Papers by Sokratis Pastromas
The increasing use of the non-vitamin K oral anticoagulants during the recent years was associate... more The increasing use of the non-vitamin K oral anticoagulants during the recent years was associated with the need of development of targeted agents that could reverse the anticoagulative activity in cases of severe bleeding episodes or urgent high risk operations. Thus, several reversal agents are currently in development and the early results seem promising. Idarucizumab is a monoclonal antibody that can immediately and specifically reverse dabigatran action. Andexanet alfa is a recombinant modified factor Xa that can bind and reverse factor Xa inhibitors, including rivaroxaban, apixaban and edoxaban, and low molecular weight heparin. Aripazine is a universal reversal agent small molecule that can reverse the action of factor Xa inhibitors, unfractionated and low molecular weight heparin and possibly dabigatran. Currently, only idarucizumab has received approval from the United States Food and drug Administration for the reversal of the dabigatran. Rhythmos 2016;11(3):70-72.
Epicardial ablation has been adopted during the last years, mainly as a supplementary technique a... more Epicardial ablation has been adopted during the last years, mainly as a supplementary technique after a failed endocardial ablation procedure, both in patients with ischemic and nonischemic ventricular tachycardias (VTs). Sosa and colleagues were the first who described the percutaneous subxiphoidal puncture to approach the epicardial space in 1996. 1 Using the 3D electroanatomic mapping systems, the endocardial and epicardial substrate mapping have become feasible during the same procedure. Because of its complexity and its potential risks this process is performed only in high experienced centers by skilled operators with a large number of VT ablation procedures. Endocardial ablation in patients with left ventricular nonischemic cardiomyopathy (NICM) has shown worst outcome compared with ablation in ischemic cardiomyopathy. The main reason seems to be the progressive nature of the disease and the presence of epicardial and intramural slow conduction areas forming reentry circuits....
The behavior of three types of large sinus node arteries with regard to the blood supply of the atrial myocardium
Surgical and Radiologic Anatomy, 2020
We describe angiographic findings of sinus node arteries (SNAs), focusing in the large sinus node... more We describe angiographic findings of sinus node arteries (SNAs), focusing in the large sinus node artery (LSNA) variants, regarding the blood supply of the SN and atrial myocardium. We examined the SN arteries via postmortem angiographic visualization in six hundred hearts derived from victims of various accidents. The main stem or a branch of the SNA supplied the right atrium (RA) and part of the interatrial septum (IS) in 32% of cases (Group A), one atrium, the IS and a small part of the other atrium (Group B) in 39% and the entire atrial myocardium (LSNAs) (Group C) in 29%. Forty-two percent (42%) of LSNAs were arising from the anterior part of the right coronary artery (RCA) (type 1), 9% from its intermediate part (type 2) and 49% from the posterolateral portion of the left circumflex artery (LCx) (type 3). Type 2 can be injured by surgical procedures, type 3 by interventional ones, while type 1 is not affected by any. The SN area was supplied in Groups A and B by the main stem of SN arteries in 370 cases (62%) and by branches (Br) in 55 (9%). The 175 cases of group C (29%) were supplied only by branches. The clockwise (40% of cases) and counterclockwise rotations (60%) of the SNA around the superior vena cava, concern surgical procedures. The above findings are essential for every day surgical and interventional procedures.
Patients with diabetes mellitus commonly are suffering from atrial fibrillation since these two c... more Patients with diabetes mellitus commonly are suffering from atrial fibrillation since these two conditions share pathophysiological mechanisms. Catheter ablation of atrial fibrillation is the cornerstone therapy for rhythm control in symptomatic patients with paroxysmal or persistent atrial fibrillation. Data regarding the efficacy and safety of catheter ablation from large randomized clinical trials in this population are limited. The only available data from small clinical trials and meta-analyses have shown a superiority of catheter ablation compared to antiarrhythmic drugs although there are some limitations. Rhythmos 2017;12(2):26-28.
Atherosclerosis Supplements, 2008
The CVD risk perception is one of the main determinants of patient adhesion to preventive treatme... more The CVD risk perception is one of the main determinants of patient adhesion to preventive treatments. We have then evaluated the risk perception of 274 familial hyperlipoproteinemic subjects (M:F= 1:2; Mean age= 56±13 years) consecutively visited in the ambulatory service of Atherosclerosis Research Unit of the Bologna University. Methods: the patient risk perception was compared with the physician perception and the risk estimation by the Progetto Cuore ISS algorithm. The factors eventually associated to a higher risk perception from physician and patients have been evaluated. Results: The risk perception of the patient is totally unrelated to the electronic risk estimation (p>0.05), while it is strongly related the subjective one of the physician (p<0.01) and mainly influences by the instrumental diagnosis of atherosclerosis and by the familial history of cardiovascular disease (both, p<0.01). Before the visit, the risk perception appeared not to be related to the basal lipid levels, nor to the co-existence of other risk factors (smoking, hypertension, diabetes, metabolic syndrome). Patients with the highest risk perception were also strongly under-treated at the moment of the visit (78% of dyslipidemias, 48% of hypertension, 12% of diabetes), and those treated were largely far from the desired target (43%, 72% and 64%, respectively). Conclusion: the cardiovascular disease risk perception by patients visit in a lipid clinic usually relies to the physician one. However, also among more sensible patients, and thus those potentially more keen to begin an adequate pharmacological treatment a large part of risk factors is untreated.
Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē, 2012
Significant evidence shows that elevated heart rate (HR) is an independent risk factor in patient... more Significant evidence shows that elevated heart rate (HR) is an independent risk factor in patients with coronary artery disease (CAD) and influences their prognosis. In addition, patients with chronic obstructive pulmonary disease (COPD) have more frequent episodes of angina and their compliance with heart rate agents, such as beta blockers, is poor. The purpose of the multicenter observational RYTHMOS study was to evaluate the role of heart rate management in the prognosis and quality of life in patients with CAD and COPD. Baseline data from 280 patients, enrolled in 22 hospitals representing all types of hospital and all geographical areas of the country, were analyzed. All patients had either a prior myocardial infarction or angiographically documented CAD, and COPD verified either after spirometry or from a clinical evaluation by pulmonologists. The mean age of the enrolled patients was 71.8 ± 9.3 years, 76% were males, mean body mass index was 28.6 ± 7.9 kg/m2, 76.3% had hypert...
Anemia and Cardiovascular Disease
Maniatis/Alternatives to Blood Transfusion in Transfusion Medicine, 2010
... kidney. Its levels can be elevated above nor-mal values in many anemic patients with HF in pr... more ... kidney. Its levels can be elevated above nor-mal values in many anemic patients with HF in pro-portion to the severity of symptoms, but this eleva-tion is unlikely to compensate for the degree of pre-vailing renal hypoxia [47]. ...
Effects of Rosiglitazone on Fasting and Postprandial Low- and High-Density Lipoproteins Size and Subclasses in Type 2 Diabetes
Angiology, 2010
Rosiglitazone may increase cardiovascular risk in patients with type 2 diabetes. Yet, its effects... more Rosiglitazone may increase cardiovascular risk in patients with type 2 diabetes. Yet, its effects on atherogenic dyslipidemia are still not fully elucidated. In a prospective open-label study rosiglitazone (4 mg/day for 12 weeks) was added to a maximum of 2 oral antidiabetic drugs in 18 diabetic patients. We evaluated the effects on plasma lipids before and after an oral fat load. The size and subclasses of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) were also determined (by gradient gel electrophoresis). Rosiglitazone improved glycosylated hemoglobin ([HbA1c] P = .0023), without significant effects on fasting and postprandial plasma lipids. Fasting LDL size increased (+1.4%, P = .034), with less small, dense LDL-IIIA (-25.1%, P = .018). Postprandially, larger HDL-2b reduced (-8.7%, P = .006) and smaller HDL-3b increased (+12.2%, P = .05), without any effects on HDL size. Rosiglitazone led to antiatherogenic changes in LDL size and subclasses, with proatherogeni...
Hellenic Journal of Cardiology
bAcKGrOUND: Prolonged duration of manual or mechanical compression at the site of femoral artery ... more bAcKGrOUND: Prolonged duration of manual or mechanical compression at the site of femoral artery access after sheath removal upon completion of coronary procedures followed by extended period of bed rest has significant logistical and practical problems for both patients and hospital staff. The availability of vascular closure devices (VCDs) has ushered in a new era in the routine clinical practice in the catheteri-zation laboratory.
Patients with diabetes mellitus commonly are suffering from atrial fibrillation since these two c... more Patients with diabetes mellitus commonly are suffering from atrial fibrillation since these two conditions share pathophysiological mechanisms. Catheter ablation of atrial fibrillation is the cornerstone therapy for rhythm control in symptomatic patients with paroxysmal or persistent atrial fibrillation. Data regarding the efficacy and safety of catheter ablation from large randomized clinical trials in this population are limited. The only available data from small clinical trials and meta-analyses have shown a superiority of catheter ablation compared to antiarrhythmic drugs although there are some limitations. Rhythmos 2017;12(2):26-28. Abbreviations: AAD = antiarrhythmic drug; AF = atrial fibrillation; CA = catheter ablation; DM = diabetes mellitus; PV = pulmonary vein Conflict of Interest
Atrial fibrillation in patients with heart failure with reduced left ventricular ejection fractio... more Atrial fibrillation in patients with heart failure with reduced left ventricular ejection fraction is common and is associated with an increased risk of mortality, hospitalization and all-cause death. Rhythm control via medical treatment in these patients is restricted to use of amiodarone as the only suitable antiarrhythmic drug with the least proarrhythmic effect compared to other antiarrhythmic drugs for this population of patients. Over the last years there is a growing evidence that catheter ablation is beneficial in patients with heart failure since randomized clinical trials with hard endpoints have already been published. However, there are still unanswered questions about the patient categories that could benefit from the ablation procedures and the optimal ablation strategies in these patients. These issues are herein reviewed. Rhythmos 2018;13(4):75-77.
Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction: Pathophysiology and the Role of Catheter Ablation: AF in HFpEF
Atrial fibrillation (AF) and heart failure (HF) often coexist, and the prognosis of patients who ... more Atrial fibrillation (AF) and heart failure (HF) often coexist, and the prognosis of patients who have both these conditions is worse than those with either condition alone. Heart failure with preserved ejection fraction (HFpEF) is a clinical condition that was initially characterized as diastolic dysfunction HF, then as HF with normal ejection fraction, and more recently as HFpEF. About one-third of patients with HFpEF suffer from AF. Although, both clinical entities share common pathophysiologic mechanisms, current knowledge of the relationship between AF and HFpEF is limited. Catheter ablation, although data from randomized trials in this category of patients are limited, seems to have beneficial effects regarding maintenance of sinus rhythm and re-hospitalization rates. Rhythmos 2020;15(2):29-32.
International clinical practice guidelines recommend early introduction and continued treatment w... more International clinical practice guidelines recommend early introduction and continued treatment with betablockers for all patients without contraindications after STEMI. Although there seemed to be little question that patients with STEMI, regardless of revascularization strategy, derive substantial benefits from both longand short-term beta-blockade, there has been a paucity of high quality evidence supporting this notion and the majority of data predate modern reperfusion therapy and current medical management strategies with statins and antiplatelet agents. Recently published data question this “one-size-fits-all” approach, showing that the use of betablockers increased the risk of heart failure and cardiogenic shock with no mortality benefit.
Arrhythmogenic right ventricular cardiomyopathy/ dysplasia (ARVC/D), mostly affecting young/middl... more Arrhythmogenic right ventricular cardiomyopathy/ dysplasia (ARVC/D), mostly affecting young/middle-aged individuals, poses a significant risk of malignant ventricular arrhythmias (VAs) and subsequent sudden cardiac death (SCD). Antiarrhythmic agents (AAA) provide insufficient arrhythmia suppression and prevention and can be proarrhythmic. Thus, the implantable cardioverters-defibrillator (ICD) is considered the first-line treatment, especially in patients with secondary prevention indication. Nevertheless, catheter ablation is an additional therapy to the ICD which has proved its efficacy in primary and secondary prevention of fatal arrhythmias and sudden cardiac death. The superiority of the combined endo- and epicardial VT ablation in this population is clear since the ARVC/D substrate has been shown to be mostly epicardial. Due to progressive nature of ARVC/D, ablation seems to be a useful tool for the patients who experience recurrent VT episodes or electrical storms.
Risk stratification for sudden cardiac death in non-ischemic dilated cardiomyopathy remains a dif... more Risk stratification for sudden cardiac death in non-ischemic dilated cardiomyopathy remains a difficult and controversial issue. This is currently guided by left ventricular ejection fraction, severity of heart failure symptoms according to New York Heart Association classification, and the morphology and duration of the QRS complex. The results of a recent study stirred some initial controversy with regards to the utility of the implantable cardioverter defibrillator in these patients, however, a subsequent meta-analysis confirmed prior findings of the survival-prolonging benefit of device therapy. These issues are herein briefly reviewed. Rhythmos 2017;12(1):1-6.
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general populatio... more Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population, affecting about 0.4% of the general population. Its prevalence increases with age reaching 15% in adults over 70 years of age. During the past decade, as techniques and technologies have improved, catheter ablation of AF has become a standard and effective therapy for patients with symptomatic and drug-refractory AF. The improved three-dimensional electroanatomic mapping systems and the induction in the clinical practice of other ablation techniques, such as cryoablation, have contributed to the worldwide increase of the number of ablation procedures. Catheter ablation seems to be superior to antiarrhythmic drug therapy (ADT) which is also associated with potential toxic or proarrhythmic effects after long term use. The recently presented data from RAAFT 2 study, showed that 55% of the patients who had randomized to AF ablation had had a recurrence compared to 72%, of those who had re...
Renewable Energy and Power Quality Journal
The major renewable energy sources can be considered wind, solar, hydro, biomass, geothermal and ... more The major renewable energy sources can be considered wind, solar, hydro, biomass, geothermal and tidal. The adaptation of more renewables in European Union (EU) lowers the dependence on fossil fuels while energy production is getting more sustainable. Wind energy is the significant contributor on achieving the committed EU 2020 goals while the penetration of wind power plants follows an increasing trend in annual basis. Wind turbines of power plants are usually installed on high altitude areas where wind conditions have been proved that wind is sufficient for such projects. The installation altitude usually exceeds 1000m causing these structures vulnerable to lightning strikes. The lightning activity of an area has to be considered once a wind power plant is going to be installed. Additionally a wind turbine has to be designed and manufactured according to relevant IEC standards and special attention has to be given to the components which are most vulnerable like the blades and the nacelle. In the current paper will be discussed the effect and the potential disturbances that a lightning strike can cause to a wind turbine and also basic protection measures will be presented which allow the wind turbine to be effectively protected against lightning strikes.
EP Europace
Pulmonary vein (PV) isolation remains the cornerstone of atrial fibrillation (AF) ablation. Cryob... more Pulmonary vein (PV) isolation remains the cornerstone of atrial fibrillation (AF) ablation. Cryoballoon ablation is shown to be non-inferior to radiofrequency ablation in terms of efficacy and safety among paroxysmal AF patients. 1 In this case, we report an intraprocedural adverse event encountered during cryoballoon ablation. A 46-year-old male patient with symptomatic, paroxysmal AF underwent cryoballoon ablation. Following successful isolation of other PVs, a cryolesion was delivered at the right inferior PV. Initially, the recorded temperature fell at À42 C after 50 s. However, a second abrupt and rapid temperature decline was noted unexpectedly, reaching À72 C within the next 7 s (Figure 1). Ablation was terminated, but despite balloon deflation, retraction of the cryocatheter (Arctic Front Advance TM) within the sheath was not feasible. The dysfunction persisted despite subsequent cycles of inflation and deflation aiming to allow appropriate balloon unwrapping. Following deflation, the cryoballoon catheter and the sheath were carefully retracted en bloc to the right atrium, and the procedure was terminated. Visual inspection Published on behalf of the European Society of Cardiology. All rights reserved.
Effectiveness investigation of wind farm earthing system
2016 IEEE International Conference on High Voltage Engineering and Application (ICHVE), 2016
Wind turbines are tall structures with heights that can exceed 80m. Their installation is usually... more Wind turbines are tall structures with heights that can exceed 80m. Their installation is usually done at high altitude and isolated areas causing these vulnerable to lightning strikes considering their total hub height and blade radius. The sites that wind farms are installed are usually of high lightning activity. Furthermore, in these areas the soil resistivity is high, leading to the design and construction of a reliable earthing system that shall ensure both lightning and earth fault current dissipation. Step and touch voltages shall be compatible with the safety limits as these are defined in IEEE80-2000. The earthing system is the main part of the wind turbine lightning protection system apart from the receptors and down conductors. It leads the lightning and the earth fault currents to the earth in a safe way both for the infrastructure and for the human beings. The earthing system of a wind turbine and thus the wind farm shall be designed on project specific conditions, considering the ground conditions, short-circuit analysis of the power plant collector system, international standards and also national requirements of the country that it shall operate if such exist. In the current paper will be discussed the effectiveness of a wind farm earthing system regarding the current dissipation. The evaluation will be executed based on project specific soil conditions which have been measured during a dry season and foundation earthing system of each wind turbine. The transient analysis will be performed via simulations in EMTP-ATP. The extracted results will be useful for other wind farms that are installed in similar soil and/or electrical conditions in order to reduce the project execution time by using a proven earthing solution.
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Papers by Sokratis Pastromas