The meeting. Italians are very vocal, and interruptions to someone speaking are normal. Do not be surprised to find the entire room speaking at the same time. Understanding Italian will allow you to not only understand the multiple conversations, but also take control or make reference. Use last names and title until you are formally introduced and requested to speak on first name terms. Married women in business in Italy generally work with their maiden name.
Read the cards. No, this is not some sort of psychic trick to get business but a sign of respect. Business cards are exchanged in most formal meetings and it is polite to take a moment, read the card and make eye contact with the person you received a card from. This simple gesture can set a positive tone for the meeting ahead. Another simple piece of advice is to have business cards translated into Italian.
Doing business in Italy is about taking things slow, doing things with intent, and looking smart. As with most countries, politeness goes a long way. Above all, speaking Italian makes a favourable and lasting impression, and is one of the best ways to secure business in Italy.