Electrophysyology Arythmology

Carlo Pappone

Years of experience: 25

Head of the Clinic Cardiology and Intensive Coronary Care Unit

CURRICULUM VITAE
POSITIONS COVERED:

  • Head of the Clinic Cardiology Operating Unit/ Unit of Intensive Coronary Care, second-level Professor of Cardiology at Università Vita-Salute San Raffaele of Milan (from 2012)
  • Head of Clinic Cardiology at the Cardiothoracic-Vascular Department of IRCCS Ospedale San Raffaele of Milan (from 2001)
  • Head of the Clinic Cardiology Operating Unit and Coronary Unit at the Cardiothoracic-Vascular Department of IRCCS Ospedale San Raffaele of Milan (1999-2001).

AFFILIATIONS:

  • From 2006 Member of the National Board of Directors of the Italian Accredited Hospital Cardiology Society (SICOA)
  • From 1990 Member of the European Society of Cardiology
  • Member of the National Association of Hospital Cardiology Physicians (ANMCO)
  • Member of the International Scientific Board – Journal of Cardiovascular Medicine.


EDUCATIONAL ACTIVITY:
From 2010 Professor of Cardiology at the Medicine and Surgery Degree Course and School of Specialization in Cardiology at Università Vita-Salute Ospedale San Raffaele.

DEPARTMENT OF CLINIC CARDIOLOGY
The Clinic Cardiology Operating Unit represents one of the centres of excellence, in the international arena, for the treatment of all main diseases affecting the cardiovascular system. It ensures assistance to both outpatients (Out Patients Clinic) and inpatients.

SURGERY

  • Coronarography and Coronary Angioplasty with stents (non-medicated, medicated and bio-resorbable)
  • Surgical procedures in congenital cardiopathies (DIA, DIV, PFO, pulmonary  valve stenosis)
  • Percutaneous repairing of the mitral failure (MitraClip) and TAVI
  • Sympathetic denervation procedures of renal arteries through percutaneous ablation
  • External electrical cardioversion
  • Implant of antitachycardia and antibradycardia devices
  • Diagnosis and treatment of cardiomyopathies.


CORONARY INTENSIVE CARE UNIT
The Coronary Intensive Care Operating Unit represents one of the centres of excellence, in the international arena, for the treatment:

  • Acute Coronary Syndromes (myocardial infarction and unstable angina), the treatment of which, beyond pharmacological antithrombotic  therapy, in the vast majority of patients, takes advantage of the emergency revascularization with coronary angioplasty and stent
  • Acute heart failure: acute pulmonary oedema; severe ventricular failure
  • Treatment of the acute phase of cardiac arrhythmias and heart blocks.


Furthermore, it is the coordination centre of multicentric studies, both pharmacological and physiopathological, diagnostic, and interventional in the field of acute coronary syndromes.
The department is composed of:

  • Intensive Care Zone
  • Sub-intensive Zone
  • Observation and Diagnostic Zone.


IN COOPERATION WITH THE HEMODYNAMIC LABORATORY
KEY FACTS & TECHNOLOGY

  • Stent
  • MitraClip
  • Denervation of Renal Arteries.


DIAGNOSTICS AND OUTPATIENT ACTIVITIES

  • Hypertensive cardiopathy
  • Cardiac insufficiency (heart failure)
  • Evaluation of the cardiologic intraoperative and postoperative risk, and cardiology preparation for surgical procedures
  • Pediatric Cardiology
  • Exercise test (exercise electrocardiogram)
  • Cardiology pre-operative evaluation. ECG execution and reporting
  • Cardiac rehabilitation.


FIGURES (Reference Year: 2014)

  • Coronarography: 650
  • Coronary angioplasties: 350
  • Intervention procedures in congenital heart diseases: 20
  • MitraClip: 70
  • External electrical cardioversions: 100
  • Pacemaker: 70
  • Defibrillators: 40
  • Electrocardiogram:  7700
  • Exercise testing: 2340
  • Transthoracic echocardiogram: 1200 – transesophageal, one-/ two-/ and three-dimensional, with continuous pulsed doppler study: 1000, and pediatric color doppler, prenatal and for adults: 1500
  • Prolonged dynamic electrocardiogram and 24h Holter electrocardiogram: 3000
  • 24h humeral blood pressure recording: 1400
  • Pulmonary function (spirometry): 240
  • Endomyocardial biopsy: 15.


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Paolo Della Bella

Years of experience: 38

Head physician, Director of the Arrythmology Unit and the Cardiac Electrophysiology Laboratories

CURRICULUM VITAE

He is one of the leading experts in pathophysiology and the treatment of heart rhythm disorders with over 15,000 operations performed (ablation of atrial fibrillation, paroxysmal supraventricular tachycardia, ventricular tachycardia, implantation of pacemakers and defibrillators).
Particularly active in the treatment of ventricular arrhythmia.
He designed and implemented the multidisciplinary treatment of patients with ventricular tachycardia within a dedicated Unit, demonstrating an increase in survival of the patients treated.

He has the most experience in Italy and one of the most in Europe in the transcatheter ablation of ventricular tachycardia with over 1000 patients subjected to ablation.
Since 2015 he has been a member of the Editorial Board of Circulation Arrhythmia and Electrophysiology.
Since 2013 he has been an untenured lecturer on the Degree course in Medicine: International MD Program Degree course in Medicine “Cardiovascular diseases” at the Faculty of Medicine of the Vita Salute San Raffaele University.
Since 1994 he has been an untenured professor at the School of Specialization in Cardiology of the University of Milan.

DEPARTMENT
The Arrhythmology and Cardiac Electrophysiology Unit is one of the centres of excellence on the international scene for the treatment of heart arrhythmia.
The department consists of:

  • 34 beds
  • 3 Electrophysiology laboratories
  • 4 outpatient rooms.


OPERATIONS

  • Intracavitary electrophysiological study
  • Transcatheter radiofrequency ablation of heart arrhythmia
  • Implantation of Pacemakers (PM)
  • Implantation of defibrillators (ICD)
  • Implantation of cardiac resynchronization therapy (CRT) systems for the treatment of cardiac decompensation
  • Percutaneous left atrial appendage occlusion
  • Transvenous removal of electrocatheters:
     
    • Pacemakers: 530 / year
    • Defibrillators: 320 / year
    • Ablations: 900/ year.


OUTPATIENT DIAGNOSTICS AND ACTIVITIES

  • Transthoracic and transesophageal echocardiography
  • 24-hour Holter monitor
  • Standard 12-lead ECG
  • Dedicated programmers for the monitoring and interrogation of pacemakers and defibrillators
  • Exercise testing (cycloergometer and treadmill)
  • Head Up Tilt Test.


KEY FACTS & TECHNOLOGY

  • CARTO3 electroanatomical mapping system
  • En-Site Velocity mapping system
  • Rhythmia navigation system
  • Use of pressure guides for the Dt/Dp study during the implantation of CRT-D
  • Implantation of leadless pacemakers.


CHARACTERISTICS OF THE LABORATORIES

  • Ergonomics
  • Simplification of the operator interface
  • Rationalization of the patient interface
  • Audio-video connectivity
  • Full integration with the patient database
  • Multiplied cables and connecting spaces
  • Full integration of the laboratory with the remote monitoring systems.


TEACHING

  • Post-specialization training courses for Italian and foreign fellows
  • EHRA centre for the fellowship in CRT-D systems and transcatheter ablation
  • International EBAC-accredited theoretical and practical courses on the transcatheter ablation of ventricular tachycardia for cardiac electrophysiologists
  • Theoretical and practical courses on the percutaneous left atrial appendage occlusion procedure for cardiac electrophysiologists
  • Theoretical Arrhythmology lessons on the Degree course in Medicine at the Faculty of Medicine
  • Theoretical and practical Arrhythmology lessons on the course of specialization in Cardiovascular disease .


RESEARCH
The research activity is centred on the following lines:

  • Ventricular tachycardia
  • Atrial fibrillation
  • Genetics of hereditary arrhythmia
  • Paediatric Arrhythmology programme on transcatheter ablation as a treatment for paediatric arrhythmia
  • European electrocatheter removal register
  • Multicentre, prospective studies on percutaneous left atrial appendage closure (TRAPS trial, EVOLUTION European Registry)
  • Randomized prospective studies on the use of pressure as a guide to optimum implantation of CRT-D (Radi-CRT Study)
  • Implantation of leadless pacemakers.


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