside the lead body. Recently, single reports described a similar failure also for Biotronik leads. Moreover, some studies reported a high rate of electrical dysfunction(not only insulation failure) with Biotronik Linox leads and a reduced survival rate in comparison with the competitors. In this paper we describe the case of a patient with a Biotronik Kentrox ICD lead presenting with signs of insulation failure and conductor externalization at fluoroscopy. Due to the high risk of extraction we decided to implant a new lead, abandoning the damaged one; lead reimplant was uneventful. Subsequently, we review currently available literature about Biotronik Kentrox and Linox ICD lead failure and in particular externalized conductors. Some single-center studies and a nonprospective registry reported a survival rate between 88% and 91% at 5 years for Linox leads, significantly worse than that of other manufacturers. However, the preliminary results of two ongoing multicenter, prospective registries(GALAXY and CELESTIAL) showed 96% survival rate at 5 years after implant, well within industry standards. Ongoing data collection is needed to confirm longer-term performance of this family of ICD leads. | Elia De Maria Ambra Borghi Lorenzo Bonetti Pier Luigi Fontana Stefano Cappelli | 2017 | World Journal of Clinical Cases2017，5，2： | 0 |
| 8 | Minimizing right ventricular pacing in sinus node disease: Sometimes the cure is worse than the disease显示文摘Traditional right ventricular(RV) apical pacing has been associated with heart failure, atrial fibrillation and increased mortality. To avoid the negative consequences of RV apical pacing different strategies have been developed, among these a series of pacing algorithms designed to minimize RV pacing. These functions are particularly useful when there is not the need for continuous RV pacing: intermittent atrioventricular blocks and, mainly, sinus node disease. However, in order to avoid RV pacing, the operationalfeatures of these algorithms may lead to adverse(often under-appreciated) consequences in some patients. We describe a case of a patient with sinus node disease, in whom right atrial only pacing involved long atrio-ventricular delay to allow intrinsic ventricular conduction, which led to symptomatic hypotension that could be overcome only by 'forcing' also right ventricular apical pacing. We subsequently discuss this case in the context of current available literature. | Elia De Maria Alina Olaru Stefano Cappelli | 2015 | World Journal of Clinical Cases2015，3，3： | 0 |
| 9 | Antitachycardia pacing programming in implantable cardioverter defibrillator:A systematic review显示文摘Implantable cardioverter defibrillator(ICD) programminginvolves several parameters. In recent years antitachycardia pacing(ATP) has gained an increasing importance in the treatment of ventricular arrhythmias, whether slow or fast. It reduces the number of unnecessary and inappropriate shocks and improves both patient's quality of life and device longevity. There is no clear indication regarding the type of ATP to be used, except for the treatment of fast ventricular tachycardias(188 bpm-250 bpm) where it has been shown a greater efficacy and safety of burst compared to ramp; 8 impulses in each sequence of ATP appears to be the best programming option in this setting. Beyond ATP use, excellent clinical results were obtained with programming standardization following these principles: extended detection time in ventricular fibrillation(VF) zone; supraventricular discrimination criteria up to 200 bpm; first shock in VF zone at the maximum energy in order to reduce the risk of multiple shocks. The MADIT-RIT trial and some observational registries have also recently demonstrated that programming with a widespread use of ATP, higher cut-off rates or delayed intervention reduces the number of inappropriate and unnecessary therapies and improves the survival of patients during mid-term follow-up. | Elia De Maria Daniele Giacopelli Ambra Borghi Letizia Modonesi Stefano Cappelli | 2017 | World Journal of Cardiology2017，9，5： | 0 |
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