Background Atrial fibrillation (AF) is the supra-ventricular tachyarrhythmia mostly encountered in the clinical practice.While appearing silent or with a constellation of symptoms, it confers a 5-fold risk of stroke. Early detection is mandatory to establish the diagnosis and recommend anticoagulation. Besides the arrhythmia recognition through several tools, such as Holter ECG and loop recorders, it has been underlined that cardiac implantable electronic devices with an atrial lead can help in recognizing asymptomatic AF periods, also known as atrial high-rate episodes (AHREs). Materials and Methods 48 patients with AHRE detection at device telemetry checks were enrolled; implanted device were pacemakers (n=31, 64.8%); implantable cardioverter/defibrillators (ICD, n=8, 16.6%); cardiac resynchronization therapy devices with defibrillators (CRT-D, n=9, 18.5%). Male gender was predominant (40 vs. 8), age was > 65years, and mean CHA2DS2VASc was 4.2±2.8. Patients underwent ECG assessment in 6-month intervals (at baseline and during follow-up), MOntreal Cognitive Assessment test, and device interrogation for AHRE of duration >5 minutes and rate >175 beats per minute. Randomization to a direct oral anticoagulant (DOAC) or usual care (aspirin when needed or placebo) was provided in a blind fashion and maintained for the entire study observation until occurrence of overt AF, followed by exclusion from the study. Results We found that 13%-16% of patients with device-detected AHRE developed AF over a mean follow-up of 2.5 year (range 4.6±2.0). These cases were given oral anticoagulation since change of indication according to current guidelines. Most important comorbidities were coronary artery disease (n=18 patients, 36.73%); systemic hypertension (n=41, 83.67%); diabetes (n=13, 26.53%); dyslipidemia (n=23, 46.8%); heart failure (n=17, 35.4%). 30 patients were treated with beta-blockers(62.5%). 2 patients died for gastrointestinal bleeding. One patient was excluded for major bleeding after one month from the enrollment. Total AHREs duration was significantly lower in patients with pacemaker (14 hrs) compared to patients with CRT-D (17 hrs) and ICD (20 hrs, p<0.05). Conclusions The impact of AHREs was higher in patients affected by cardiac dysfunction and concomitant diseases; none of the patients enrolled in the study developed ischemic stroke; major bleedings were observed in both arms. Further studies are warranted for considering oral anticoagulation based on the sole device interrogation in the context of subclinical atrial fibrillation.

Background Despite many therapeutic resources and technological innovations, coronary artery diseases (CAD) yet represent the first cause of death in industrialized countries. In order to improve outcomes in CAD and other chronic diseases, it has been proposed to implement personalized and continuous home-monitoring through digital applications. Currently, dyslipidemias are considered the ideal target condition for the development of such telemedicine approaches. Objectives The main goal is to evaluate the efficacy of a mobile app on the clinical cardiovascular outcomes, by analyzing the adherence to lipid-lowering therapy of dyslipidemic patients, compared to out clinics patients followed under standard work-ups. Materials and methods From March 2022 to September 2022, 15 patients were enrolled who were able to benefit from remote monitoring and 8 patients undergoing outpatient monitoring. The two groups were divided into four categories: 8 ischemic patients to whom the mobile app was recommended admitted with a diagnosis of CAD and undergoing PCI (percutaneous coronary intervention), 4 ischemic patients undergoing outpatient follow-up, 7 not ischemic admitted for other procedure for which remote monitoring was proposed, 4 non-ischemic patients with outpatient procedure. the lipid profile was assessed by mobile application and outpatient visit, respectively. Results In the evaluation between the group of patients who underwent the diagnostic application procedure and the outpatient group, greater adherence to the use of telemedicine was found in patients aged 40-69 years or who could benefit from the help of family members. Lack of information and experience in using the systems and devices was a significant obstacle in 5 percent of patients all over 78 years of age and in the absence of a family member. Given the many logistical and waiting time problems for hospital visits, 57 percent of patients who underwent a medical examination via the app benefited most from using the remote app. Mean LDL values of 97 mg/dL at one month after discharge were found in 66% of patients particularly the subgroup of ischemic patients who, given the strong correlation between atherosclerotic disease and ischemic heart disease, require closer follow-up, with mean LDL values of 95mg/dL found. Conclusions Telemedicine has the potential to improve clinical outcomes in patients with dyslipidemia, although efficacy is influenced by parameters such as age and family support; in the future, telemedicine platforms could be an aid to evaluate new therapeutic opportunities for innovative treatments, such as bempedoic acid. Telemedicine helped patients in understanding the importance of reducing LDL cholesterol.

Background The risk of cardiac conduction system defects (CCD) after transcatheter aortic valve implantation (TAVI) remains high and requiring permanent pacemaker implantation (PPI) in 20% of the patients. Numerous studies have suggested that up to half of patients who underwent PPI within 30 days after TAVI do not depend on their PM at one year. The micro-calcific deposits of the atrioventricular node cannot be detected by standard echocardiography, while CT scan can reliably identify them. While pacemaker implantation was recommended according to clinical status and current guideline, in this small retrospective analysis, pre-procedural CT scan calcium quantification was considered an anatomical predictor of AV conduction prolongation until advanced disorder and cardiac block. We assume that differential calcium localization into the AV node might contribute to progression of conduction disorders until complete heart block. Aims The objective of this pilot study is to evaluate the impact of calcium score assessment as a predictor of the development of CCD after TAVI. The goal is to evaluate the interaction between PM dependency and the value of calcium score at the CT scan pre-TAVI. the data collected in this single-center cohort analysis AIMS TO help identify patients at higher risk of permanent pacemaker implantation after TAVI pacemaker insertion and pacemaker-dependent patients at one year through CT calcium scoring. Methods From January 2020 to September 2021, we retrospectively collected data from our institute. One-hundred and thirty patients without prior PM underwent TAVI in our institution. Overall mean age was 79,7 years old with 57,1% of females, with a pre-procedural diagnosis of aortic stenosis and a mean gradient of 47,4 mmHg. At 30 days, PPI was reported in 21 patients (16,1%). Out of twenty-one patients 47,6% developed complete atrioventricular block, 19% developed atrioventricular block II grade type 2 and 33,3% other conduction defects. The dependency at the implantation was 51,1%. With a dedicated software at the CT scan, we assessed the calcium score located in three regions near the atrioventricular node: aortic valve, left ventricular outflow tract (LVOT) and anterior mitral annular (Figure 1). Two patients were excluded for the diagnosis of severe aortic stenosis low-flow low-gradient. The Primary endpoint was to identify patients who had higher risk of PPI after TAVI pacemaker insertion. Results At 12 months follow-up, 23,8% of patients died (n=5). All the remaining patients, 28,5% had a high rate of ventricular pacing (Vp) at implantation (n=6). One year later at the follow up, three of these patients restored intrinsic rhythm and had a low Vp rate. The rate of patients found pacemaker-dependent at one year of follow-up was 76,2%. Conclusions Among 21 patients who requiring PPI after TAVI, at 12 months 14,2% restored intrinsic rhythm. The methodology of calcium scoring outside the coronary arteries is still an active area of study. In the coming months, the collected data will be analyzed to assess the association between PM dependence at follow-up and calcium score on CT scan before TAVI.

Introduction Brugada syndrome (BrS) is a genetic disorder with a characteristic pattern on the electrocardiogram (ECG) that predisposes to lethal arrhythmias and sudden cardiac death (SCD). Precise diagnosis is therefore mandatory. Aims We evaluated the feasibility and accuracy of a smartwatch in recording multiple ECG leads and detecting ST-segment changes diagnostic for BrS both in basal condition and after ajmaline infusion. Materials and Methods Twelve-leads and smartwatch ECGs were obtained in 32 unselected patients admitted at our institution with type II/III ST-segment elevation suspected for BrS from September 2021 to March 2022. After written informed consent for continuous ECG monitoring during ajmaline test (1 mg/kg, i.v. for 10 min), consecutive ECG strips acquired with both techniques were analyzed before and after drug administration. For each patient smartwatch was tested at three different sites: wrist, abdomen and chest, and intercostal spaces from second to fourth were further studied. The concordance among the results of the smartwatch and standard ECG recordings was assessed using the Cohen κ coefficient and Bland-Altman analysis. Results Subjects were 42±15 y.o. on average; 67% were men (n=25), and diagnosis of BrS was reached in 12 cases (37.5%). Concordance was found between the smartwatch and standard ECG for the identification of the following findings: i) a normal/negative ECG (Cohen κ coefficient, 0.89); ii) ST-segment elevation shift (Cohen κ coefficient, 0.934). In addition, the Bland-Altman analysis demonstrated concordance between the smartwatch and the standard ECG in the assessment of the amplitude of ST-segment elevation shift (bias, −0.003; SD, 0.68; lower limit, −0.52; and upper limit, -0.031). The smartwatch power in diagnosing normal ECG showed a sensitivity of 92% (95% CI, 66%-99%) and a specificity of 100% (95% CI, 64%-100%); for detection of ST-segment elevation and BrS diagnosis, sensitivity was 92% (95% CI, 64%-99%) and specificity was 95% (95% CI, 76%-99%). Conclusions The findings of this study suggest agreement between the multichannel smartwatch acquisition and standard ECG for the identification of Brugada syndrome-associated ST-segment changes.

Background The comprehensive management of patients affected by heart failure with reduced ejection fraction (HFrEF) should pursue the goals of improving quality of life and reducing hospitalizations. Disease amelioration and cardiovascular mortality reduction are currently obtained by following guidelines-directed medical therapy (GDMT) that includes beta blockers, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitors (ARNIs), diuretics and mineralocorticoid receptor antagonists (MRAs); recently, sodium-glucose cotransporter-2 inhibitors (SGLT2Is) have been added on top of previous drugs, but real-world data are yet missing. Whether clinical management of patients affected by HFrEF bearing either implantable cardioverter/defibrillators (ICD) or cardiac resynchronization therapy devices (CRT-D) with a digital application (App) might further reduce hospitalization for HF independently of GDMT yet needs to be addressed. Materials and methods From February 2021 to June 2022 a total of 28 patients with HFrEF in GDMT previously undergone ICD/CRT-D implants were remotely monitored at our institution. Patients were instructed to download a dedicated application (MYTRIAGEHF) on their smartphones/tablets. Clinical data were retrieved monthly, through the App, according to data sent from answering to the following questions: i) shortness of breath; ii) feet, legs or ankles swelling; iii) feeling tired; iv) fatigue, lack of energy; v) weight gain in the last 3 days; vi) inconstant intake of diuretic therapy. Medical therapy was optimized accordingly. Results Satisfaction and regular use of the app was reported by 18/28 patients; most data came from ICD-implanted subjects (n=12, 75% dual chamber; 25% single chamber), while remaining were CRT-D. Eleven percent of App-users received SGLT2 inhibitors on top of medical therapy. Remarkably, only one patient of the non-App group was treated with SGLT2 inhibitors on top of medical therapy. Remaining non-App users as well as patients not in therapy with SGLT2 inhibitors are lost at follow-up; they presented with ischemic etiology in most cases and significantly reduced ejection fraction compared to App-group. Conclusion Our cohort demonstrated that implementing therapy with SGLT2 inhibitors and/or digital applications that follow patients remotely are valuable tools for the optimization of HFrEF clinical condition. Although cause and effect cannot be decisive from this study, the utilization of remote monitoring for therapy adjustments requires further investigation. The use of digital technologies to ensure a more personalized decision-making process will lead better care assistance.