[Artificial intelligence applied to the electrocardiogram.] / L'intelligenza artificiale applicata all'elettrocardiogramma.

Artificial intelligence is able to read and interpret Ecg traces quickly and precisely, increasing the diagnostic capacity and offering the possibility of anticipating preventive therapies. However, there is no evidence on the clinical utility and cost-effectiveness of certain practical applications. In fact, the literature shows the prognostic importance in favor of prevention, but clear evidence is not available that correcting strokes, embolisms, heart failure early improves quality and life span of patients.

[e-Health, telemedicine and applications in cardiology: state of the art in Italy and experience of the cardiology unit of the G.B. Grassi Hospital of Rome]. / e-Health, telemedicina e applicazioni in Cardiologia: stato dell'arte in Italia ed esperienza dell'U.O.C. di Cardiologia dell'Ospedale G.B. Grassi di Roma.

e-Health (electronic health) refers to the use of information and communication technologies (ICT) to promote organizational change and facilitate new healthcare skills. In the last few years, several telemedicine services using ICT have been launched and the updating of related regulations has started, also for the increase in demand for services, their complexity and the need to offer adequate care to the patient. In cardiology, the experiences concern mainly patients suffering from heart failure or the carriers of cardiac implantable electronic devices (CIEDs), and few experiences are described in ischemic heart disease. In this article we present the design, the implementation and the results of the telemedicine service at the Cardiology Unit of the G.B. Grassi Hospital in Rome, concerning follow-up televisits for patients with heart failure, ischemic heart disease and for management of treatment plans, telemonitoring and telecontrol of CIEDs carriers and teleconsultation in ischemic heart disease. The considerations of this review, the experiences reported and the speed of digital evolution make the implementation of existing practices and the redesign of new pathways necessary.

Pacemaker malfunctions in Danon's disease.

We describe a case of a 30-year-old man with Danon's disease, an X-linked genetic disorder due to deficiency of lysosomal-associated membrane protein 2 with secondary intracytoplasmatic glycogen and autophagic material storage. This disease is characterized by skeletal muscle involvement, mental retardation, ophthalmic abnormalities, and cardiac disease. In this patient, cardiac involvement was characterized by hypertrophic cardiomyopathy in young age, preexcitation, and parossistic atrioventricular block. The patient underwent to an implantable cardioverter defibrillator implantation for conduction disorders and for primary prevention of sudden death, a frequent event in Danon's disease. This case report describes cardiac involvement with conduction disorders and multiple pacemaker malfunctions in Danon's disease.

Common atrial flutter and atrial fibrillation are not always two stages of the same disease. A long-term follow-up study in patients with atrial flutter treated with cavo-tricuspid isthmus ablation.

OBJECTIVE: Both atrial flutter and atrial fibrillation (AF) frequently develop in the same patient. There is therefore reasonable doubt that flutter ablation may not solve the clinical problem, owing to the occurrence/recurrence of AF. The aim of this study was to establish whether cavo-tricuspid isthmus ablation is curative in patients with common atrial flutter alone or combined with AF. METHODS: One hundred and forty-one patients (114 male, 27 female, mean age 63 +/- 10 years) who had cavo-tricuspid isthmus ablation were followed up for 44 +/- 20 months. Before ablation, 48 patients had only atrial flutter (group A), whereas 93 patients had both atrial flutter and AF. Among the latter, during antiarrhythmic therapy, 31 patients had only atrial flutter (group B1), whereas 62 patients (group B2) continued to experience both arrhythmias. RESULTS: During follow-up, 27% of group A and 61% of group B patients had documented recurrent AF (P < 0.001). AF recurred in 51% of group B1 and in 66% of group B2 patients (P = NS). Permanent AF occurred in 6% of group A, 3% of group B1 and 21% of group B2 (P < 0.01). Specific symptom scale scores significantly decreased in all groups, particularly in group A. Two patients of group B had cerebral ischaemic attacks. CONCLUSIONS: Over a long-term follow-up, cavo-tricuspid isthmus ablation is curative in >70% of patients with atrial flutter alone. Therefore, if no AF is documented, more extensive ablation is not needed. By contrast, cavo-tricuspid isthmus ablation is frequently unable to prevent AF in patients with both atrial flutter and AF, although in some cases a significant clinical benefit may be obtained.

Brugada-like electrocardiogram pattern: how to stratify the risk for sudden cardiac death. Is sports activity contraindicated?

Brugada syndrome is associated with a considerable risk of sudden death in young and otherwise healthy adults. The syndrome is estimated to be responsible for at least 4% of all sudden deaths and at least 20% of sudden deaths in patients with structurally normal hearts. The diagnosis of Brugada syndrome is based on peculiar electrocardiogram (ECG) abnormalities classified by the European Society of Cardiology in three types: type 1 (coved-type) is the diagnostic pattern; type 2 (saddle-back type); and type 3 are considered significant if there is a conversion to a type 1, spontaneously or during administration of class I A/C anti-arrhythmic drugs (flecainide, etc.). There is a general agreement about the high risk of sudden death in patients with previous cardiac arrest, for whom an implantable defibrillator (ICD) is recommended. In contrast, controversy exists on the correct clinical behaviour in individuals without a history of previous cardiac arrest. To stratify the risk in patients with type 1 pattern, three major factors have been suggested: typical ECG pattern in the basal state; a history of syncope; and inducible ventricular tachycardia/ventricular fibrillation during electrophysiological study (EPS). However, the indication and usefulness of an EPS is debatable. In patients with a type 2 or 3 pattern a pharmacological test is indicated in the presence of symptoms or of a familial history. With regard to sports eligibility, patients with a history of cardiac arrest should have an ICD and they can practise (low intensity) sport only after the implant of the device. Patients without documented cardiac arrest but at high risk (basal type 1 ECG pattern, syncope and/or positive EPS) should also have an ICD and they can practise (low intensity) sport only after the implant of the device. In patients at low risk (type 1 ECG pattern in the absence of symptoms, without family history and negative EPS) the behaviour regarding sport eligibility is not a matter of debate. In cases with type 2 or 3 pattern, in the absence of familial history and symptoms, a permissive behaviour should be assumed.

Ablation of a single pulmonary vein arrhythmic focus triggering several supraventricular arrhythmias.

Pulmonary veins are a well-recognized source of focal ectopies that may trigger atrial fibrillation. Many ablative strategies, in particular ablation of the four pulmonary vein ostia, have been developed in order to cure atrial fibrillation. In some patients, the predominant arrhythmia may be an ectopic atrial tachycardia arising from a pulmonary vein and atrial fibrillation may be only a consequence of rapid atrial activation. There is a paucity of data regarding the electrocardiographic and electrophysiological characteristics of pulmonary vein tachycardia and the ablation strategy of this arrhythmia. In the present paper, we describe a case of a young woman with an arrhythmic focus localized in the right superior pulmonary vein with episodes of atrial tachycardia, paroxysmal atrial fibrillation and atrial flutter, who was successfully treated with transcatheter ablation.