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Background Cardiopulmonary resuscitation (CPR) Guidelines are updated every five years in the light of new evidence. Recent major changes emphasized the importance of quality chest compressions during CPR and simplified recommendations for lay providers, but it is unknown whether these changes improved neurological outcomes. Purpose To analyse whether changes in CPR guidelines had an impact on the prognosis of comatose survivors after cardiac arrest (CA). Methods Prospective database of consecutive patients (pts) admitted to the acute cardiac care unit of a tertiary hospital after in-hospital and out-of-hospital CA (IHCA and OHCA) treated with targeted temperature management (32–34°) from August 2006 to January 2020. Patients were divided into three groups, each one representing the 5-year time frame of publication/implementation of CPR Guidelines: G1 (2006–2010); G2 (2011–2015); G3 (2016–2020). Results A total of 510 pts were included: G1 94 (18.4%), G2 243 (47.6%), G3 173 (33.9%). Mean age was 62.6±14.5 and 413 (81.0%) were men. Demographic characteristics and cardiovascular risk factors did not differ significantly among groups. Changes in CA features among the three analysed periods are shown in Table 1. On regards of prehospital care, CPR provided by lay bystanders (G1 51.6%; G2 63.3%, G3 69.8%) and the use of automated external defibrillators (AED) (G1 11.0%; G2 14.9%; G3 18.9%) progressively increased (p=0.01 and p=0.04, respectively) (Figure 1, A and B). After 2010, there was a higher proportion of CPR-related injuries: G1 12.7%, G2 23.5%, G3 22.7% (p=0.02). Global survival at discharge was 51.6% (263/510). Cerebral Performance Category (CPC) of 1–2 within a 3-month follow-up period significantly increased over time when comparing G1, G2, G3 groups (p=0.04) (Figure 1, D). Among all pts, those with CPR related injuries had a higher proportion of CPC 1–2 (71/109, 65.1% vs 168/389, 43.2%, p<0.01). Conclusions We found a progressive increase of lay bystander CPR and use of AED over the three time periods. Moreover, a higher proportion of CPR-related injuries was observed after publication of 2010 CPR Guidelines which recommended greater depth and higher rate of chest compressions. Survival and neurological outcomes improved significantly over time. Figure 1 Funding Acknowledgement Type of funding source: None

Funding Acknowledgements Type of funding sources: None. Introduction Ablation of atrioventricular nodal re-entrant tachycardia (AVNRT) is an extremely safe procedure, being complete atrioventricular (AV) block the most feared complication.  Transient AV or ventriculoatrial (VA) block during ablation is considered a risk marker of immediate AV permanent block. Purpose To study whether TB (transient block) during AVNRT ablation is associated with a higher risk of AV permanent block and pacemaker implantation during long term follow-up. Methods Retrospective analysis of all patients who underwent ablation for AVNRT in our center and had a minimum five years follow-up. Patients carrying a cardiac pacing device were excluded. Data was extracted from electronic medical records and follow-up was performed by telephone contact. TB was defined as AV or VA loss of conduction of at least 1 beat during energy delivery. Results We included 689 patients who underwent AVNRT ablation from March 1995 to December 2015: mean age 52.6 ± 18.6 years; 240 (34.8%) male; 677 radiofrequency and 12 cryotherapy ablations. TB was observed in 106 (15,4%) patients. Baseline characteristics are described in Table 1. Within the TB group, 44 (41.5%) patients presented with AV block, 60 (56.6%) with VA block, and 2 patients presented with both. TB concerned more than one beat in 65 (61.9%) cases and persisted after cessation of energy delivery in 15 (14.2%) cases.  Two patients did not recover AV conduction, requiring pacemaker implantation before discharge. During a median 12.5 years follow-up (IQR 9.5-16.6), 3 of the remaining 104 TB patients required pacemaker implantation due to AV block. All 3 had presented AV TB and had undergone radiofrequency ablation; they were not significantly older (67.0 ± 9.3 vs 48.8 ± 19.8, p = 0.12) but presented longer basal PR (237.0 ± 115.2 vs 152.6 ± 26.5, p < 0.001) and HV (57.3 ± 6.7 vs 44.2 ± 7.6, p = 0.004) intervals. When compared to the non-TB group, there were no differences in pacemaker implantation due to AV block during follow-up (7 (1.2%) p = 0.19). However, median time to pacemaker implantation was shorter in TB patients than in non-TB: 0.7 [0.1-1.4] vs 13.7 [5.2-22.0], p = 0.02. Conclusion Long term incidence of permanent AV block did not differ between TB and non-TB groups, however AV block occurred significantly earlier in TB patients. Non-TB group(n = 583) TB group(n = 106) p Age (mean ± SD) 53.2 ± 18.3 49.3 ± 19.8 0.05 PR (mean ± SD) 153.0 ± 28.4 155.0 ± 33.8 0.54 AH (mean ± SD) 83.3 ± 23.6 82.1 ± 22.2 0.64 HV (mean ± SD) 44.4 ± 7.8 44.6 ± 7.9 0.76

Background Cardiopulmonary resuscitation (CPR) manoeuvres involve vigorous compressions with the proper depth and rate in order to keep sufficient perfusion to organs, especially the brain. Accordingly, high incidences of CPR-related injuries (CPR-RI) have been observed in survivors after cardiac arrest (CA). Purpose To analyse whether CPR-related injuries have an impact on the survival and neurological outcomes of comatose survivors after CA. Methods Observational prospective database of consecutive patients (pts) admitted to the acute cardiac care unit of a tertiary university hospital after in-hospital and out-of-hospital CA (IHCA and OHCA) treated with targeted temperature management (TTM 32–34°) from August 2006 to December 2019. CPR-RI were diagnosed by reviewing medical records and analysing image studies during hospitalization. Results A total of 498 pts were included; mean age was 62.7±14.5 years and 393 (78.9%) were men. We found a total of 145 CPR-RI in 109 (21.9%) pts: 79 rib fractures, 20 sternal fractures, 5 hepatic, 5 gastrointestinal, 3 spleen, 1 kidney, 26 lung and 6 heart injuries. Demographic characteristics and cardiovascular risk factors did not differ between the non-CPR-RI group and CPR-RI group. Also, we did not find differences in CA features (Table 1). Survival at discharge was higher in the CPR-RI group [74 (67.8%) vs 188 (48.3%); p<0.001]. Moreover, Cerebral Performance Category (CPC) 1–2 within a 3-month follow-up was significantly higher in the CPR-RI group [(71 (65.1%) vs 168 (43.2%); p<0.001; Figure 1]. Finally, pts who recieved blood transfusions were proportionally higher in the CPR-RI group [34 (32.1%) vs 65 (16.7%)]; p=0.004). Conclusions In our cohort, the presence of CPR-RI was associated with higher survival at discharge and better neurological outcomes during follow-up. Figure 1 Funding Acknowledgement Type of funding source: None

Background Poor adherence is a barrier to optimal secondary cardiovascular prevention. The need for a polymedication, the cost of some drug therapies and the silent evolution of some cardiovascular conditions are often related to poor adherence. A fixed-dose polypill strategy (AAS, ACEi and statin) has emerged as a possibility to improve adherence in cardiovascular prevention and therefore improve outcomes. Nevertheless, the complexity of cardiovascular disease patients' drug therapy regimes and the need for titration of doses in order to reach the goals, makes it difficult to introduce a fix-dose polypill. Methods We performed a prospective study of consecutive patients attending a secondary prevention consultancy. In order to find out whether they were amenable to a polypill regime, we analyzed their drug therapy scheme and the level of control of blood pressure and LDL cholesterol. Results We included 302 patients, and their treatment is shown in table 1. Of the total of patients, we found that only 25 patients (8.3%) were optimal candidates for receiving a fixed-dose polypill. The reasons for not being eligible are summarized in figure 1, highlighting the need for higher statin dose or statin intolerance as the most frequent cause (79.5%), or the need for titration or combination of drugs according to the blood pressure levels. Patients' characteristics and therapy Patients (n=392) Sex (male) 252 (83.4%) Age (mean ± SD) 60.82 (±11,33) Event (STEMI, NSTEMI, angina) 155 (51.3%), 123 (40,7%), 24 (7.9%) ACEi/ARBs 279 (72.5%) ASA 279 (92.4%) Statins (Atorvastatin 80mg, atorvastatin 40mg, rosuvastatin, other statin) 221 (73.2%), 37 (12.3%), 25 (8.3%), 17 (5.6%) Anti-arterial hypertensive combination pill 51 (16.9%) Number of drugs (mean±SD) 6.61 (±2.47) Optimal blood pressure control (<140/90 mmHg) 197 (65.2%) Optimal LDL control (<70 mg/dl) 208 (69.8%) Causes of non-eligibility for polypill Conclusion Despite the fact that polypill could bring the opportunity to improve cardiovascular drug therapy adherence, the complexity of secondary prevention patients and the common need for a high dose statin makes it difficult to implement a polypill scheme in the real practice.