Interventional Cardiology Units

Interventional Cardiology Area
Antonio BARTORELLI, MD
Area Coordinator
Interventional Cardiology Units
Antonio BARTORELLI, MD
Director of Unit 1
Piero MONTORSI, MD
Director of Unit 2
Alessandro LUALDI, MD
Director of Unit 3
Franco FABBIOCCHI, MD
Director of Unit 4
STAFF Senior Deputy Directors: Luca Grancini, MD,
Paolo Ravagnani, MD
Deputy Directors: Stefano Galli, MD, Daniela Trabattoni, MD
Assistants: Giuseppe Calligaris, MD, Stefano De Martini, MD,
Giovanni Teruzzi, MD
Residents: Maria Antonietta Dessanai, MD, Pamela Gatto, MD,
Marco Valerio Morpurgo, MD, Paolo Olivares, MD,
Chiara Stefania Pandini, MD, Francesca Pizzamiglio, MD
Fellows: Cristina Ferrari, MD, Anna Garlaschè, MD,
Massimo Mapelli, MD, Ilaria Previtali, MD
Head Nurse: Gabriele Bucca
Nurses: Mariangela Alberti, Gabriella Battaini,
Francesca Bonfiglio, Daniele Buono, Ivan Consoli,
Fernanda Giancola, Rossella Paloschi, Gabriella Panetta,
Gaetano Seletti, Enrico Speranza
Chief Technician: Giuseppe Squilla
Technicians: Vania Battaglini, Chiara De Pasquale,
Vincenzo Lo Mascolo, Flavio Mu, Stefania Pergolizzi
Secretaries: Mariagrazia Cortesi, Fernando Di Marino
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Activities 2011. Interventional cardiology is a
modern branch of medicine with a very high technology
content, which deals with the non-surgical management of
cardiovascular diseases. The role of invasive cardiology
has rapidly grown from a predominantly diagnostic
activity to a full range of therapeutic interventions
as alternatives to traditional surgical and medical
treatments. The cardiac catheterization laboratories of
Centro Cardiologico Monzino are equipped with the most
advanced and innovative tools to offer a full range of
state-of-the-art diagnostic and therapeutic procedures.
Together with traditional angiography, additional
diagnostic modalities such as intravascular ultrasound and
virtual histology, optical coherence tomography, flowwire and quantitative angiography allow a more precise
and accurate evaluation of lesion to be treated and postprocedural results.
In 2010, Centro Cardiologico Monzino continued to be
at the forefront of elective coronary artery disease
treatment using constantly updated coronary angioplasty
techniques and state-of-the-art drug-eluting stents.
Patients with acute coronary syndromes were also treated
using coronary angioplasty and stenting and the latest
technology for protecting the coronary microcirculation,
particularly in acute myocardial infarction. This patient
subset can receive prompt treatment by a skilled team of
interventional cardiologists available on a 24/24-hour 7/7day basis. Moreover, cardiac support devices (intra-aortic
balloon pump, percutaneous cardiopulmonary support and
Impella device) are available and were used to support
patients with reduced left ventricular function. We also
offered angioplasty and stenting in the arteries of the leg
and the kidneys, the carotid arteries, and the abdominal
vessels, such as the aorta and the iliacs. Interventional
cardiologists also used their extensive expertise in the
successfully treatment of structural heart disease using
innovative therapeutic modalities such as alcohol septal
ablation for hypertrophic obstructive cardiomyopathy,
atrial septal defect and patent foramen ovale closure,
and left atrial appendage obliteration for prevention of
cardiogenic embolization in atrial fibrillation patients.
In 2008, in collaboration with the Cardiac Surgery
Unit, we started a minimally invasive procedure for the
treatment of high-risk symptomatic patients with severe
aortic stenosis using the Edwards SAPIEN transcatheter
heart valve. Among preventive strategies in high-risk
patients, a particular attention has been devoted to
contrast nephropathy using very effective prophylactic
treatments such as continuous veno-venous hemofiltration
(CVVH) and novel investigational devices. Other critical
collaborations continued for prevention, diagnosis and
treatment of patients with cardiovascular disorders and
for research purposes with the Cardiovascular Imaging
Area (MDCT, 3D-echo, TEE), the Intensive Cardiac Care
Unit, the Laboratory of Biology and Biochemistry of
Atherothrombosis and the Laboratory of Gene Therapy.
In addition to their clinical activity, many members of
our Units have university and institutional teaching
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Electrophysiology Area
Claudio TONDO, MD, Ph.D Area Coordinator
Electrophysiology Unit
Claudio TONDO, MD, Ph.D
Director
Corrado CARBUCICCHIO, MD, Ph.D
Director of Ventricular Intensive Unit
responsibilities involving mainly student and fellow
training, and are engaged in Continuing Medical Education
(CME) programs.
Publications
Silber S, Windecker S, Vranckx P, Serruys PW;
RESOLUTE All Comers investigators. Unrestricted
randomised use of two new generation drug-eluting
coronary stents: 2-year patient-related versus stentrelated outcomes from the RESOLUTE All Comers trial.
Lancet. 2011; 377(9773):1241-7
Serruys PW, Silber S, Garg S, van Geuns RJ, Richardt
G, Buszman PE, Kelbaek H, van Boven AJ, Hofma SH,
Linke A, Klauss V, Wijns W, Macaya C, Garot P, DiMario
C, Manoharan G, Kornowski R, Ischinger T, Bartorelli
A, Ronden J, Bressers M, Gobbens P, Negoita M, van
Leeuwen F, Windecker S. Comparison of zotarolimuseluting and everolimus-eluting coronary stents. N Engl J
Med. 2010; 363(2):136-46
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Marenzi G, Assanelli E, Campodonico J, De Metrio M, Lauri
G, Marana I, Moltrasio M, Rubino M, Veglia F, Montorsi P,
Bartorelli AL. Acute kidney injury in ST-segment elevation
acute myocardial infarction complicated by cardiogenic
shock at admission. Crit Care Med. 2010; 38(2):438-44.
Pontone G, Andreini D, Bartorelli AL, Cortinovis S,
Mushtaq S, Bertella E, Annoni A, Formenti A, Nobili E,
Trabattoni D, Montorsi P, Ballerini G, Agostoni P, Pepi M.
Diagnostic accuracy of coronary computed tomography
angiography: a comparison between prospective and
retrospective electrocardiogram triggering. J Am Coll
Cardiol. 2009; 54(4):346-55.
Marenzi G, Assanelli E, Campodonico J, Lauri G, Marana
I, De Metrio M, Moltrasio M, Grazi M, Rubino M, Veglia
F, Fabbiocchi F, Bartorelli AL. Contrast volume during
primary percutaneous coronary intervention and
subsequent contrast-induced nephropathy and mortality.
Ann Intern Med. 2009; 150(3):170-7.
STAFF Senior Deputy Director: Stefania Riva, MD
Deputy Directors: Antonio Dello Russo, MD, Ph.D,
Gaetano Fassini, MD
Senior Assistant: Michela Casella, MD, Ph.D
Assistants: Massimo Moltrasio, MD,
Fabrizio Tundo, MD, Ph.D
Fellows: Benedetta Majocchi, MD, Martina Zucchetti, MD,
Vittoria Marino, MD
Nurses: Luana Barbieri, Rosario Cervellione, Pasquale De
Iuliis, Roberta Fasana, Mario La Notte, Claudia Perlotti,
Maria Lena Ranghetti, Romina Ranzato, Alberto Somenzi,
Michela Vendramin
Secretaries: Viviana Biagioli, Tiziana Peroncini
Activities 2011. The clinical activity of the
Electrophysiology Area deals with electrophysiological
procedures and cardiac pacing.
Electrophysiological procedure. Almost every type
of arrhythmia is managed in the Electrophysiology
Area: supraventricular paroxysmal tachycardia, WolffParkinson-White syndrome, atrial tachycardia, atrial
flutter, atrial fibrillation, ventricular tachycardia and
ventricular premature beats. Treatment consists mostly
in radiofrequency catheter ablation of the arrhythmia
guided by conventional mapping or, more often, after 3D
reconstruction and substrate mapping. The efforts of the
Electrophysiology Area mostly converge on ablation of
atrial fibrillation and ventricular tachycardia.
Atrial fibrillation is the most common significant cardiac
arrhythmia, responsible for approximately one-third of
all hospital admissions of patients suffering from cardiac
rhythm disturbances. It is responsible for an increased
risk of stroke, heart failure and all-cause mortality. The
vast improvement over the last decade in the long term
efficacy of catheter ablation, compared to pharmacological
treatment, supports the use of ablation in the early
management of patients suffering from atrial fibrillation. In
the Electrophysiology Area catheter ablation is currently
performed for paroxysmal and persistent atrial fibrillation
(up to 300 per year). The procedure is usually guided by
3D electroanatomical mapping systems (Carto 3/NavX)
integrated by a previously acquired CT or MRI image
of the left atrium and/or intracardiac echocardiography
(CartoSound technology).
In the setting of atrial fibrillation, the Electrophyisology
Area is also equipped to perform transcatheter closure
of the left atrial appendage in order to reduce the
cardioembolic risk in those patients with persistent/
permanent atrial fibrillation who are not candidates for
warfarin therapy.
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Ventricular Tachycardia. Until recently, antiarrhythmic
drugs were the preferred treatment for most patients
with recurrent ventricular tachycardia, whatever the
underlying heart disease. However, the risk of sudden
cardiac death and recurrences remains high despite drug
therapy; alternative treatment options include surgical
ablation, implantation of a cardioverter-defibrillator
(ICD), and catheter ablation. Although ICDs prolong
survival, they do not prevent ventricular tachycardia
recurrences, thus being a merely palliative treatment.
Catheter ablation, on the contrary, is a potentially
curative approach, preventing ventricular tachycardia
recurrences in more than 70% of patients.
In the Electrophysiology Area catheter ablation of
ventricular tachycardia is often performed in the setting
of dilated cardiomyopathy, ischaemic cardiopathy,
arrhythmogenic right ventricular cardiomyopathy, or
in the context of an apparently normal heart, as it is
often the case with right and left ventricular outflow
tract tachycardia. Ablation is usually guided by 3D
electroanatomical mapping systems, including noncontact systems.
Moreover, the Electrophysiology Area includes a new
and unique service focused on critical ventricular
arrhythmias, called Ventricular Intensive Care (VIC).
It strives for a “global” treatment of patients with
ventricular arrhythmias responsible for critical
impairment of clinical conditions and/or for multiple ICD
interventions. The VIC unit aims at improving quality
of life and optimizing antiarrhythmic therapies by
integrating acute and long-term care provided by the
same team of operators.
The Electrophyisology Area is also equipped to perform
endomyocardial biopsies (EMB) to improve diagnostic
accuracy and prognostic correlations in the setting
of cardiomyopathy, arrhythmogenic right ventricular
dysplasia, myocarditis, cardiac tumors, arrhythmia, etc.
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The right internal jugular vein and the femoral vein are
the most common percutaneous access sites for right
ventricular EMB, which is usually performed safely
under fluoroscopic and intracardiac echo guidance.
Histological samples are also examined for genetic
mutations and for amplification of viral genomes. In
addition to its clinical uses, EMB may be a precious
instrument to better understand the cellular and
molecular pathophysiology of cardiovascular disease.
Cardiac pacing. The Electrophysiology Area performs
implantation and replacement of permanent pacemakers,
including both single-chamber and (more often)
dual-chamber devices. Each year approximately 200
implantable cardioverter-defibrillators (ICD) and/or
biventricular pacemakers (for cardiac resynchronization
therapy: CRT) are implanted, for the prevention of
sudden cardiac death and for improvement of heart
failure respectively, often in patients with severe left
ventricular dysfunction and/or malignant ventricular
arrhythmias. Over the last years, the technique of
catheter lead extraction with the use of Locking Stylets,
Telescoping Synthetic Sheaths, Electrosurgical Dissection
and Laser Extraction has been implemented to answer
the increased demand generated by lead damage or
device infection.
Publications
Santangeli P, Dello Russo A, Pieroni M, Casella M,
Di Biase L, Burkhardt JD, Sanchez J, Lakkireddy
D, Carbucicchio C, Zucchetti M, Pelargonio G,
Themistoclakis S, Camporeale A, Rossillo A, Beheiry
S, Hongo R, Bellocci F, Tondo C, Natale A. Fragmented
and delayed electrograms within fibrofatty scar predict
arrhythmic events in arrhythmogenic right ventricular
cardiomyopathy: Results from a prospective risk
stratification study. Heart Rhythm. 2012 (Epub ahead of
print)
Santangeli P, Pieroni M, Dello Russo A, Casella M,
Pelargonio G, Di Biase L, Macchione A, Burkhardt JD,
Bellocci F, Santarelli P, Tondo C, Natale A. Correlation
between Signal-Averaged Electrocardiogram and the
Histologic Evaluation of the Myocardial Substrate
in Right Ventricular Outflow Tract Arrhythmias. Circ
Arrhythm Electrophysiol. 2012 (Epub ahead of print)
Dello Russo A, Casella M, Pieroni M, Pelargonio G,
Bartoletti S, Santangeli P, Zucchetti M, Innocenti E, Di
Biase L, Carbucicchio C, Bellocci F, Fiorentini C, Natale
A, Tondo C. Drug-Refractory Ventricular Tachycardias
Following Myocarditis: Endocardial and Epicardial
Radiofrequency Catheter Ablation. Circ Arrhythm
Electrophysiol. 2012 (Epub ahead of print)
Casella M, Dello Russo A, Pelargonio G, Bongiorni MG,
Del Greco M, Piacenti M, Andreassi MG, Santangeli P,
Bartoletti S, Moltrasio M, Fassini G, Marini M, Di Cori
A, Di Biase L, Fiorentini C, Zecchi P, Natale A, Picano E,
Tondo C. Rationale and design of the NO-PARTY trial:
near-zero fluoroscopic exposure during catheter ablation
of supraventricular arrhythmias in young patients.
Cardiol Young. 2012;3:1-8.
Dukkipati SR, Neuzil P, Kautzner J, Petru J, Wichterle
D, Skoda J, Cihak R, Peichl P, Dello Russo A, Pelargonio
G, Tondo C, Natale A, Reddy VY. The durability of
pulmonary vein isolation using the visually guided laser
balloon catheter: multicenter results of pulmonary vein
remapping studies. Heart Rhythm. 2012 (Epub ahead of
print)
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