[Competitive sports and leisure-time physical activity in patients with coronary heart disease]. / Il cardiopatico ischemico: approccio all'attività fisica e sportiva.

During recent years, the central role of exercise in the prevention of cardiovascular disease has gradually been demonstrated, and in 2003 the consensus document of the Council on Clinical Cardiology and Council on Nutrition, Physical Activity and Metabolism on the role of physical exercise in the prevention and treatment of coronary artery disease defined sedentary lifestyle as a modifiable independent cardiovascular risk factor, responsible for 12% of total mortality in the United States and for a 1.9-fold increase in the risk of ischemic heart disease. The reduction in cardiovascular mortality and cardiac ischemic events in subjects who perform regular physical activity is mainly due to the action that exercise plays on the control of cardiovascular risk factors. In particular, physical training has proved capable of improving lipid profile, reducing blood pressure and body weight, and improving glycemic control in diabetic subjects. In patients with coronary artery disease, combined exercise training, including both aerobic activities and strength training, is currently recommended. However, physical training in patients suffering from ischemic heart disease should be carefully prescribed, in order to maximize the positive effects and minimize the risks. It is also important that physical training programs are conducted in suitable facilities, with appropriately trained staff and with technical equipment suitable to deal with any emergency situations.

[Epidemiology, classification and prognosis of palpitations]. / II cardiopalmo: epidemiologia, classificazione e prognosi.

Palpitations can be defined as an unpleasant feeling of heart beat, which is perceived as particularly fast, irregular or intense. This feeling is usually associated with perception of movements and hits in the chest. From the pathophysiological point of view, current knowledge of the neural pathways responsible for the perception of heart beat remains to be clearly elucidated. It has been hypothesized that these pathways include different structures located both at the intracardiac and extracardiac level. Palpitations are a widely diffused complaint in the general population, and particularly in subjects affected by structural heart disease. Clinical presentation makes it possible to divide palpitations into four groups: extrasystolic, tachycardic, anxiety-related, and intense. From the etiological point of view, palpitations may be divided into the following groups: palpitations caused by arrhythmias, by structural heart disease (non-arrhythmic), by psychiatric disease, by systemic noncardiac disease, and by drug or illicit substance assumption. The prompt detection of the causes of palpitations allows to identify clinical conditions potentially at high risk and to choose the most appropriate therapeutic approach.

[Idiopathic ventricular tachycardia: clinical characteristics and management]. / La tachicardia ventricolare idiopatica: significato clinico e terapia.

Outflow tract ventricular tachycardia (VT) is the most common form of idiopathic VT in clinical practice. The correct differential diagnosis with VTs caused by structural heart diseases (particularly arrhythmogenic right ventricular cardiomyopathy) is extremely challenging for the cardiologist. When correctly diagnosed, outflow tract VTs have a favorable prognosis in the majority of patients. At present, technical advancements and improved clinical experience in transcatheter ablation procedures may offer a definite therapy to an increasing number of patients with an acceptable complication rate.

Microvolt T-wave alternans for risk stratification in athletes with ventricular arrhythmias: correlation with programmed ventricular stimulation.

BACKGROUND: Aim of our study is to evaluate the role of T-wave alternans (TWA) to stratify the risk of sudden cardiac death in athletes (Ath) with complex ventricular arrhythmias (VA), and to document a possible correlation between TWA and electrophysiological testing (EPS) results. METHODS: We studied 85 Ath with VA (61 M, mean age 32 +/- 11 years). In all cases a cardiological evaluation was performed, including TWA and EPS. The patients were evaluated during a follow-up of 30 +/- 21 months. The end point was the occurrence of sudden death (SD) or malignant ventricular tachyarrhythmias (VT). RESULTS: TWA was negative in 57 Ath (68%), positive in 15 (18%) and indeterminate in 13 (14%). All subjects with negative TWA did not show induction of VT at EPS, with significant correlation between negative TWA and negative EPS (P < 0.001). All Ath with positive TWA also had VT induced by a EPS, with significant correlation (P < 0.001). By contrast, our data did not show significant correlation between indeterminate TWA and positive or negative EPS. However, there was significant correlation between abnormal TWA test (positive + indeterminate) and inducibility of VT at EPS (P < 0.001). During follow-up we observed a significant difference in end point occurrence (VT or SD) between Ath with negative or abnormal TWA and between Ath with negative or positive EPS. CONCLUSION: TWA confirm its role as a simple and noninvasive test, and it seems useful for prognostic stratification of Ath with VA.

[Current limitations and new perspectives in the diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia]. / L'iter diagnostico della cardiomiopatia aritmogena del ventricolo destro: limiti attuali e nuove prospettive.

Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a genetic cardiomyopathy characterized by ventricular arrhythmias and structural abnormalities of the right ventricle. In ARVC/D there is a progressive replacement of right ventricular myocardium with fatty and fibrous tissue and ventricular arrhythmias of right ventricular origin. The precise prevalence of ARVC/D has been estimated to vary between 1 in 1000 to 1 in 5000 of the general population. ARVC accounts for approximately 3-10% of sudden deaths in young people under the age of 65 years. The purpose of this paper is to review the current knowledge of ARVC/D and its management. Particular attention will be focused on some of the recent advances in the understanding of the genetic basis of ARVC/D. Increasing evidence suggests that ARVC/D is a disease of desmosomal dysfunction. Attention will also be focused on the new and somewhat controversial concept that ARVC/D may present primarily as a left ventricular disease. In our experience ARVC/D typically presents as a right ventricular disease, unless a patient has advanced disease. Diagnosis of ARVC/D is challenging and requires a comprehensive evaluation with both non-invasive and invasive testing.

Efficacy and safety of radiofrequency catheter ablation in the elderly.

INTRODUCTION: Radiofrequency (RF) catheter ablation has not been widely undertaken in elderly patients. The aim of our study was to compare the success rate of radiofrequency ablation and the incidence of severe procedural complications in young-adult and elderly patients. METHODS: We enrolled all patients undergoing radiofrequency catheter ablation procedures for supraventricular and ventricular arrhythmias at our Cardiology Department from January 2000 to December 2005. The patients were divided into two groups according to age: patients aged <70 years (group A) and those aged >or=70 years (group B). Group B was then divided into two subgroups: B1 (age 70-79 years) and B2 (age >or=80 years). We recorded the incidence of procedural complications and the long-term efficacy (mean follow-up 46 +/- 20 months). RESULTS: We studied 605 patients, 69% in group A and 31% in group B (24% in subgroup B1 and 7% in B2). The prevalence of structural heart disease was higher in elderly patients than in young adults (83 vs 37%, p < 0.01). The rate of procedural complications was 1.3%; no differences emerged between groups A and B (1.2 vs 1.5%, p = NS) or among groups A, B1 and B2 (1.2 vs 1.4 vs 2%, p = NS). The success rate of catheter ablation was 91%, with no differences between the age-groups (92 vs 88%, p = NS) or among groups A, B1 and B2 (92 vs 88 vs 88%, p = NS). CONCLUSION: Catheter ablation in elderly and very elderly patients is as effective and safe as in young-adult subjects, at least in cases which do not require left heart catheterization.

Ventricular arrhythmias in competitive athletes: risk stratification with T-wave alternans.

INTRODUCTION: Aim of our study is to evaluate the role of TWA to stratify the risk of sudden cardiac death in athletes (Ath) with complex ventricular arrhythmias (VA), and to document a possible correlation between TWA and electrophysiological testing (EES) results. METHODS: We studied 43 Ath with VA (31 M, mean age 34 ± 12 years). In all cases a cardiological evaluation was performed, including TWA and EES. The patients were evaluated during a follow-up of 25 ± 22 months. The end-point was the occurrence of sudden death or malignant ventricular tachyarrhythmias (VT). RESULTS: TWA was negative in 28 Ath (65%), positive in 8 (19%) and indeterminate in 7 (16%). All subjects with negative TWA did not show induction of VT at EES, with significant correlation between negative TWA and negative EES (p<0.001). All Ath with positive TWA also had VT induced by a EES, but without significant correlation between positive TWA and positive EES. In 2 Ath with undetermined TWA (29%) VT were induced at EES. Our data did not show significant correlation between indeterminate TWA and positive or negative EES. However, logistic regression analysis showed significant correlation between abnormal TWA test (positive or indeterminate) and inducibility of VT at EES (p<0.001). During follow-up we observed a significant difference in end-point occurrence between Ath with negative or positive TWA and between Ath with negative or positive EES. CONCLUSION: TWA confirm its role as a simple and non-invasive test, and it seems useful for prognostic stratification of Ath with VA.