James Gandolfini has died aged 51 after a suspected heart attack.
The Sopranos star was on vacation in Rome with his son Michael, 13, wife Deborah and nine-month-old daughter Liliana Ruth ahead of the 59th Taormina Film Festival in Sicily.
Gandolfini suffered a heart attack in his room on Wednesday at around 10pm at the Hotel Exedra after a day out in Rome with his family.
Son Michael, 13, called the reception desk for help, and hotel employees immediately called paramedics, confirmed a spokesman for the hotel.
Doctors pronounced him dead less than an hour later.
Untimely death: Sopranos star James Gandolfini has died of a suspected heart attack in Italy, seen here on June 10th at a charity gala
James Gandolfini with his son and second wife Deborah Lin at a film premiere in 2011
The spokesman told ABC News the actor was alive when the ambulance left for Policlinico Umberto I hospital in central Rome.
Gandolfini arrived at the hospital at around 10:40 p.m. in cardiac arrest, confirmed Prof Claudio Modini, director of the Emergency Department of the Policlinico.
Paramedics in the ambulance had already started the resuscitation procedure but he was declared dead 40 minutes after his arrival at the hospital.
In a statement Gandolfini's managers Mark Armstrong and Nancy Sanders confirmed the death, which happened on Wednesday.
Married to the mob: In character with his Sopranos co-stars Edie Falco, Robert Iler and Jamie-Lynn Sigler
'Our hearts are shattered and we will miss him deeply. He and his family were part of our family for many years and we are all grieving,' they said.
Gandolfini seen in the first season of the hit HBO show in 1999
Cable channel HBO called the actor a 'special man, a great talent, but more importantly a gentle and loving person who treated everyone, no matter their title or position, with equal respect.'
The actor and his family had spent a 'beautiful day out together' in Rome before his tragic passing, according to Gandolfini'sassistant, Tom Richardson.
According to Mike Sullivan, a close friend of Gandolfini's, Richardson told him: 'When they got back to the hotel, Jimmy went to use the restroom. And something happened in there.
'His sister said he was alive when they took him out in the ambulance on the way to the hospital.'
The teenager's mother, James' first wife Marcy Wudarski, is said to have immediately booked a flight to Italy to be with her son after learning of the actor's death.
He was married to Michael's mother Marcy for three years until they divorced in 2002.
Gandolfini's second wife, former model Deborah Lin, was with the star in Italy along with their daughter Liliana.