Abstract Background Nowadays the benefits of remote monitoring (RM)of cardiac implantable electronic devices (CIEDs) are Known: an improved both device surveillance and patient clinical management and a decrease in office follow up. So RM is used as supplement in clinic follow up for patients with CIED.However despite decades to RM utilization there are challenges in managing patients with RM including large number of trasmissions and lack of trained staff. There are many different model of care to RM management. Methods We describe our model of care to management CIED recipients with RM considering data collected from January 2021 to November 2023. Results Our model of care consists of 4 electrophysiologists Physicians and 4 Tecnicians. RM enrollment is performed at scheduled in office visit after ten days from hospital discharge after device implantation. implantable cardiac device(ICD)recipients with RM are annualy followed in office and biennal for pacemaker (PM) recipients and they send every three months transmissions. Trained tecnicians gives home monitor, take care of patients education and collected and screen transmissions. Tecnicians inform immediately physicians in case of urgent alert (shock or antitachicardia pacing therapy (ATP), sustained ventricular tachycardia(TV), ventricular fibrillation (Fv) indicator of elective replacement (ERI), lead releted alert or noise). Physician contact patients the same day (exept Saturday and Sunday). In addiction Physicians twice a week review less urgent and scheduled transmissions and call the patients by phone for visit in office for patients with low rate of biventricular pacing, detection of atrial fibrillation. We have 1000 patients with RM: 746 ICD recipients (103 Biotronik, 150 Abbott, 200 Boston scientific, 293 medtronic), 50 implantable cardiac monitor (ICM) recipients and 204 PM recipients. We analyze 12721 transmissions.Considering ICD recipient we detect 96 episode of ATP and 31 of shock. Shock of ICD was registered in 52 patients (6,9%)We received 1982 atrial fibrillation (AF) detection, with 35 for new detectable AF.The most of transmisisone were for low bIV pacing. We contacted these patients by phone about clinical status and in some case we called them in office. Conclusions Our model of care allows to control a large number of trasmissions with fast management of urgent alert trasmissions.

Abstract Background Starting from February 2023, the Piacenza’s Hospital has approved the use of a cardiological telemonitoring system called ‘TeleCuore’ project. This system, through the monitoring of various vital parameters which are frequently sent by patients via a dedicated platform, allows for remote assessment of the clinical status of 250 individuals with chronic heart failure (CHF). Objectives The objective of this study is to analyze the number and nature of alerts in the data sent by patients and the consequences on patient’s management derived from the alerts received through the telemedicine system. Materials and Methods 250 patients with CHF identified following recent episodes of clinical instability have been equipped with a home monitoring device (Adilife system). This involves collecting the following data: body weight, temperature, blood pressure, heart and respiratory rate, oxygen saturation, and single–lead EKG. These data are daily filtered by perfusionist technicians (TFCPC) and dedicated nurses, reviewed by the Case Manager and cardiologists. In case of recognition of altered parameters, the platform generates alerts according to pre–set clinical parameters, enabling proactive and personalized interventions on patients. In the 9 months of the TeleCuore project, 494 alerts were received, with 119 (24%) judged not clinically relevant, while 375 (76%) required operator intervention. Of these, 99 were due to weight gain (26%), 40 to low blood pressure (11%), 42 to high blood pressure (11%), 33 to tachycardia episodes (9%), 30 to bradycardia (8%), 49 for technic issues with the weight scale (13%), 78 for EKG artifacts (21%), and 4 for previously unknown atrial fibrillation (1%). 25 patients (8%) were invited for ambulatory clinical evaluation, 28 (7%) were managed through teleconsultation, and the remaining majority (85%) was handled via telephone contact for therapy adjustments (60.5%). 39.4% underwent re–training on the correct device use in the first month. Conclusions The TeleCuore Project is a pilot cardiological telemedicine initiative. Initial data confirm the utility of this system in optimizing the follow–up of patients with CHF, allowing for instant therapeutic adjustments based on the patient’s clinical progress. Teamwork of different healthcare professionals have emerged as crucial for the proper management of alerts. Further data will be needed to assess whether TeleCuore also helps reduce hospitalizations related to CHF.

Abstract Background Previous studies established a role for the wearable cardioverter defibrillator (WCD) in patients with transient risk os sudden cardiac death (SCD). The WEARIT–II Registry highlighted an higher burden of ventricular and atrial arrhythmic events in women than in men, in spite of a similar ICD implantation rates. Objectives We aimed to describe the sex differences in WCD use and compliance. Moreover we reviewed the rate of cardiac events detected with WCD and the rate of ICD implantation in women in a real–world single center experience. Methods and results Between August 2017 and June 2022, 60 consecutive patients receiving a WCD at Piacenza Hospitals were retrospectively included in this analysis: mean age 66.9±11.9 years, 56.6% with ischaemic cardiomyopathy, 38.3% with dilated cardiomyopathy, 5% after implantable cardioverter–defibrillator explant. 8 patients were women (13.3%). Women and men presented similar clinical characteristics. Median WCD usage period and median daily wear time were not different between women and men (49.6±25.3 vs 51.8±32.8 days, 23.6±0.3 vs 23.1±1.7 hours, respectively). No ventricular fibrillation was detected in the monitoring period. Non–sustained ventricular tachycardia and atrial arrhythmias were similar between women and men. However, ICD implantation rate at the end of WCD use was significantly lower in women than and men (25% vs 61.5%; p< 0.01). Conclusions In this real word analysis WCD was underused in women despite a nice compliance. A similar burden of ventricular and atrial arrhythmic events were detected, with a lower ICD implantation rate at the end of WCD use in women than in men.

ABSTRACT Background Globally nearly 20% of cardiovascular disease deaths were attributable to air pollution. Out-of-hospital cardiac arrest (OHCA) represents a major public health problem, therefore, the identification of novel OHCA triggers is of crucial relevance. The aim of the study was to evaluate the association between air pollution (short-, mid-and long-term exposure) and out-of-hospital cardiac arrest (OHCA) risk, during a 7 years-period from a highly polluted urban area with a high density of automated external defibrillators (AEDs). Methods and results OHCA were prospectively collected from the “Progetto Vita Database” between 01/01/2010 to 31/12/2017; day-by-day air pollution levels were extracted from the Environmental Protection Agency (ARPA) stations. Electrocardiograms of OHCA interventions were collected from the AEDs data cards. Day-by-day particulate matter (PM) 2.5 and 10, ozone (O3), carbon monoxide (CO) and nitrogen dioxide (NO2) levels were measured. A total of 880 OHCAs occurred in 748 days. A significantly increased in OHCA risk with the progressive increase in PM 2.5, PM 10, CO and NO2 levels was found. After adjustment for temperature and seasons, a 9% and 12% increase of OHCA risk for each 10 μg/m3 increase of PM 10 (p< 0.0001) and PM 2.5 (p< 0.0001) levels was found. Air pollutants levels were associated with both asystole and shockable rhythm risk while no correlation was found with pulseless electrical activity. Conclusions Short-term and mid-term exposure to PM 2.5 and PM 10 is independently associated with the risk of OHCA due to asystole or shockable rhythm.

Abstract Background Previous studies established a role for the wearable cardioverter defibrillator (WCD) In patients with transient risk of sudden cardiac death ( SCD) . In clinical trials, nearly 40% of patients received implantable cardioverter–defibrillator (ICD) implantation at the end of WCD use. It’ unknown if WCD can be usefull in final ICD implantation indication. Objectives We aimed to describe the clinical predictors of ICD implantation rate at the end of WCD use in a real–world single center experience. Methods and results Between August 2017 and June 2022, 60 consecutive patients receiving a WCD at Piacenza Hospitals were retrospectively included in this analysis: : mean age 66.9±11.9 years, 56.6% with ischaemic cardiomyopathy, 38.3% with dilated cardiomyopathy, 5% after implantable cardioverter–defibrillator explant. A total of 34 participants (56.6%) received implantable cardioverter–defibrillator (ICD) implantation at the end of WCD use. We evaluated clinical features related to ICD implantation rate with Chi Square test and Student’s t test. Female sex was related with no ICD implantation ( ICD 5,9% vs no ICD 23,1%, p= 0,03), whilst Low ejection fraction at beginning of evaluation was related with ICD implantation ( ICD 27.1±9.3 vs no ICD 33.1±11.9, p=0,03). Although in our population there weren’t shock of WCD, the strongest clinical predictor was arrhythmic event recordered at WCD monitoring both non sustained ventricular tachicardia, sustained ventricular tachicardia and supraventricular tachicardia ( ICD 20 vs no ICD 0, p < 0,01). Age ( ICD 66.6±11.9 vs NO ICD 67.4±11.9, p=0,7) and etiology of cardiopathy both ischemic and non ischemic ( ICD 52% vs no ICD 53,8%, P=0.5) were not factors associated with ICD implantation. Conclusion In our study the rate of ICD implantation after wearing time of WCD is consistent but slightly major to European registries. Arrhythmic Event recordered at WCD monitoring is related with ICD implantation, so WCD, when it is used, may be a further help in final ICD implantation.

Abstract Background Heart failure (HF) has an high social–health impact that requires frequent checks and urgent hospital visits. The management of chronicity through telemedicine, integration of hospital–territory care and multidisciplinarity represents a goal of the italian PNRR. Objectives The project tests the feasibility of an organizational model of integrated management of heart–failure patients based on multidisciplinary integration and the use of telemedicine. Materials and Methods 250 heart failure patients will be selected by the Heart Failure Outpatient Department of AUSL Piacenza, with the following characteristics: positive technological anamnesis, NYHA functional class II–III, clinical instability (hospital access for heart failure/need to boost diuretics in the previous 12 months) and management complexity. We will use Aditech devices, which through mobile–app will send the following parameters to the platform on a daily basis: blood pressure, weight, ECG (single track) and saturation. A QoL Assessment Questionnaire (KCCQ) will be administered. 10 GPs will be selected to view the data on the platform and be able to carry out a cardiological Teleconsultation. The Case manager (CM) and a cardiovascular technician (TFCPC) will explain the functioning of the device to groups of 2–3 patients and, in collaboration with the nursing staff, the baseline control of the parameters and blood tests will be carried out. Pre–set alerts will be activated based on the changes in the detected parameters, which will be evaluated by the TFCPC/CM and managed with the Cardiologist for therapy optimization and patient empowerment. Through televisit, the CM will evaluate the case, based on pre–established protocols, will program the necessary diagnostic services (EGC, chest echo/fast echo, performed by the TFCPC using wireless echo probes at community homes) and will plan ways to improve lifestyle. The intervention of the GP or cardiologist will be scheduled after a multidisciplinary briefing based on the clinical case. Conclusions The project experiments an integrated hospital–territory service model for the heart failure patient, through the use of telemedicine. The home management of the instrumental parameters and their daily sending should help to quickly manage any problems. Televisit integrated with telemonitoring and teleconsultation should reduce the number of hospital admissions.

Abstract Funding Acknowledgements Type of funding sources: None. Background the risk of sudden cardiac death (SCD) currently represents a severe problem that significantly involves the population. The implantable cardiac defibrillator (ICD) has been used to prevent SCD among patients with a high risk for life-threatening sustained ventricular arrhythmias. However, there are a number of patients at risk for SCD either awaiting a work-up for reversible causes of SCD or with acute contraindications to ICD implantation. Nevertheless, ICD implantation is dependent on defining ventricular substrate, evaluating the future risk of SCD and estimation of the patient’s overall survival. The wearable cardiac defibrillator (WCD) provides an option for protection during this vulnerable period when the risk of SCD is unclear. Methods our virtual device control clinic is managed by 3 cardiovascular technicians and 3 electrophysiologists. From August 2017 to January 2022, we included 29 patients who received WCD, 6 women (21%), with an average age of 66 years. The indications for the use of WCD were: ischemic cardiomyopathy (62,1%) and non-ischemic cardiomyopathy (17,24%),during cardiovascular rehabilitation pending eventual recovery of the ejection fraction (EF), waiting for genetic test result (10,34%) or ICD explant for infection awaiting reimplantation (10,34%).The patient is trained by technician staff to ensure the correct wearing of the WCD, the management of any alarms, the management of the device in case of arrhythmia and shock, as well as the daily replacement of the battery and the management of the remote monitoring system. Results in virtual control device clinic Cardiovascular Technician checks the transmissions from the WCD site: only clinical parameters such as recorded ECGs (manual, asystolic, events detected but not treated and events treated with shock) and patient compliance (wearing hours per day) can be verified.The average wearing duration has been 37 days, with a daily average of 23.1 hours. We received and controlled a total of 1097 transmissions, of which 22 with events, of which 7 were generated for VT, 4 for TSV, 10 for T wave oversensing and 1 for inappropriate Shock; in all these cases, the patient has been contacted by the clinic staff for clinical management. At the end of wearing period, technical staff schedules a check-up with echocardiogram monitoring the EF to evaluate the patient's clinical path. Following the clinical evaluation, a recovery of cardiac function has been possible for 13 patients, without any implantation of ICD, whereas 16 patients underwent a defined implantation of ICD. Conclusions the WCD has been shown to be an effective device in protecting SCD from VT/VF. Despite the small number of patients, it was necessary to take them in charge at the virtual remote monitoring clinic for proper clinical management, which generated a workload increase. Therefore, it will be important to propose a recognition of the service and its reimbursement.

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND The debate about the independent prognostic responsibility of functional mitral regurgitation (FMR) is still in turmoil. Growing findings about the predictive role of left atrial (LA) function are emerging in several scenarios. PURPOSE This study aims to define FMR linkage to cardiovascular (CV) outcomes and the interplay with LA function in a prospective cohort of consecutive heart failure patients with reduced ejection fraction (HFrEF). METHODS 286 consecutive outpatients with chronic HFrEF were enrolled. FMR was quantified by effective regurgitant orifice area (EROA). Global peak atrial longitudinal strain (PALS) was measured by speckle tracking echocardiography (STE). The primary endpoint was defined as a composite of congestive HF hospitalization and CV death. RESULTS The majority (81%) of patients were men (mean age: 67 ± 11 years, mean LVEF: 32 ± 6%). The median global PALS was 17.7% ranging from 2.7% to 49.2%. FMR was quantifiable in 240 (84%) patients. During a median follow-up period of 6.4 (IQR 3.9-7.7) years, the primary endpoint occurred in 88 (31%) patients (35 HF admissions, and 53 deaths). EROA showed independent prediction for the primary endpoint (HR 1.30 [1.05-1.57], P = 0.01). The spline modeling of the risk by EROA values showed an excess event risk starting at about the EROA value of 0.1 cm2 (Figure 1). There was a remarkable graded association between the EROA strata, even if tested per 0.1 cm2 increase, and the risk of congestive HF hospitalization and CV death (P = 0.0004). Any FMR grade presenting with reduced LA function (PALS < 14%) was associated with dismal outcome (event rate of 63 ± 10% for EROA exceeding 0.3 cm2 and 49 ± 6% for EROA ≥0.1 cm2 at 5 years). Conversely, the presence of EROA ≥0.1 in the context of preserved global PALS showed a better outcome (Figure 2). CONCLUSIONS Our results refine the independent association between FMR and CV outcome among HFrEF outpatients. The risk of CV events starts at a low EROA value, reaching a severe level above the threshold of 0.3 cm2. Within a moderate EROA range, the LA function mitigates the clinical consequences of the mitral regurgitation, providing measurable proof of the interplay between the regurgitation and the LA compliance. Abstract Figure 1 Abstract Figure 2

Abstract Background Worldwide, cardiovascular disease are still a major mode of death, being sudden arrhythmic death (SCD)25 % of total death. Implantable cardioverter defibrillator (ICD) is an effective weapon for SCD prevention in high risk patients with reasonable expectation of survival with good functional status for >1 year. However sometimes the risk of SCD can be transient, so the use of a wearable cardioverter defibrillator (WCD) is considered. Methods We considered consecutively 40 patients discharged from our cardiology department of Piacenza and Castel san Giovanni that, for potentially transient high risk of SCD, weared a WCD from August 2017 to September 2021, after a systematic education session lasting 30 – 45 minutes. They are followed through remote monitoring. Results Out of 40 patients, with average age 66 years old and average left ventricular ejection fraction (LVEF) 29%, 88% were males, 70 % suffered from arterial hypertension, 32% diabetes mellitus, 17,5 % peripheral vascular disease, 35 % chronic renal failure, 55% heart failure, 7,5% previous stroke. 56% of these patients weared WCD for severe systolic disfunction in ischemic cardiac disease after recent myocardial infarction, after percutaneous coronary intervention or coronary artery bypass graft, 7% after removal of an infected ICD, 9 % whilst awaiting completion of diagnostic tests (chanalopathies/right arrhythmogenic ventricular cardiomyopathy), 34% after newly diagnosed cardiomyopathy.The patients were discharged in high risk mode of SCD with WCD protection.The average wearing time of WCD was 51 days and 22,98 hours daily. We received 953 trasmissions, with 21 events: 7 ventricular tachicardia, 4 Sopraventricular tachicardia and 5 T wave oversensing .Neither inappropriate shock and neither death were detected .After wearing time and after clinical evaluation, only 52% of patients were subjected to ICD implantation. Conclusions In our experience we may consider that WCD use is effective, safe and with a good adherence in all patients, considering wearing time. The WCD allows saving resources with less hospitalization time.

Abstract Background The wearable cardioverter defibrillator (WCD) is considered in patients with increased risk of sudden cardiac death (SDC), in which implanted cardiac defibrillator (ICD) is temporary not definitively indicated. A few registry confirmed efficacy and safety of WCD and left ventricular ejection fraction recovery (LEVS)after wearing time. Methods We considered in our study 40 consecutively patients that used WCD in Piacenza and Castel San Giovanni Cardiology Department from August 2017 to September 2021 with recent acute myocardial infarction, newly diagnosed cardiomyopathy, primary arrhythmias syndrome awaiting diagnostic completation. They were followed by remore monitoring. The primary outcome were: the need of ICD implantation or not indication to ICD at the of the wearing time, We analyzed clinical variables related to primary outcome. Results Out of 40 patients, average age 66 years, average LEVS media 29%±12,5,88% were males, 32% suffered from diabetes mellitus, 35% renal failure, 55% acute and chronic heart failure, 10% previous ischemic stroke, 17% atrial fibrillation (AF), 12% cardiac arrest (ACC) after STEMI onset, 20% ventricular tachicardia (VT). 27% of these patients took amiodarone,92% beta blockers and 82% ACEi.The average wearing time of WCD was 51 days and 22,96 hours dailyAt the end of this period 48% of patients didn‘t receive ICD implantation for increasing LEVS.We evaluated clinical variables related to primary outcome with Chi Square test and Student’s t test.There weren’t significant difference regarding primary outcome between ischemic disease and other cardiophaties. The presence of AF, previous stroke, renal failure, hypertension, diabetes mellitus was more but not significant in ICD group. No significant age difference(66.8±14.1 vs 66.3±11.8, p = 0,6) neither FEVS (29.4±11.6 vs 29.5±12.7, p = 0,8) was in patients that received ICD versus not received .The clinical variables related to primary outcome only were: ACC after STEMI onset and amiodarone therapy. Conclusions In our study of patients with WCD, the percentage of LEVS increase is consistent with European registries. A few clinical variables may be related to ICD indication. Further studies can be useful to identify patients who need more of WCD for a lack of LEVS improvement.

Backgrond: During the first outbreak of COVID 19 pandemic, Piacenza was particularly affected since it counted over one hundred daily access in emergency department, of patients (pz) with SARS COV2 virus. This fact led to a reorganization of hospital activity consisting in the formation of 7 department devoting COVID 19 care and in temporarily postponing scheduled activities of various disciplines to prevent the spread of virus. Also Our Division of cardiology has kept only urgent clinical and interventional activity. With the use of remote monitoring (RM), we were able to check implantable cardiac devices (ICD) almost scheduled and we called ICD recipients in office only for urgent troubles. Methods: In our study we evaluated all ICD recipients that had a scheduled follow up in our electrostimulation clinic on the period from 23th February 2020 to 18 th May 2020 Results: In office scheduled controls during the period considered, involved 216 patients. 85% out of them was followed also with MR;after postponing in office visits, we requested control transmissions. In total we received 441 scheduled and with alert transmissions. Regarding alert transmission: 3 of them signaled ERI (elective replacement indicator), so the replacement of device has been planned;3 of them indicated noise in Ventricular Fibrillation zone related to lead malfunction, so we planned reimplantation of new ventricular lead;12 recorded ventricular arrhythmias (only one patient was called to visit in office for recurrent ventricular arrhythmias);1 of them signaled long lasting atrial fibrillation so we called him to begin anticoagulant therapy. We performed phone triage before confirming in office visit. None of the scheduled transmissions detected troubles. Only 1,8% of patients followed by remote monitoring came in hospital in that period. Conclusions: RM during phase 1 of the first wave of COVID 19 outbreak allowed us to reduce in office visits and to call in hospital only patients with real needs, decreasing the spread of the virus and maintaining identification of clinical and technical troubles.