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Electrical heart diseases: the new challenge in cardiology

Riccardo Proietti ( Luigi Sacco Hospital of Milan )

The distinction between heart attack and sudden cardiac death is not definite for the scientific community. The heart attack or myocardial infarction consists in the occlusion of a coronary artery which can determine ischemia and necrosis of the myocardial muscle. The evolution of heart attack is extremely variable from a totally asymptomatic one to sudden cardiac death. Due to the amazing development in the field of cardiovascular prevention and in the treatment of myocardial infarction, the heart attack is a manageable issue in clinical setting.

The sudden cardiac death (SCD) is a very tragic situation in which a previously asymptomatic individual suddenly collapses dead. For a cardiologist SCD usually implies a malignant ventricular arrhythmias (ventricular fibrillation or ventricular tachycardia) occurring with little or no warning.

In some cases the ventricular arrhythmias (VA) can result from ischemia during myocardial infarction or in the setting of a healed myocardial infarct with scar. Also a large number of non ischemic patients with a structural heart disease (dilated cardiomyopathy, right ventricular dysplasia and hypertrophic cardiomyopathy) can experience SCD.  Recently the occurrence of malignant VA has consistently been noticed in patients with a structurally normal heart but with an alteration in the ion channel of the myocytes  membrane  also named channelopathies (Brugada, short QT, long QT syndrome).

SCD represents a real challenge for the cardiology community. Currently non invasive tests are not able to predict the occurrence of VA. The therapeutic option available is  an implantable cardiac defibrillator. However only a limited number of  the large cohort of patients will utilize the device while a large number of patients who do not meet the implantation criteria will die of a sudden cardiac death. Recently, the development of a system able to delineate an electro-anatomical 3D map of heart chambers allows the percutaneous treatment of malignant VA  through  percutaneus radiofrequency catheter ablation. However, the outcome of the procedure is still not satisfactory. An integrated approach to the evaluation of the recorded intracardiac signal can provide insight in the pathogenesis of VA and provide new pathways for the prevention and treatment of SCD.

Speaker bio

Dr. Riccardo Proietti MD - PhD. degree in medicine (1997) at the Catholic University of Rome; - Residency in cardiology at University of Perugia 2002; - PhD in Cardiovascular Sciences 2008, University of Padua; - Master in Electrophysiology 2009, Hospital Agostino Gemelli, Catholic University of Rome; - Admitted to the medical profession in United States; - Since 2010, Consultant Cardiologist at Luigi Sacco Hospital of Milan with main activity in cardiac pacing and electrophysiology; - Next July, joining electrophysiology team of Montreal General Hospital, McGill University, Montreal, Canada; - Certified in transthoracic echocardiography by the Società Italiana di Ecografia Cardiovascolare (SIEC); - Author of articles in national and international peer-reviewed journals. Member of European Heart Rhythm Association (EHRA), National Cardiology Association (ANMCO) and Italian Society of Echocardiography (SIEC).

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