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Background: In patients (pts) with sick sinus syndrome (SSS), right ventricular apical (RVA) pacing increased the risk of developing atrial fibrillation (AF). However, the mechanism of proarrhythmic effect of RVA pacing remains unclear. Methods: We performed detailed echocardiograhic examination with Tissue Doppler Imaging in 60 pts with SSS (mean age 73A9 years, 42 F) who implanted with DDD pacemakers during atrial and ventricular pacing with atrioventricular interval programmed at 120-150 mesc (ApVp mode) and AAI mode with (ApVs mode) at 70 bpm. Echo measurements were taken after 15 mins of pacing in each mode. The myocardial atrial contraction velocity was measured at annulus of right free wall (Ra), septal (Sa) and lateral free wall (La) respectively. Results: As expected, the AV interval was significantly shorter (118A25 vs.163A45 ms, P=0.002), and QRS duration was longer (146A33 vs.97A26 ms, P,0.001) during ApVp mode as compared with ApVs mode. Although there was no significant difference in left ventricular ejection fraction, left atrial (LA) ejection fraction (50A14 vs.55A14%, P=0.005), LA active emptying fraction (32A17 vs.37A16%, P=0.018) and LA filling fraction (43A13 vs. 48A13%, P=0.007) were all significant improved by 18%, 54% and 18%, respectively during ApVs mode as compared with ApVp mode. Furthermore, atrial myocardial contraction velocities among Ra (14.0A3.8 vs.15.2A4.6cm/s, P=0.026), Sa (7.8A2.6 vs. 8.8A2.8cm/s, P=0.001), and La (8.9A3.2 vs.9.7A2.7cm/s, P=0.020) were also significantly increased during ApVs mode by 12%, 19% and 21%, respectively as compared with ApVp mode (Figure). Conclusions: In pts with SSS, avoidance of RVA pacing during ApVs mode improves LA haemodynamic and mechanical function, which might contribute to a lower risk of development of AF after pacemaker implantation. P773Qualitative and quantitative assessment of 3 novel post-processing methods for enhancing echocardiographic images. Echocardiography, while a prevalent tool for assessing cardiac morphology and function, suffers from a range of artefacts that reduce its diagnostic value. This work qualitatively and quantitatively evaluates 3 novel post-processing methods for enhancing echocardiographic images. Data enhancement is achieved by utilising multiple partially decorrelated instances of a cardiac cycle acquired through a single acoustic window. Such information has until now been largely disregarded during data post-processing. Moreover, unlike past approaches, data enhancement is achieved without filtering out information based on static or adaptive selection criteria. Qualitative assessment using 32 clinical datasets demonstrated (i) suppression of cavity noise, (ii) increase in tissue/cavity contrast, and (iii) visual enhancement of tissue structures previously masked-out by various artefacts (Figure 1). The effect of each post-processing method on the diagnostic value of cardiac ultrasound data was quantitatively assessed by examining the repeatability coefficient variations (via Bland-Altman plots) in clini...

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Funding Acknowledgements Type of funding sources: None. Introduction Elderly people represent a vulnerable but increasing population presenting to percutaneous coronary intervention (PCI). The benefit of revascularization in acute coronary syndromes (ACS) is well-stablished. However, the benefit in elderly patients has been questioned, considering the patient’s expected survival, functional and cognitive status, comorbidities, procedure’s risk and need for extended anti-thrombotic therapy. Purpose To evaluate the effect of PCI on the prognosis of a group of very old patients with acute coronary syndrome (ACS). Methods We retrospectively analyzed all consecutive very old patients (≥90-year-old) admitted with ACS submitted to coronarography (CA) in one tertiary center, from January 2008 to December 2021. Clinical features were collected, including major adverse cardiac events (MACE), a defined composite endpoint of all-cause death, ischemic stroke, ACS, or hospitalization for acute heart failure, which were compared according if PCI was performed or not. Q-square, Cox regression and Log-rank tests were applied. Results A total of 79 patients were enrolled; 43 of them underwent PCI. Groups were comparable in basal characteristics, with similar median age at the event (92 years old, interquartile range IQR: 3), see picture 1. Most patients with ST-elevation (STE) ACS (n=45) had PCI (70% vs. 41%, p= 0,01), while in non ST-elevation (NSTE) ACS and unstable angina there was higher proportion of non-PCI (30% vs. 58%, p= 0,01). Individuals submitted to PCI were more likely to have single or double lesion vessel (76% vs 27%, p<001), while non-PCI patients presented more complex disease (23% vs 25%, p=0,5). Among the PCI-patients, the majority was singly revascularized (86%) and submitted to stent implantation (83%). Regarding in-hospital mortality, there was no difference between groups: 21% in the PCI group versus 33% in the non-PCI control group (p=0.2). During median follow-up time of 6 months (IQR: 27), mortality was similar in both groups (79% vs 67%; p=0.1). Nevertheless, overall MACE-free survival was significantly longer in PCI group than in the no-PCI group, and PCI treated patients had a risk of MACE 52% lower than the patients assigned to medical therapy (hazard ratio 0.508, p=0.007); see picture 2. Conclusion Very old patients presenting with ACS treated with either PCI presented longer MACE-free survival. These finding suggest that very old patients with ACS and single vessel disease may benefit systematically from PCI with stent. Efforts should be made to optimize care in this under-represented population in the clinical trials.