Giornale italiano di cardiologia最新文献

{"title":"[Management of oral anticoagulant therapy after catheter ablation of atrial fibrillation].","authors":"Giuseppe Boriani, Paola Trapanese, Marta Mantovani, Enrico Tartaglia, Manuela Orlandi, Niccolò Bonini, Jacopo F Imberti, Marco Vitolo, Davide A Mei","doi":"10.1714/4741.47565","DOIUrl":"10.1714/4741.47565","url":null,"abstract":"<p><p>In recent years, catheter ablation for atrial fibrillation (AF), particularly pulmonary vein isolation, has become an increasingly used and evidence-based treatment aimed primarily at improving symptoms and quality of life. In this context, the management of oral anticoagulation (OAC) after the procedure has become a major topic of discussion within the scientific community. Current guidelines recommend continuing OAC based on the thromboembolic risk profile assessed by the CHA2DS2-VA score, regardless of the apparent success of the ablation. However, in recent years several research groups have explored the possibility of discontinuing anticoagulation after successful ablation in patients without documented arrhythmia recurrence. In particular, two recent randomized trials, ALONE-AF and OCEAN, have investigated strategies of anticoagulation discontinuation or de-escalation in the post-ablation setting, contributing to renewed debate regarding the necessity of long-term anticoagulation in selected patients. In parallel, the OPTION trial evaluated an alternative strategy based on left atrial appendage occlusion as a means to avoid long-term anticoagulant therapy. The aim of this review is to summarize and critically discuss the most recent evidence regarding antithrombotic management after AF ablation, focusing on clinical implications, methodological limitations, and potential future directions toward more individualized therapeutic strategies.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 8","pages":"544-550"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148601230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Mechanical circulatory support with ventricular assist devices in cardiogenic shock: 10-year results from an Italian center].","authors":"Marco Marini, Valentina Tozzetti, Luca Angelini, Ilaria Battistoni, Matteo Francioni, Maria Vittoria Matassini, Cristian Mattei, Elisa Nicolini, Giulia Pongetti, Matilda Shkoza, Tommaso Piva","doi":"10.1714/4741.47566","DOIUrl":"10.1714/4741.47566","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock is a critical condition with a short-term mortality rate of around 40-50%, which has remained unchanged over the years despite therapeutic advances in acute cardiac diseases. In this context, the use of microaxial flow pumps is increasing and in the DanGer Shock trial it reduced the 6-month mortality in patients with cardiogenic shock due to acute myocardial infarction compared to standard therapy. The aim of this study was to evaluate how the use of microaxial flow pump in our population of patients with cardiogenic shock impacted survival and short- and mid-term outcomes.</p><p><strong>Methods: </strong>We retrospectively collected data from 78 patients with cardiogenic shock treated with microaxial flow pump and admitted to the Cardiac Intensive Care Unit of Ospedali Riuniti of Ancona, Italy, between April 2014 and December 2024. The primary end-point was the assessment of independent predictors of in-hospital mortality, while the secondary end-point was a composite end-point (all-cause death, rehospitalization for heart failure, acute coronary syndrome, arrhythmias, heart transplantation, or ventricular assist device implantation at 12-month follow-up).</p><p><strong>Results: </strong>Mean age of the population was 59.3 years, predominantly of male sex. The mean left ventricular ejection fraction at admission was 24.2%, mean serum lactate level at admission was 5.8 mmol/l. In 17 patients, Impella mechanical circulatory support represented an escalation therapy from intra-aortic balloon pump. In-hospital mortality was 32.1%, and variables such as age, left ventricular ejection fraction at intensive care unit admission, and the presence of right ventricular dysfunction were associated with higher in-hospital mortality. The secondary end-point occurred in 7 patients (8.9%): 3 patients died and 4 patients were rehospitalized for cardiovascular causes within 12 months after discharge.</p><p><strong>Conclusions: </strong>Impella circulatory support is a device capable of \"resting\" the ventricular myocardium while ensuring adequate cardiac output. In our observational evaluation, the use of Impella was associated with a reduction in in-hospital mortality. However, optimal timing of implantation remains to be clarified to maximize its benefit and avoid futile use.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 8","pages":"551-558"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148601374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Cardiac arrest due to fever-induced ventricular fibrillation in a 73-year-old patient with hidden Brugada syndrome: an exceptional case of late onset].","authors":"Natale Di Belardino, Rosaria Di Nuzzo, Alfredo Scorza, Marco Pafi","doi":"10.1714/4705.47204","DOIUrl":"10.1714/4705.47204","url":null,"abstract":"<p><p>Brugada syndrome is an inherited cardiac channelopathy associated with sudden cardiac death, typically diagnosed in middle-aged individuals. Fever is a well-known trigger for malignant ventricular arrhythmias in predisposed patients. We report the case of a 73-year-old man without cardiovascular risk factors or previous syncope who experienced ventricular fibrillation-related cardiac arrest triggered by fever as the first clinical manifestation of Brugada syndrome. This case highlights the pivotal role of fever in unmasking high-risk ECG patterns and challenges the assumption of age-related protection.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 6 Suppl. 1","pages":"5S-7S"},"PeriodicalIF":1.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148029171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Leadless pacemaker implantation in an adult patient with surgically repaired tetralogy of Fallot].","authors":"Paolo Bonfanti, Sara Elena Di Martino, Antonio Mantovani, Nicola Berlinghieri, Andrea Pozzi, Camilla Pini, Giovanni Corrado, Roberto De Ponti","doi":"10.1714/4705.47203","DOIUrl":"10.1714/4705.47203","url":null,"abstract":"<p><p>We report the case of a 47-year-old male patient with a history of tetralogy of Fallot surgically corrected in childhood using the Waterston-Cooley and Cooley techniques. In adulthood, he developed severe pulmonary insufficiency, treated percutaneously with the implantation of a bioprosthetic valve. The patient was admitted for an elective surgery procedure. Following the administration of spinal anesthesia, ECG monitoring revealed the onset of atrioventricular block progressing to asystole, requiring immediate external cardiac massage. During the subsequent period, the patient also experienced a 5 s third-degree atrioventricular block associated with dizziness following carotid sinus massage. After multidisciplinary evaluation, the decision was made to implant a leadless pacemaker (Abbott Aveir VR). The procedure presented technical challenges, primarily due to the altered cardiac anatomy resulting from the underlying congenital heart disease and previous surgical corrections. Despite these difficulties, successful implantation was achieved. To our knowledge, this represents one of the few reported cases in the literature of leadless pacemaker implantation in a patient with corrected congenital heart disease. Given the absence of standardized procedural guidelines for such complex cases, we present our experience and discuss the associated technical considerations.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 6 Suppl. 1","pages":"2S-4S"},"PeriodicalIF":1.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148029098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Which antiplatelet therapy and how long in the first year after an acute coronary syndrome?]","authors":"Luigi Oltrona Visconti, Antonio Landi, Marco Ferlini, Stefano De Servi","doi":"10.1714/4704.47191","DOIUrl":"10.1714/4704.47191","url":null,"abstract":"<p><p>Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is considered the cornerstone of pharmacological treatment after acute coronary syndrome in order to avoid recurrent ischemic episodes. Since 2002, guidelines from scientific societies strongly recommend maintenance of two drugs for 12 months. Given that bleeding events have a similar or even worse impact on mortality than recurrent myocardial infarction, in the last years several trials have challenged guideline-recommended dual antiplatelet therapy duration after percutaneous coronary intervention by testing the clinical effect of P2Y12 inhibitor reduction and de-escalation or, in particular, maintenance of only P2Y12 inhibitor monotherapy. We provide a literature overview on aspirin-free antiplatelet strategies in light of the results of recent studies in patients with acute coronary syndrome undergoing percutaneous coronary intervention.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 6","pages":"406-415"},"PeriodicalIF":1.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148029175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Incidental diagnosis of cor triatriatum sinister in a young woman].","authors":"Rita Cristina Myriam Intravaia, Michele Massimo Gulizia","doi":"10.1714/4705.47206","DOIUrl":"10.1714/4705.47206","url":null,"abstract":"<p><p>Cor triatriatum sinister (CTS) is a rare congenital heart defect, with an estimated incidence of 0.1-0.4% of all congenital heart defects, characterized by the presence of a fibromuscular septum that divides the left atrium into two chambers. We report the case of a 37-year-old woman with an incidental diagnosis of CTS during hospitalization for chest pain. Transthoracic echocardiography revealed a left intra-atrial membrane without hemodynamic significance, subsequently better characterized by transesophageal echocardiography, which ruled out the presence of a significant gradient and associated cardiac anomalies, including atrial septal defects. The patient was classified in Loeffler group III due to the presence of extensive patency of the membrane associated with a non-significant transmembrane gradient. In the absence of hemodynamically significant obstruction and associated congenital heart disease, the natural history is generally favorable. In asymptomatic patients, a conservative approach is adopted, involving clinical and instrumental follow-up and control of risk factors. However, in light of the risk of atrial fibrillation and cardioembolic events, long-term arrhythmia monitoring is indicated. This case highlights the role of echocardiographic imaging in the diagnosis and risk stratification of CTS in adults.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 6 Suppl. 1","pages":"12S-14S"},"PeriodicalIF":1.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148029082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The evolution of robotic cardiac surgery: state of the art and future perspectives].","authors":"Laura Giroletti, Ascanio Graniero, Piersilvio Gerometta, Alfonso Agnino","doi":"10.1714/4704.47192","DOIUrl":"10.1714/4704.47192","url":null,"abstract":"<p><p>In recent decades, there has been a growing interest in applying robotic technology to cardiac surgery. The advantages of robotic technology, such as magnified vision, precise robotic instruments and 360° movement of robotic arms, have attracted the cardiac community to reduce the invasiveness of the procedure, postoperative risks, and improve clinical outcomes. While in the United States the adoption of robotic assistance immediately gained widespread acceptance (approximately 1900 cases per year), in Europe the beginning has been slower with a significant growth in the last 10 years. The robotic platform has been used for various procedures, including mitral valve repair and replacement, coronary artery bypass grafting, arrhythmia ablation, aortic valve surgery, and tricuspid valve surgery. Intraoperative and postoperative results are encouraging showing good safety, a low mortality rate, a low conversion rate to larger incisions, shorter hospital stays compared to other techniques, and low postoperative complication rates. The procedure has also been effective, yielding good surgical quality and patient satisfaction. In this review, we analyze the current state of robotic cardiac surgery in the ever-evolving field of personalized cardiac surgery for each patient.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 6","pages":"416-425"},"PeriodicalIF":1.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148029122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Gender bias and artificial intelligence in cardiology: evidence, clinical implications, and future perspectives].","authors":"Maria Teresa Manes, Giuseppe Ciliberti, Antonia Mannarini, Daniela Pavan, Stefania Angela Di Fusco, Georgette Khoury, Daniela Aschieri, Beatrice Scardovi, Noemi Bruno, Sara Cocozza, Giovanna Geraci, Michele Massimo Gulizia, Domenico Gabrielli, Furio Colivicchi, Massimo Grimaldi","doi":"10.1714/4704.47190","DOIUrl":"10.1714/4704.47190","url":null,"abstract":"<p><p>Artificial intelligence is increasingly used in cardiovascular medicine, with applications in diagnosis, risk prediction, and clinical decision-making. However, emerging evidence suggests that these tools may exhibit differences in performance between men and women, with the potential to amplify existing disparities in cardiovascular care. This narrative review examines the role of sex and gender in artificial intelligence models applied to cardiology, focusing on the main areas of application, including electrocardiography, cardiovascular imaging, risk prediction, and clinical decision support systems. In many settings, models demonstrate good overall performance; however, stratified analyses reveal reduced sensitivity and higher rates of false-negative results in women. These differences may lead to underdiagnosis, delayed treatment, and inadequate risk stratification. Major contributing factors include the underrepresentation of women in training datasets, the lack of sex-specific variables, and the use of non-sex-specific diagnostic criteria. A systematic evaluation of model performance across subgroups, together with the integration of sex- and gender-specific variables, is essential to ensure a more equitable and clinically appropriate use of artificial intelligence in cardiovascular practice.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 6","pages":"398-405"},"PeriodicalIF":1.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148029047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[SICOA-GISE Consensus document on carotid atherosclerotic disease: from increased intima-media thickness to stenosis. Diagnostic and therapeutic management].","authors":"Mario De Michele, Francesco Saia, Giovanni Esposito, Luigi Argenziano, Alfredo Marchese, Stefano Nardi, Tiziana Attisano, Vittoria Marino, Massimo Fineschi, Carlo Tedeschi, Lucio Addeo, Milena Sidiropulos, Carmine Musto, Salvatore Giordano, Pasquale Campana, Federico De Marco, Angelo Silverio, Vincenzo Tuccillo, Marco Contarini, Salvatore Severino, Simona Pierini, Roberto Franco Enrico Pedretti, Antonio Di Lascio, Damiano Regazzoli, Simona Mariani, Simona Leone, Fausto Castriota, Eugenio Stabile, Pasquale Guarini, Laura Adelaide Dalla Vecchia","doi":"10.1714/4704.47195","DOIUrl":"10.1714/4704.47195","url":null,"abstract":"<p><p>Carotid atherosclerotic disease represents one of the leading causes of ischemic stroke. It should be considered as a pathological continuum that includes increased intima-media thickness, development of atherosclerotic plaque and progression to clinically significant carotid stenosis. Non-invasive imaging techniques currently allow accurate characterization of carotid plaque in terms of composition, echogenicity, echostructure, presence of intraplaque hemorrhage, ulceration and vascular remodeling, all factors closely associated with plaque instability and the risk of ischemic events. At the same time, advances in medical therapy and revascularization techniques have improved clinical outcomes but have also increased the complexity of therapeutic decision-making in individual patients, requiring the integration of clinical, anatomical, hemodynamic and imaging data. Despite the availability of international guidelines, areas of uncertainty and significant heterogeneity remain in clinical practice, terminology, risk stratification criteria and indications for revascularization, particularly in asymptomatic patients or those with intermediate-grade stenosis. The aim of the present SICOA-GISE consensus document is to harmonize terminology between the different disciplines involved (cardiology, neurology, radiology and vascular surgery), promote a multidisciplinary approach and provide practical guidance on the appropriate use of imaging techniques, identification of high-risk carotid plaque and integration of medical and interventional therapy.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 6","pages":"437-447"},"PeriodicalIF":0.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148029127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Ventricular tachycardia and left bundle branch block after transcatheter aortic valve implantation: is the valve guilty forever or not?]","authors":"Giulia Bugani, Francesco Pergolini, Cristina Rizza, Valeria Carinci, Giampiero Nobile, Mauro Colletta, Gaetano Barbato, Gianni Casella","doi":"10.1714/4705.47205","DOIUrl":"10.1714/4705.47205","url":null,"abstract":"<p><p>New-onset left bundle branch block (LBBB) following transcatheter aortic valve implantation (TAVI) is a common conduction disorder, sometimes transient. Conversely, the development of sustained ventricular tachycardia (VT) after TAVI is rare and its management is challenging. We report the case of a female patient with aortic stenosis treated with transcatheter self-expandable aortic valve implantation, who developed new-onset LBBB post-procedure. Several days later, the patient experienced hemodynamically tolerated slow VT with a right bundle branch morphology. She underwent an electrophysiological study, but slow VT was only transiently interrupted. Due to the persistence of slow VT, the patient was discharged with an external loop recorder, which revealed spontaneous resolution of VT and regression of LBBB after a few days.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 6 Suppl. 1","pages":"8S-11S"},"PeriodicalIF":1.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148029123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}