Arrhythmology and Electrophysiology

Policlinico San Donato

key figures

CLINICAL SERVICES:

  • Cardiac Ablation
  • Brugada Syndrome Treatment
    • Epicardial Ablation
    • Substrate Mapping
  • Heart Rhythm Management Devices Implantation
  • Cardiac Electrical Resynchronisation

PROCEDURES PERFORMED PER YEAR:

  • 1.406 Cardiac ablations 
  • 350 Epicardial Ablations for patients with Brugada syndrome
  • Heart Rhythm management devices and cardiac electrical resynchronisation:
    • 338 Pacemakers,
    • 511 Defibrillators

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

Ablation of congenital substrate supraventricular arrhythmias

The unit has the largest world experience in supraventricular arrhythmia ablation, with particular emphrasis on ablation of high risk atrio-ventricular accessory pathways.

The scientific publications of the unit have been instrumental in defining the international guidelines for the treatment of Wolff Parkinson White syndrome.

Main pathologies treated:

  • AV node reentrant tachycardia,
  • Wolff Parkinson White Syndrome,
  • Coumel Tachycardia,
  • Atrial flutter and Atrial tachycardia.

Ablation of ventricular tachycardia

The program of Ventricular tachycardia ablation is active in the treatment of all forms of ventricular tachycardia with a particular interest on the interventional treatment of high risk patients with hemodynamically unstable patients. The procedures are performed with both endocardial and percutaneous epicardial access using state of the art technologies and ECCMO support when needed.

Major pathologies treated:

  • Idiopathic ventricular tachycardia,
  • Ventricular tachycardia in ischemic heart disease,
  • Ventricular tachycardia in idiopathic dilated cardiomiopathyes.

Treatment of Brugada Syndrome

The unit has discovered the interventional treatment of Brugada syndrome, first describing the electrophysiological substrate of this disease and inventing the ablation procedure for eliminating the arrhythmogenic substrate responsible for the occurrence of cardiac arrest associated with it.

The unit has developed the technological tools for Brugada syndrome substrate mapping and ablation and has the largest world experience in the diagnosis, risk stratification and treatment of Brugada syndrome. This experience has produced ground-breaking scientific publications demonstrating, for the first time, that Brugada syndrome can be cured.

Main pathologies treated:

  • Brugada syndrome

Heart rhythm management devices and cardiac electrical resynchronization

The unit has a large experience in the implantation and follow up of cardiac pacemakers and implantable cardiac defibrillators with an implant rate of more than 1000 devices per year. The area of major expertise is that of cardiac resynchronization treatment of refractory heart failure in dilated cardiomyopathies in which the unit has developed new techniques for the optimization of the hemodynamic response to this therapy trough the technique of single electrode multisite pacing of the left ventricle. The unit has published the first evidence of the feasibility and superior clinical effects of multiple site left ventricular stimulation in major medical journals. The unit has also an active program for chronic malfunctioning and infected leads management using laser and mechanical extraction devices.

Main pathologies treated:

  • Bradycardia and atrioventricular conduction defects,
  • Aborted sudden death,
  • Prevention of arrhythmic sudden death,
  • Heart failure in idiopathic and ischemic cardiomyopathies,
  • Heart rhythm devices and leads malfunction and infection.
     

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

  • 3 state of the art cardiac catheterization laboratories.
  • 1 Stereotaxis Niobe II robotic navigation system
  • 1 hybrid room for combined interventional-surgical procedures
  • All labs equipped with state of the art computerized 3D navigation system
  • Rotational angiography in all cath labs
  • ECCMO system backup for procedures in hemodynamically unstable patients
  • Full audio-video setup in all laboratories for remote teaching
  • 30 seats meeting room fully connected to the cath labs for onsite teaching courses