Arrhythmology and Electrophysiology

Ospedale San Raffaele

key figures

  • 5.000 outpatient services
  • 2.000 electrophysiological procedures  

The Arrhythmology and Electrophysiology Unit is one of the centers of excellence in the international scene for the treatment of all types of cardiac arrhythmias. Carlo Pappone, the head physician, and his team are considered pioneers in the treatment of atrial fibrillation and supraventricular arrhythmias. It is precisely the treatment of supraventricular arrhythmias that constitutes the strong point of this group as demonstrated by the many publications in international journals of high scientific caliber and supported by the large population of patients already undergoing interventional procedures of transcatheter ablation.

 

treatments

  • Electrophysiological Study 
  • Ablation of Supraventricular Arrhythmias 
  • Ablation of Atrial Fibrillation 
  • Ablation of Ventricular Tachycardia
  • Pacemaker Implantation 
  • Implantable Defibrillator and CRT Implantation 
  • Loop Recorder implantation 
  • Left Appendage Percutaneous Closure 
  • Device Lead Extraction 
  • Endomyocardial Biopsy 

The San Raffaele’s Arrhythmology and Electrophysiology Unit is one of the Centers of excellence in the national and international scene for the treatment of cardiac arrhythmias, with over 5.000 outpatient services, and 2.000 electrophysiological procedures performed per year. It is one of the most experienced departments in Italy for catheter ablation of arrhythmias, an effective treatment for which the Unit is also recognized as one of the best centers in Europe.

Ventricular tachycardia

The main field of interest of the Arrhythmology and Electrophysiology Unit is the treatment of Ventricular Tachycardia (VTs), with a dedicated division focused on the management of patients with multiple ICD shocks and electrical storm.

In the Unit, a multidisciplinary model is applied; it is characterized by the cooperation with the Anesthesiology team, providing an increase in survival rates of the patients treated.

Whenever indicated (non-tolerant VTs), an ablation procedure under mechanical support (ECMO) can be performed. Patients affected by non-ischemic cardiomyopathy, in the presence of a documented arrhythmia, are treated with an endo-epicardial approach, determining the best arrhythmia-free survival.

The Arrhythmology and Electrophysiology Unit, chaired by Dr. Paolo Della Bella is a high-volume reference Centre for the ablation of Ventricular Tachycardia and the management of Electrical Storms.

Main Pathologies Treated:

  • Ventricular Tachycardia
  • NonIschemic Cardiomyopathy

Top procedures: 

  • Ablation of Ventricular Arrhythmias
  • Defibrillator Implant
  • Cardiac Mapping
  • Electrophysiological Study
  • Endomyocardial biopsy

Atrial arrhythmias

Atrial fibrillation is a very common arrhythmia, in young patients it might lead to severe impacts on the quality of life, starting as paroxysmal, and gradually becoming persistent or permanent. In the Arrhythmology and Electrophysiology Unit at Ospedale San Raffaele, a comprehensive approach to atrial arrhythmias is applied, making it a reference Centre for this kind of treatment in Italy. Depending on the stage of the natural history of this disease, a percutaneous approach of ablation (in the paroxysmal ones), or a hybrid surgical-percutaneous ablation (in the persistent-permanent ones), can be performed.

In case of contraindication to anticoagulant therapy in patients affected by atrial fibrillation, percutaneous closure of left appendage is a treatment option to safely withdraw anticoagulant therapy.

Main pathologies treated:

  • Atrial fibrillation
  • Atrial tachycardia

Top Procedures:

  • Catheter ablation of Atrial Fibrillation
  • Atrial Tachycardia mapping and ablation
  • Hybrid surgicalpercutaneous ablation
  • Left atrial appendage percutaneous closures

Cardiac devices implantation

The Unit performs implantations of conventional and leadless pacemakers. Defibrillators are implanted in the cases of primary and secondary prevention. In patients affected by heart failure, Cardiac Resynchronization Therapy (CRT) is performed very accurately, aiming to improve the cardiac systolic function.  Loop recorders are implanted in case of need for prolonged rhythm monitoring (syncope, cryptogenic stroke, suspected atrial fibrillation) with a minimally invasive procedure.

Main Pathologies Treated:

  • Cardiac Arrest
  • Brady arrhythmias
  • Nontolerated VTs
  • Heart failure
  • Syncope

Top Procedures:

  • Pacemakers and defibrillators Implant
  • Cardiac Resynchronization Therapy

Cardiac devices and leads extraction

In case of infected and malfunctioning cardiac devices, lead extraction is a treatment option. The San Raffaele Arrhythmology and Electrophysiology Unit is a referral Centre for complex lead extractions with many years of experience.

Top Procedures:

  • Extraction of cardiac devices

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

  • X-ray fluoroscopic system
  • Intracardiac electrograms recording system
  • Non-fluoroscopic intracardiac high density mapping systems with the possibility of CT scans merging
  • Biosense Carto Univu module
  • Abbott Navx Precision
  • Boston Rhythmia
  • Availability of mechanical cardiac (ECMO) and respiratory support if needed
  • Echocardiography (transthoracic and transesophageal)