INTRODUCTION:Left bundle branch area pacing (LBBAP) has emerged as a physiologic alternative to conventional right ventricular and biventricular pacing, yet large real-world evidence remains limited. We aimed to assess changes in ventricular function and symptoms after LBBAP in patients with different clinical indications. METHODS AND RESULTS:Consecutive patients discharged with confirmed LBBAP across 29 Italian centers underwent evaluation of echocardiographic parameters and New York Heart Association (NYHA) functional class at follow-up. A total of 697 patients were included: 532 with a bradycardia indication and 165 with a heart failure (HF) indication, assessed at a median follow-up of 12.4 months. In the bradycardia group, left ventricular ejection fraction (LVEF) showed a slight improvement from 55% (interquartile range, 50-60) to 56% (52-60) (p = 0.027). Paced-induced cardiomyopathy (PICM), defined as a ≥ 10% absolute LVEF reduction to < 50%, occurred in 3% of patients. Loss of LBBAP capture (p = 0.025) and lower LBBAP percentage (p = 0.024) were independent predictors of PICM. In the HF group, LVEF improved from 35% (30-41) to 45% (36-52) (p < 0.001). Overall, 61.8% were classified as responders (LVEF increase ≥ 5%), rising to 73.8% among patients with ≥ 12 months of follow-up. Higher LBBAP pacing percentage and absence of coronary artery disease independently predicted response. NYHA functional class improved significantly in both groups. CONCLUSIONS:In this large real-world cohort, LBBAP was associated with meaningful improvements in ventricular function and symptoms in both bradycardia and HF populations. A high percentage of effective LBBAP capture is essential for optimizing outcomes, supporting its role as an effective physiologic pacing strategy.

BACKGROUND:The role of atrial pacing support is unclear in patients receiving cardiac resynchronization therapy-defibrillator (CRT-D) without sinus node dysfunction. METHODS:We conducted a randomized, parallel-group, noninferiority trial to evaluate whether a 2-lead CRT-D capable of atrial sensing (but no pacing) by a floating dipole on the right ventricular lead (CRT-DX) is not inferior to a 3-lead CRT-D with a conventional atrial lead. Between October 17, 2018, and March 5, 2024, a total of 636 patients (68±10 years old, 28.6% women) with standard CRT-D indication, optimized medical therapy, and resting sinus rate ≥45 beats/min were randomized 1:1 to CRT-DX (atrial tracking without atrial pacing mode 35 beats/min) or CRT-D (atrial tracking with atrial pacing mode 50 beats/min) at 23 Italian sites. A centralized block-randomization procedure stratified by site was used, with patients and primary outcome assessors blinded to treatment assignment. The primary end point was a 1-year composite of all-cause mortality, cardiovascular hospitalization, and lead-related complications (loss of functionality not correctable by device reprogramming). Secondary end points included each individual component of the primary end point separately, echocardiographic reverse remodeling, and 6-minute walk test distance at 12 months. RESULTS:The primary end point occurred in 41 (13.1%) patients in the CRT-DX group and 47 (15.6%) patients in the CRT-D group, corresponding to a hazard ratio of 0.82 (95% CI, 0.54-1.25). This confirmed noninferiority (prespecified relative margin of 1.20) in both the per-protocol (P=0.039) and intention-to-treat (P=0.044) analyses. Individual components showed no significant differences, except for lead complications related to right atrial functionality (4 [1.3%] patients in the CRT-DX group versus 13 [4.2%] patients in the CRT-D group; P=0.040). Reverse remodeling responders were 203 (77.5% of 262) patients receiving CRT-DX and 190 (76.3% of 249) patients receiving CRT-D (P=0.83). Walking distance did not differ between 2 study arms (404 versus 398 m; P=0.62). After a median follow-up of 2.4 years, only 1 patient receiving CRT-DX required implantation of a standard atrial lead. CONCLUSIONS:The 2-lead CRT-DX system without atrial pacing is noninferior to conventional 3-lead CRT-D, with fewer atrial lead-related complications. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT03587064.

INTRODUCTION:The optimal duration of implantable loop recorder (ILR) monitoring remains uncertain and may differ according to the indication for implantation. We evaluated whether the time-dependent diagnostic yield and clinical relevance of ILR-detected arrhythmias differ among patients implanted for syncope, palpitations, cryptogenic stroke, or Brugada syndrome. OBJECTIVE:This study sought to define the time-dependent diagnostic yield of ILRs across clinical indications and to assess whether early and late diagnoses differed in their impact on clinical management. METHODS AND RESULTS:We retrospectively analyzed 1734 consecutive patients undergoing ILR implantation at 5 Italian centers for unexplained syncope, palpitations, cryptogenic stroke, or Brugada syndrome. Diagnosis of interest was defined according to the implant indication: pauses for syncope, supraventricular tachycardia or atrial fibrillation for palpitations, atrial fibrillation for cryptogenic stroke, and ventricular tachycardia or pauses for Brugada syndrome. Median follow-up was 34 months. Maximally selected rank statistics identified 26 months as the global threshold separating early from late diagnoses, while indication-specific optimal diagnostic windows were 14 months for syncope, 13 months for palpitations, 16 months for cryptogenic stroke, and 55 months for Brugada syndrome. In syncope and palpitations, most actionable diagnoses occurred early, and diagnostic efficiency declined markedly after 26 months, with late findings often less clearly related to the index presentation. In cryptogenic stroke, atrial fibrillation detection was most frequent early but could still lead to changes in antithrombotic management later, supporting an individualized "gray-zone" approach to prolonged monitoring. By contrast, Brugada syndrome showed sustained diagnostic yield over extended follow-up, with late ventricular arrhythmias or pauses retaining major prognostic and therapeutic implications, including implantable cardioverter-defibrillator implantation and device-type selection. CONCLUSIONS:The value of ILR monitoring is strongly time- and indication-dependent. Prolonged routine monitoring or reimplantation appears to have limited incremental value in syncope and palpitations when early follow-up is unrevealing, whereas extended surveillance may remain justified in Brugada syndrome and should be individualized after cryptogenic stroke. These observations support indication-driven ILR follow-up strategies rather than a uniform approach based on device longevity alone.

Subclinical coronary atherosclerosis is common but its biological aggressiveness and interplay with extracoronary disease in asymptomatic individuals remain unclear. We evaluated the prevalence of high-risk coronary plaques (HRPs) and their relationship with mild carotid atherosclerosis and coronary calcium in a cardiovascular (CV) high-risk cohort in primary prevention. This retrospective multicenter study enrolled 269 asymptomatic adults with multiple CV risk factors who underwent Coronary Computed Tomography Angiography (CCTA) after prior carotid duplex ultrasound (CDUS). Coronary artery disease (CAD) was graded as absent, non-obstructive (<50% stenosis) or obstructive (≥50%), and HRPs were identified by ≥1 adverse morphological feature (low attenuation, positive remodeling, napkin-ring sign, spotty calcification). Carotid disease was classified as CDUS 0 (no plaque), CDUS 1–49% (mild), or CDUS ≥ 50% (significant). Pre-specified analyses explored prevalence of HRPs across CDUS–calcium-score strata (cut-off 100 Agatston) and independent predictors within the CDUS 1–49% subgroup. CAD was absent in 31%, non-obstructive in 41%, and obstructive in 28%. HRPs were present in 30.9% of all cases, in 26.6% of non-obstructive and in 64.6% of obstructive CAD. HRPs prevalence rose step-wise from 10.0% (CDUS 0 + Ca < 100) to 27.7% (CDUS 1–49% + Ca < 100), 41.2% (CDUS 0 + Ca ≥ 100) and 59.4% (CDUS 1–49% + Ca ≥ 100). In patients with CDUS 1–49%, current smoking independently predicted HRPs (OR 2.1, 95% CI 1.0–4.5; p = 0.049). Nearly one-third of asymptomatic adults with high CV risk already showed HRPs. Mild carotid atherosclerosis synergized with a calcium score ≥ 100 to identify a subgroup in which six of ten individuals exhibited HRPs. Smoking was the only independent clinical correlate identified of plaque vulnerability. Combined carotid ultrasound, calcium scoring and CCTA may substantially refine primary prevention risk stratification beyond traditional factors.

BACKGROUND:The clinical significance of device-detected atrial high-rate episodes (AHREs) is believed to increase with AHRE burden. OBJECTIVE:This study evaluated whether a daily burden ≥6 minutes is associated with major cardiovascular (CV) outcomes. METHODS:We analyzed 1160 patients with sinus node dysfunction and dual-chamber pacemakers or defibrillators from the B3 randomized trial, followed for 3 years. The primary composite end point included CV death, worsening heart failure hospitalization (WHFH), and stroke or transient ischemic attack (TIA). Secondary end points were individual components of the primary end point and progression to long-lasting AF. Using competing-risk survival models with AHRE burden as a time-varying covariate, we calculated CHA2DS2-VASc-adjusted hazard ratios (HRs) after the first day with burden ≥6 minutes. AHREs were all adjudicated. RESULTS:AHRE burden ≥6 minutes occurred in 52.5% of patients, 47.1% of whom had no prior AF. There were 65 primary events (10 CV deaths, 39 WHFHs, 16 strokes/TIAs). In patients without prior AF, AHRE burden ≥6 minutes was significantly associated with the primary end point (HR 4.9; 95% confidence interval [CI], 2.19-10.91; P < .001), and with CV death (P = .033), WHFH (P < .001), and long-lasting AF (P < .001), but not with stroke/TIA (P = .34). In contrast, no significant association was found in patients with prior AF (HR 0.83; 95% CI, 0.37-1.87; P = .65). CONCLUSION:In patients without prior AF, a daily AHRE burden ≥6 minutes was linked to a >4-fold increased risk of major CV events, mainly driven by CV death, WHFH, and progression to long-lasting AF. No such association was observed in patients with prior AF.

Abstract Infections associated with cardiac implantable electronic devices (CIEDs) pose significant clinical challenges due to their life-threatening nature and complex management. Recent advancements in prevention, diagnosis, and treatment have been driven by landmark trials such as PADIT and WRAP-IT, alongside evolving diagnostic tools like [18 F]FDG PET/CT and updated diagnostic criteria (e.g., 2023 Duke-ISCVID). A combination of well-established approaches—such as leadless pacemakers, subcutaneous ICDs, and an antibiotic-eluting envelope—and evolving adjunctive strategies, including a taurolidine-containing antimicrobial agent, incision drapes, fascial plane blocks or double gloving, have broadened the spectrum of options to reduce and potentially mitigate the risk of CIED infection. While devices like leadless pacemakers, subcutaneous ICDs, and antibiotic envelopes are supported by randomized controlled trials, adjunctive measures such as taurolidine rely predominantly on observational data. To address this variation in the strength of available evidence, a modified Delphi consensus process was conducted, bringing together cardiologists and infectious disease experts to define experience-based best practices in areas where current guidelines offer limited or no specific recommendations. The consensus achieved strong agreement (≥ 80%) on key strategies, including mandatory double-gloving to reduce contamination, the use of validated risk models (e.g., PADIT, BLISTER) for tailored infection prevention employing an antibiotic eluting envelope, multidisciplinary decision-making for non-extractable infections and the use of taurolidine solutions as adjuncts to prevent CIED infection. Moderate consensus (60–79%) supported non-delayed reimplantation after lead-related endocarditis and single-session reimplantation in pacing-dependent patients under specific circumstances. However, no consensus was reached on mandating a minimum annual procedural volume (≥ 500 cases) for CIED centers, reflecting concerns about access and operator expertise. The findings emphasize the importance of personalized risk stratification, procedural innovations, and multidisciplinary collaboration in optimizing CIED infection outcomes. Areas requiring further research include the efficacy of iodophor-impregnated drapes, fascial plane blocks, and taurolidine solutions. This consensus provides a pragmatic framework for clinicians, highlighting evidence-informed strategies to mitigate infection risks and improve care for patients undergoing CIED procedures.

INTRODUCTION:Cardiac implantable electronic device (CIED) infections are associated with substantial morbidity and mortality, and early recognition with referral for device extraction is crucial for optimal outcomes. General practitioners (GPs) are essential for long-term follow-up, yet their adherence to international guidelines remains poorly defined. This survey aimed to assess GPs' levels of awareness and clinical management of CIED infections. METHODS:A nationwide survey endorsed by the Electrophysiology and Cardiac Pacing Study Group of the Italian Federation of Cardiology was sent to GPs throughout Italy. The questionnaire explored epidemiology, prognosis, clinical scenarios, preventive strategies, therapeutic pathways, and educational background regarding CIED infections. RESULTS:A total of 183 GPs from 10 Italian regions participated. Most respondents (62.8%) correctly estimated CIED infection incidence at 1-2%. However, two-thirds (122 GPs, 66.6%) considered conservative management to be associated with good outcomes, and only 28.4% recognized CIED infection as a condition with a poor prognosis. While 93.4% identified systemic inflammatory symptoms as warning signs, fewer than one-third would refer febrile CIED carriers to an electrophysiology specialist. Preventive strategies were heterogeneous, with more than half (54.1%) prescribing antibiotic prophylaxis before dental procedures. Only six GPs (3.8%) reported having received adequate training or dedicated education courses on CIED infections during their educational pathway. CONCLUSIONS:Italian GPs demonstrate reasonable epidemiological awareness of CIED infections. However, major gaps exist in prognostic understanding, diagnostic referral, prevention, and therapeutic alignment with guidelines. These findings highlight the need for structured educational programs and shared care pathways between primary care and electrophysiology services.

This review examines the protocols and rationale for stopping antiarrhythmic drugs (AADs) before interventional electrophysiology (EP) procedures to establish a drug-free baseline, ensuring diagnostic accuracy and procedural success. The review provided a detailed analysis of procedure-specific AADs washout requirements for supraventricular tachycardia, atrial fibrillation, and ventricular tachycardia ablation, and a comprehensive, drug-by-drug guide to calculate washout periods, based on pharmacokinetic and pharmacodynamic principles. This guide details the half-life, metabolism, and elimination pathways for all major AAD classes, and gives specific, actionable recommendations for adjusting wash-out times based on patient-specific factors, including age, renal function, and hepatic impairment. The aim is to provide clinicians with evidence-based guidance for standardizing AADs washout, thereby improving the safety and success of interventional EP procedures.

Background Over the last decades, the sphingosine kinase 1 (SK1)/sphingosine1-phosphate (S1P) axis has attracted increasing attention in cardiovascular research due to its effects under acute or chronic stress conditions. Despite this, the specific role of this molecular pathway in human heart failure (HF) remains poorly defined. Likewise, the potential of circulating S1P as a biomarker of HF has not been fully established. Methods and results To this aim, we enrolled 28 patients with HF and 16 non-HF controls. We observed that serum S1P levels were significantly reduced in HF patients compared with controls, and S1P was positively associated with left ventricular ejection fraction (EF). Further, ROC analysis demonstrated a moderate discriminatory capacity of S1P for HF. However, this relationship was partly influenced by age, as S1P levels were inversely correlated with age. Among laboratory parameters, circulating S1P levels were inversely associated with serum creatinine, suggesting a potential link between S1P signaling and cardiorenal dysfunction.Next, In differentiated human AC16 cardiomyocytes, acute β-adrenergic stimulation with isoproterenol increased SK1 and PCNA expression, whereas prolonged stimulation reduced SK1 levels, indicating a biphasic regulation of the SK1/S1P axis under sustained adrenergic stress. Similarly, hypoxic insult in AC16 cells resulted in a significant reduction in SK1 levels and increased p53 levels. Finally, in AC16 incubated withwith human blood serum from HF patients we observed a robust reduction in SK1 compared with cells incubated with control serum. Conclusions In conclusion, this study supports SK1/S1P axis as an adaptive cardioprotective mechanism activated during acute stress that becomes impaired in chronic HF-related stress. Although the association between circulating S1P and myocardial SK1 requires further investigation, reduced circulating S1P was consistently associated with HF and impaired cardiac function, supporting its potential value as a biomarker and highlighting the SK1/S1P axis as a promising therapeutic target.

BACKGROUND:False-positive (FP) alerts from implantable loop recorders increase clinical workload and may delay appropriate intervention. AccuRhythm AI, a cloud-based filtering algorithm, is designed to reduce these alerts in Reveal LINQ and LINQ II devices. This study assessed the algorithm's effect on FP and clinician burden reduction, with a focus on the influence of R-wave sensing amplitude. METHODS:This multicentre, retrospective study included 800 patients with either Reveal LINQ or LINQ II. We analysed automated artificial intelligence (AI) reports and compared FP rates and transmission burden before and after software-based AI activation in the subset of Reveal LINQ patients to assess patient-level changes. The relationship between R-wave amplitude and FP incidence was also evaluated. RESULTS:AI-based filtering, by AccuRhythm AI automatic analysis, reduced false pause alerts by 62% and false atrial fibrillation alerts by 33%, saving 210 clinician hours over 6 months. Patient level analysis, among 465 Reveal LINQ patients, showed FP+ patients (patients with ≥1 false-positive transmission) reduction from 55.5% to 15.1% post-AI (p<0.001), translating to 1128 hours saved. All residual false alerts occurred in patients with R-wave amplitudes <0.4 mV. CONCLUSION:Use of AccuRhythm AI was associated with a significant reduction in FPs and clinician workload while preserving diagnostic accuracy. R-wave amplitude remained a key factor influencing alert specificity, emphasising the continued importance of optimal device implantation and signal quality.

BACKGROUND:Left bundle branch area pacing (LBBAP) has emerged as a promising physiological pacing strategy. However, its feasibility and safety using conventional stylet-driven leads (SDL) such as INGEVITY+ remain under investigation. OBJECTIVE:To evaluate the clinical performance, safety, and follow-up outcomes of LBBAP using the INGEVITY+ lead in a real-world electrophysiology setting. METHODS:From 2021 to 2024, 207 consecutive patients underwent LBBAP implant attempts using the INGEVITY+ lead across 19 centers. Of these, 146 had bradycardia indications, and 61 had heart failure indications. A control group of 200 patients received standard right ventricular (RV) pacing with the same lead. Procedural outcomes, electrical parameters, complications, and mid-term lead performance were assessed. RESULTS:LBBAP was successfully achieved in 201 (97%) cases. Procedural and fluoroscopy times were slightly longer for LBBAP than for RV pacing. Acute complications included one helix fracture, one atrioventricular block, and one septal perforation. During a median follow-up of 9 months, no lead fractures were reported; lead dislodgment occurred in three cases. Kaplan-Meier analysis showed no significant difference in time to first lead-related complication between the LBBAP and RV pacing groups (hazard ratio: 4.69, 95%CI: 0.63-34.90, p = 0.139). Electrical performance remained stable, with 98% of retained leads maintaining capture thresholds ≤ 2 V and 92% with sensed amplitudes ≥ 5 mV. CONCLUSIONS:LBBAP using the INGEVITY + SDL is feasible and safe in clinical practice, with excellent implant success and stable mid-term electrical performance. These findings support its use as a viable conduction system pacing strategy.

Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF) [1], but for persistent AF PVI appears to be suboptimal and any kind of additional lesion has been proven to not enhance the efficacy of the ablation [2-3]. In this setting, the Vein of Marshall ethanol infusion (VOM-EI) has shown to improve the efficacy of AF ablation as compared to PVI [4]. In all previous studies VOM-EI and AF ablation were different step of the same procedure [5]. Nevertheless, performing voltage map right after the VOM-EI could lead to an overestimation of ethanol-induced scar due to the possibility of certain amount of reversible oedema. For that reason, we started performing VOM ethanol infusion in day surgery setting one month before the ablation procedure, demonstrating that VOM-EI related scar is indeed smaller as compared to conventional procedure. To evaluate safety, efficacy and feasibility of single day discharge VOM-EI. All patients referred for de novo ablation of persistent AF have been enrolled. In day 0 VOM-EI was performed according to previously described method (5) but by echo-guided left axillary vein access. Ethanol infusion was considered successful if repeat angiograms between the 3 injections showed: stability of the angioplasty balloon; visualization of the distal VOM arborization; absence of contrast leakage back in the coronary sinus; absence or limited dissection of the VOM; and progressive appearance of tissue contrast staining (tattoo). Mean procedure time was 39,1±7,8 min and X-Ray time was 4,2±0,9 min. At least 30 days after ablation procedure was performed using The Bordeaux group protocol (PVI, ridge and saddle, posteriors box, mitral isthmus and cavo-tricuspid isthmus). We compared our data with previously published 700 patients cohort [5] We enrolled 63 patients (81% male, 67±7.6 years old). Analyzing the safety, rate of failure and feasibility of the procedure we demonstrated that single day discharge is comparable to ordinary setting for VOM-EI. Failure rate was 19% (6% due to non-identification of VOM, 13% due to VOM dissection), peri-operative complication rate was 3.2%: notably there were only pericarditis without neither significant pericardial effusion nor cardiac tamponade (which was 1% in Kamakura cohort). This would probably be related to the absence of heparin treatment which is needed for the ablation procedure protocol in the conventional procedure. These preliminary data shows that VOM-EI in day surgery is feasible and very promising in terms of safety. It would be also theoretically more effective in improving long term efficacy of AF ablation but this needs to be addressed in specific trial.Map of the Scar Complications and failures

Time-dependent Survival Effectiveness of Sacubitril/Valsartan and Gliflozins in Cardiac Resynchronization Therapy Recipients Robust evidence validating the long-term efficacy of Sacubitril/valsartan (ARNi), gliflozins (SGLT2i), and cardiac resynchronization therapy (CRT) combination remains scarce and data suggesting a synergistic advantage of these drugs alongside CRT have not considered their time-varying administration, leading to the well-known immortal bias, since only patients with longer initial survival could commence these treatments (Panel A in the Figure). This single-center longitudinal cohort study aimed to examine survival impacts of ARNi and SGLT2i in HFrEF patients after CRT implantation. 183 HFrEF patients consecutively admitted for CRT implantation between January 2015 and August 2022 were included. To account for patients who started or discontinued ARNi and/or SGLT2i at different time points during the study period, guided by the gradual emergence of scientific evidence (Panel B), an adapted Kaplan-Meier survival function and Cox regression models were constructed, updating the patient’s status to compare mortality rates during off-therapy with on-therapy periods. Of the 183 patients enrolled (81% men; median [IQR] age at CRT implantation: 67.2 [60.8-75.5] years), 62 were already receiving the drugs at the enrollment. During a median follow-up (CI 95%) of 7.1 (6.6-8.1) years, an additional 54 ARNi and 68 SGLT2i were prescribed, resulting in a total of 33, 13 and 78 patients in ARNi, SGLT2i and both drugs, respectively (Panel B). In total, 73 (40%) patients died, with 54 (30%) deaths related to HFrEF. Specifically, 37 occurred in no drugs group (total person-years:525) and 17 in ARNi/SGLT2i recipients (total person-years: 413). Time-dependent Cox regression analysis revealed a significant reduction in HF-related mortality risk associated with ARNi use, also confirmed after adjusting for confounders (HR 0.5 [CI 95%, 0.2-0.9; p=0.029]). To corroborate sacubitril/valsartan efficacy irrespective of the timing of prescription, as sensitivity analysis we compared only patients who started ARNi concomitantly or after CRT implantation, vs no drugs group: remarkably, Cox regression models showed a comparable reduction in HF-related mortality risk (HR 0.3, CI 95% 0.1-0-6, p=004; and HR 0.4, CI 95% 0.2-0.8, p=0.02, respectively). Prescribing SGLT2i did not affect survival, although the shorter periods of patients in gliflozins compared to ARNi or no drugs groups (p<0.001) requires cautious interpretation of these data. 1-year response to CRT remained the strongest predictor of lower mortality (p<0.001) (Panel C). Using appropriate time-dependent analysis, ARNi improved survival regardless of whether prescribed at the time of CRT or during follow-up. Further studies are needed to conclusively determine the role of gliflozins in this setting of patients (Panel D).

Cardiac implantable electronic device (CIED) replacement, mainly due to battery depletion[1], has become a pivotal aspect of activity in leading implant centers [2]. The complication rate significantly exceeds that of initial implantation [3]. Day surgery setting (DS) represents an emerging option in interventional cardiology compared with ordinary setting (OS), but the lack of studies regarding this setting leads to a gap in literature especially regarding complex devices (i.e. CRT-D or S-ICD). To show the safety and feasibility of DS setting for any kind of generator replacement. This is a retrospective observational, single center study of patients receiving CIED replacement between 2017 and 2024, which enrolled 208 patients. The cohort was divided into two groups: one underwent replacement in DS setting (125 patients) and one in OS (83 patients). We analyzed the safety of DS approach evaluating the infection rate at 1 year. We analized patients’ satisfaction with a questionnaire developed by our department and with The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and The Anesthesia and Surgery dependent Preoperative Anxiety (ASPA) questionnaire. Patients enrolled were 208 (66% male, 76 [25-97] years). Complex devices were 23% (1 CRT-P, 40 CRT-D, 6 S-ICD). Infection rate was 1,6% (n=2) in DS group and 2,4%(n=2) in OS group (p=0.677). Patients’ preference was found to be, in the DS group, 88,8%(n=111) for DS setting and 5,6%(n=7) for ordinary setting whereas, in OS group, 65,1%(n=54) preferred DS setting and 28,9%(n=24) preferred OS setting (p= <0.001). The day surgery setting is safe for patients undergoing any type of generator replacement, including complex ones. Our data suggests that shifting to a same-day discharge leads to higher levels of satisfaction and lower levels of preoperative anxiety and stress, with a reduction in the number of hospital bed-days and economic benefits for the healthcare system.Graphical Abstract

Remote Monitoring (RM) systems have been introduced in the early 2000s to remotely follow patients with cardiac implantable electronic devices (CIEDs). Initially data transmissions from CIEDs to physicians were performed via radiofrequency transmitters connected to CIEDs. Nowadays Bluetooth technology and smartphone applications allow to connect CIEDs with patients’ mobile avoiding an additional transmitter, and transmitting device diagnostic data to physicians in a timely manner, when relevant arrhythmic or clinical events occur. To assess patient compliance and acceptance in using Bluetooth technology and smartphone applications for CIED RM. The REACTION REGISTRY is a no-profit, International, multicenter, prospective observational conducted in Italy, Spain, Portugal and Greece. Data on connectivity were collected to assess the feasibility and effectiveness while the REMASQ questionnaire was used to assess the patient acceptance. The REMASQ questionnaire is composed by 12 questions aimed at investigating five aspects linked to the acceptance and satisfaction of remote monitoring: (i) relationship with one's hospital, (ii) ease of use of the technology, (iii) related psychological aspects, (iv) health implications and (v) overall satisfaction. Each response is scored on a five-point scale: from 0 to 4. The maximum score achievable in the questionnaire is 48. From September 2021 21 Cardiology Departments have included 228 patients. The demographic characteristics are shown in table 1. 185 patients (81,14%) were able to connect the device implanted with the RM system by themselves. In the remaining 43 patients, RM connection was facilitated by hospital staff, caregivers or device manufacturer technical support teams [Table 2]. Furthermore, 196 patients (85,96%) were able to perform device data transmissions. 66 REMASQ questionnaires were collected at 6 months follow-up. The mean scores for each of the five areas of the REMASQ were: 3.5±0.9 for the relationship with the hospital, 3.2±1.1 for ease of use, 2.4±1.7 for psychological aspects , 3.6±0.8 for clinical implications and 3.6±0.7 for the general satisfaction. The average score on the questionnaire was 38±8. Considering responses with a value ≥ 2 as positive, the total satisfaction with the remote control system was 98.51%. The preliminary results of our real-world registry show a satisfactory use and compliance of the RM through Bluetooth technology and a good acceptance of this method.Demographic Characteristics Connectivity data on Remote Monitoring

Aims The subcutaneous implantable cardioverter defibrillator (S-ICD) is an alternative to traditional ICDs. The PRAETORIAN score, based on chest radiographs, has been validated to predict the probability of successful S-ICD defibrillation testing by assessing factors like fat thickness between the coil and sternum and generator placement. This study evaluated the correlation between the PRAETORIAN score and clinical characteristics, as well as implantation variables. Methods and results We retrospectively analysed data from 1253 patients who had undergone implantation of an S-ICD across 33 centres. The intermuscular positioning of the pulse generator was adopted in all patients. Post-implantation posterior-anterior and lateral chest radiographs were analysed to calculate the PRAETORIAN score. A total of 95.7% of patients had a PRAETORIAN score < 90, indicative of a low risk of conversion failure. Body mass index (BMI) was the only independent predictor of a score >= 90, and all patients with BMI < 25 kg/m2 (normal weight or underweight) had a score < 90. The intermuscular positioning technique resulted in optimal posterior placement of the device in all patients and significant sub-generator fat in only 3% of cases. A shock impedance value > 88 Ohm enabled to detect a PRAETORIAN score >= 90 with 98% (95% CI 97-99%) negative predictive value. Conclusion In contemporary practice, the PRAETORIAN score can be simplified. By adopting an intermuscular approach, two of the three steps of the score-evaluating the adequate posterior positioning of the generator and measuring the sub-generator fat-become superfluous, and impedance may serve as a reliable surrogate of sub-coil fat thickness. Furthermore, our data suggest that for non-obese patients, a favourable PRAETORIAN score is assured, making the score evaluation potentially unnecessary. Clinical trial registration URL: http://clinicaltrials.gov/ Identifier: NCT02275637.

Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF) [1], but for persistent AF PVI appears to be suboptimal and any kind of additional lesion has been proven to not enhance the efficacy of the ablation [2-3]. In this setting, the Vein of Marshall ethanol infusion (VOM-EI) has been proven to reduce recurrences of AF 12 months [4]. The VOM-EI has been proven to cause up to 2,8% of procedure-related pericarditis in a large cohort of 700 patients [5]. Evaluate the effects of colchicine in VOM-EI related pericarditis reduction. We retrospectively analyzed the incidence of pericarditis in a cohort of consecutive patients with persistent AF without an history of previous ablation who underwent single day discharge VOM-EI 30 days before the ablation procedure according to our center protocol. We enrolled 63 patients (71.1% male, 65±6.8 years). In the first 44 (69,8%) the incidence of pericarditis was 4,5% as compared to the next 19 (30,2%) patients, who started to receive prophylactic colchicine (as for our Centre protocol update, 1 day before and 7 days after VOM-EI), who did not experienced pericarditis. Our data show that prophylactic colchicine treatment in patients undergoing VOM-EI is promising in reducing the incidence of procedure related pericarditis.Population Pericarditis

Brugada syndrome (BrS) is an arrhythmic hereditary disorder affecting mainly males, aged 30–50 years. Type D personality has a prevalence of 32.7% among BrS patients and 15% of these patients have an history of psychiatric disorders. One out of six BrS patients could develop anxiety/depression after BrS diagnosis or after the implantation of a defibrillator. This review evaluates the psychological profile of BrS patients, the impact of its diagnosis, and potential tools to evaluate these features.