The tragedy of Mattia, mystery on the defibrillator. “It’s the first thing to do that could have saved his life”

Florence, 17 April 2024 – Matthias Giani could he be saved? It is the question that more than any other mainly torments the family of twenty-six year old footballerhis teammates and the football clubs, the one where he played and the one that hosted him at home.

“In these cases”, when a player collapses on the ground, “the first thing to do is take the defibrillatorwho by law must be there on the sidelines and place the two plates on the chest: then the machine is intelligent and does everything by itself, it is activated only if necessary”. Domenico Corrado of the University of Padua, one of the world’s leading experts on sudden cardiac deathtechnical consultant appointed by the Florence prosecutor’s office for the expert opinion on the pathology of the Fiorentina captain Davide Astoriwho died six years ago due to a carrhythmogenic cardiomyopathy.

There timeliness using the defibrillator is essential when ventricular fibrillation is underway which – if not stopped – leads to death very quickly. The first responders on the field spoke of an epileptic seizure, but more likely it was “a convulsive seizure due to cardiac arrest”, a condition that can be determined when an insufficient amount of blood reaches the brain.

But the defibrillator Was he really on the sidelines? (This is also asked by the vice president of the Chamber and Forza Italia deputy, Giorgio Mulè). When he was activated and did not start – as the boy’s father claims – was the player already in asystole (i.e. without ventricular electrical activity and therefore not shockable)? Many questions and few certainties. The answers are expected from the diagnostic findings, from the autopsy, from the tests carried out in hospital at the time of hospitalization and from the work of the magistrates who will ask for the certificates of competitive fitness.

In the case of Astori l‘electrocardiogram under stress he had shown ventricular extrasystoles which should have led to subsequent investigations which never took place, as shown by the various reports. What happened to Mattia? Are there pathologies that can remain invisible on the electrocardiogram? Which? According to protocol, heart ultrasound is reserved for professional athletes and is not routinely performed in amateurs. “The screening protocol is effective enough for the majority of cardiac pathologies at risk of sudden death is identifiable with the electrocardiogram, such as dilated cardiomyopathies, hypertrophic and arrhythmogenic”, explains Professor Corrado.

However, there are more subtle pathologies that do not show changes in the electrocardiogram: three of the most probable. “If the presence of coronary atherosclerotic plaques stenosing may be suspected in the exercise test due to the appearance of symptoms and/or electrocardiographic alterations due to myocardial ischemia, it may happen that atherosclerotic coronary plaques that create non-critical and invisible stenoses on the tracing, rupture and close due to superimposed thrombosis, causing ventricular fibrillation from acute ischemia”, says Corrado, head of the Genetic Center for arrhythmic cardiomyopathies and sports cardiology of the Padua hospital-university company.

Between pathologies which can also hide on the electrocardiogram “myocardial ischemia due to crushing of a coronary artery due to the aberrant path due to an anomalous congenital origin”. Finally, a condition identified with increasing frequency: “A non-ischemic scar confined to the external region of the left ventricle which escapes ultrasound because it does not alter regional contractility – explains the professor – This is the case of arrhythmogenic cardiomyopathy which can usually be suspected for the appearance of ventricular arrhythmias on the exercise tracing. It can be genetic or caused by myocarditis, there have been many viral ones, even post Covid”.