Cardiac electrophysiologist, Niguarda Hospital, Milan. Crypto Enthusiast - Ham radio (IZ2JOJ) and RC model fan
Milano, Lombardia
Joined September 2009
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Antonio Frontera retweeted
Very interesting study; how to do anatomical approach abl. in LVS PVC’s! #Epeeps
This #JACCCEP study suggests that endocardial radiofrequency catheter ablation of LVS VAs through an anatomical approach should first target the endocardial earliest activation site (EAS) rather than sites anatomically closest to the epicardial EAS. jacc.org/doi/10.1016/j.jacep…
Antonio Frontera retweeted
⚡ #EHRATopicWeek on Atrial Tachycardias
Catheter ablation has become the preferred treatment strategy for most symptomatic or recurrent ATs, while antiarrhythmic drug therapy often shows limited long-term efficacy.
📌 Key concepts from the latest evidence:
• Beta-blockers and calcium channel blockers remain important for rate control
• Catheter ablation is now first-line in many patients
• High-resolution electroanatomical mapping has transformed our understanding of AT circuits
• Entrainment and activation mapping remain essential tools for distinguishing focal vs reentrant mechanisms
• Pulsed-field ablation and ultra-high-resolution mapping are opening a new era in AT treatment
💡 Success in AT ablation depends on identifying the “critical isthmus” — the key region maintaining the arrhythmia — while durable bidirectional block is increasingly recognized as a crucial procedural endpoint.
Importantly, recurrence remains a major challenge, especially in patients with structural heart disease, prior AF ablation, or extensive atrial scarring
Find out more in the #EHRA_ESC Consensus document on Atrial Tachycardias 👉bit.ly/4wk5sBn
@escardio @EuropaceEiC
Antonio Frontera retweeted
🔍 #EHRATopicWeek on Atrial Tachycardias
Atrial Tachycardia is more complex than we once thought
Traditionally, rapid regular atrial arrhythmias were divided into “atrial tachycardia” and “atrial flutter” based mainly on ECG appearance. Today, high-resolution mapping shows these distinctions are often oversimplified.
📌 Current concepts classify all regular atrial rhythms >100 bpm as AT:
• Non-reentrant AT
• Reentrant AT (localized or macro-reentrant)
Importantly, many arrhythmias previously labeled as “flutter” may actually represent different AT mechanisms.
⚡ Differentiating AT from organized AF can be challenging, especially in scarred atria or after ablation. ECGs, EP studies, intracardiac mapping, and even wearable devices all play an important role in diagnosis.
💡 Precise classification matters — for diagnosis, treatment strategy, and improving ablation outcomes.
Find out more in the #EHRA_ESC Consensus document on Management of patients with atrial tachycardia 🔗bit.ly/4wk5sBn
@escardio @EuropaceEiC
Antonio Frontera retweeted
In the latest #ESC_EHRA Podcast, I discuss w/ @sozi81 & @simovicst on the substrate, mechanisms & strategies for redo #Afib ablation procedures💥
👉🎙️tinyurl.com/5n9y54nu
Key readings:
📘tinyurl.com/m5cv9whn
📘tinyurl.com/ym566dd6
Thrilled as author! EHRA Consensus on Atrial Tachycardia mgmt published in EP Europace. Collab w/ HRS, APHRS, LAHRS, AEPC: new AT classification, updated strategies, anticoagulation & ablation guidance. Game-changer for pts! 🔗 lnkd.in/geF-Ra7f
LAT 1yr post-PVI for paroxysmal AFib. Index procedure: standard 4-PV isolation only. HD mapping at redo revealed evolving anterior low-voltage substrate organizing into complex double-loop reentry (anterior wall + RIPV). Entrainment identified dominant circuit at anterior wall.
Antonio Frontera retweeted
The congress may be over, but the day isn't done yet! 📸Looking forward to attending the medal ceremony later in Metropolis. 🥇🥈🥉See you there!#EHRA_ESC @TKDResmi @universitemDEU #traceolympics2025
Antonio Frontera retweeted
Do you always rely on sinus rhythm voltage during atrial mapping?
👇
Change in atrial voltage maps during Cs pacing compared to sinus rhythm in a re-do procedure after PVI. Decremental pacing clearly elucidates functional substrate.
pubmed.ncbi.nlm.nih.gov/4039…
#EPeeps @pace_journal
75yo w/ ischemic cardiomyopathy & recurrent atrial tachycardia. Ablation targeted both anatomical & electrical isthmi, resolving initial arrhythmia but inducing a second. Posterior circuit ablation achieved success. No tachycardia post-procedure. @EPeeps_Bot
Nice #CruxCordis PVC inducing tachycardiomyopathy. CS mapping revealed the site of ablation ahead of mapping. PVC was intramural but RF 45W was enough to achieve complete suppression. Very nice uni and bipolar signal! #Niguarda @EPeeps_Bot
Antonio Frontera retweeted
The Right Ventricular Moderator Band: From Leonardo da Vinci’s Drawings to Current Cardiac Imaging
doi.org/10.1016/j.jaccas.202…
@cardiac_anatomy
cardiacanatomyatlas.com/
🧑🎓👩🎓The Right Bundle Branch (RBB) & Moderator Band (MB)
doi.org/10.1016/j.jaccas.202…
The compact AV note & penetrating AV bundle (green arrow). The RBB on the right side of the interventricular septum following the septomarginal trabeculation (SMT) & MB to the Anterior PM (red arrow)
Antonio Frontera retweeted
Must read 🆕 #ESC_EHRA Consensus Paper on arrhythmia management in #LVAD pts. tinyurl.com/5cn7en7d
Focus on:
🔎Drug therapy
🔎Catheter ablation
🔎Peri-procedural aspects
@EHRAPresident @ESCStrokeChair @escardio @EuropaceEiC @sozi81 @Petr_Peichl @EPDeneke @simivicst #EPeeps
Antonio Frontera retweeted
Atrial fibrillation nomenclature, definitions, and mechanisms: Position paper from the international Working Group of the Signal Summit
heartrhythmjournal.com/artic…
Deeply honored and thrilled to have had the privilege of contributing to a Consensus Statement by the European Society of Cardiology (ESC) on Drug Therapy and Catheter Ablation for the Management of Arrhythmias in LVAD Patients.
This document, now published in the Europace Journal (shorturl.at/3Muwh), addresses critical challenges in managing arrhythmias in patients with LVADs—life-saving devices for those with advanced heart failure.
Despite their benefits, arrhythmias remain a serious complication, affecting up to 20-50% of patients within the first year after implantation. These complications increase risks of recurrent ICD shocks, right ventricular failure, and mortality, underscoring the importance of effective management.
The Consensus Statement offers essential guidance on anti-arrhythmic drug therapy and catheter ablation, tackling unique complexities such as mechanical irritation from the inflow cannula, procedural challenges, and interference with electro-anatomic mapping systems.
I am deeply humbled and grateful to have been part of this effort alongside esteemed colleagues.
As I celebrate this achievement, I remain inspired to continue on this journey of learning, innovation, and teamwork in service of our medical community.
Antonio Frontera retweeted
Presented at #AHA24:
Among patients with ventricular tachycardia and ischemic cardiomyopathy, catheter ablation as an initial therapy led to a lower risk of adverse outcomes than antiarrhythmic drug therapy. Read the full VANISH2 trial results: nej.md/3Z5ECOD
ALT Kaplan–Meier analysis of the primary end point.
The Functional Substrate Predicts Recurrences of Atrial Fibrillation” is now online in Heart Rhythm Journal and free to download!
🔗authors.elsevier.com/a/1k3tC…
*Dual high-density mapping during sinus and paced rhythms is able to unmask functional, rhythm-dependent phenomena that are independent pre- dictors of AF recurrences during the follow-up.
* Functional substrate mapping is reproducible in every electrophysiology Lab
* Novel method to define the dynamic electrical substrate in patients undergoing AF ablation procedures.
