Dynamic evaluation of atrial fibrillation risk factors using multiple sensors of implantable cardioverter defibrillators.

Aims: The HEAD2TOES schema was introduced to identify modifiable risk factors (RF) for atrial fibrillation (AF), including heart failure (HF), physical inactivity (PA), and sleep apnea (SA). Modern implantable cardioverter-defibrillators (ICDs) can detect SA, assess HF status, and measure daily PA. This study investigates the relationship between atrial high-rate episodes (AHREs) and ICD-detected surrogates for these RF in HF patients.

Coronary Artery Identification With Intracardiac Echocardiography and Integration on 3D Mapping During Radiofrequency Ablation of Premature Ventricular Complexes.

Image: Intracardiac echocardiography imaging integration with 3D mapping during premature ventricular complexes ablation.

Case Summary: A 73-year-old male patient with idiopathic premature ventricular complexes originating from the left ventricular outflow tract in the left coronary cusp area underwent radiofrequency ablation with tridimensional electroanatomic mapping and intracardiac echocardiography imaging integration, which permitted identification and avoidance of the left coronary artery ostium.

Current clinical practice versus remote monitoring recommendations for cardiovascular implantable electronic devices: A real-world analysis from a remote monitoring database.

Background: The recently published Consensus Statement on the Practical Management of Remote Device Clinics offers recommendations for managing patients with cardiovascular implantable electronic devices (CIEDs). They recommend activating remote monitoring (RM) soon after implantation and maintaining connectivity. Moreover, it is reasonable to replace scheduled device follow-up with alert-based RM, with alert parameters customized to clinical indications to reduce RM workload.

Subcutaneous Implantable Defibrillator Therapy in Patients With Brugada Syndrome: Data From a Large Multicenter Registry.

Background: The implantable cardioverter-defibrillator (ICD) is recognized as the most effective life-saving therapy in patients with Brugada syndrome (BrS). However, transvenous ICD is associated with a notable rate of complications over time. The subcutaneous implantable cardioverter-defibrillator (S-ICD) has emerged as a promising alternative to the transvenous ICD.

Real-world single-center preliminary experience of radiofrequency balloon pulmonary vein ablation for atrial fibrillation.

Atrial fibrillation (AF) is the most common cardiac arrhythmia and pulmonary vein isolation (PVI) by percutaneous transcatheter ablation is its pivotal treatment. Nowadays, several techniques using different energy sources are used, such as radiofrequency (RF), cryoablation and laser ablation. A new technology that combines the strengths of different techniques has been developed, in particular having both the speed of one-shot techniques and the selectivity and precision of point-by-point RF: the RF balloon (RFB).

Real-time Technical Support Using a Remote Technology During Cardiac Implantable Electronic Device Follow-up: A Preliminary Multicenter Experience in Clinical Practice.

Industry-employed allied professionals (IEAPs) provide technical assistance to physicians during cardiac implantable electronic device (CIED) implantation, programming, troubleshooting, and follow-up. The Heart Connect™ application (Boston Scientific Inc., Marlborough, MA, USA) is a data-sharing system that enables remote access and display sharing of the CIED Programmer.

Shortened radiofrequency delivery time to optimize efficiency and safety of pulmonary vein isolation with the radiofrequency balloon: insights from the COLLABORATE registry.

Aims: Previous clinical studies on pulmonary vein isolation (PVI) with a radiofrequency balloon (RFB) reported safe and effective procedures using conventional ablation settings with 20/60 s RF delivery via posterior/anterior (PST/ANT) electrodes. The latest evidence suggests that reducing the application time to 15 s (s) on the posterior wall when facing the oesophageal region is as effective as applying 20 s. To prospectively assess whether reducing RF time on PST/ANT segments to 15/45 s can ensure sufficient quality of lesion metrics and compare the new shortened ablation settings with the conventional one in terms of safety, and effectiveness at 1-year.

Device programing and SMART pass algorithm activation in subcutaneous implantable defibrillator patients: Data from a remote monitoring database.

Background: The programing of subcutaneous implantable cardioverter-defibrillators (S-ICD) in clinical practice has been little studied, as the activation status of the SMART Pass filter, which was implemented to reduce inappropriate shocks.

Purpose: We assessed device programing during follow-up and the rate of detected arrhythmias in consecutive S-ICD recipients.

Methods: We analyzed data from 670 S-ICD patients followed on the remote network at 17 Italian centers for a median of 31 months (25th-75th percentile: 16-51).

Ablation of CTI-dependent flutter using different ablation technologies: acute and long-term outcome from the LEONARDO study.

Background: A novel ablation catheter has been released to map and ablate the cavo-tricuspid isthmus (CTI) in patients with atrial flutter (AFL), improving ablation efficiency.

Methods: We evaluated the acute and long-term outcome of CTI ablation aiming at bidirectional conduction block (BDB) in a prospective, multicenter cohort study enrolling 500 patients indicated for typical AFL ablation. Patients were grouped on the basis of the AFL ablation method (linear anatomical approach, Conv group n = 425, or maximum voltage guided, MVG group, n = 75) and ablation catheter (mini-electrodes technology, MiFi group, n = 254, or a standard 8-mm ablation catheter, BLZ group, n = 246).

Association Between Device-Detected Sleep-Disordered Breathing and Implantable Defibrillator Therapy in Patients With Heart Failure.

Background: Sleep-disordered breathing is highly prevalent in heart failure (HF) and has been suggested as a risk factor for malignant ventricular arrhythmias. The Respiratory Disturbance Index (RDI) computed by an implantable cardioverter-defibrillator (ICD) algorithm accurately identifies severe sleep apnea.

Objectives: In the present analysis, the authors evaluated the association between ICD-detected sleep apnea and the incidence of appropriate ICD therapies in patients with HF.

Decongestive treatment adjustments in heart failure patients remotely monitored with a multiparametric implantable defibrillators algorithm.

Aims: HeartLogic algorithm combines data from multiple implantable defibrillators (ICD)-based sensors to predict impending heart failure (HF) decompensation. A treatment protocol to manage algorithm alerts is not yet known, although decongestive treatment adjustments are the most frequent alert-triggered actions reported in clinical practice. We describe the implementation of HeartLogic for remote monitoring of HF patients, and we evaluate the approach to diuretic dosing and timing of the intervention in patients with device alerts.

Combined Use of S-ICD and Absorbable Antibacterial Envelopes: A Proof-of-concept Study.

Background: Absorbable antibacterial envelopes (AAEs) are currently recommended in patients undergoing a transvenous ICD implantation in cases at high risk of infection, who are now preferably implanted with a subcutaneous ICD (S-ICD). Nevertheless, experiences using a combined approach with S-ICD and AAE have not been reported. The aim of our study was to evaluate this strategy in patients at very high risk of infection.

A reproducible sensor pattern to suspect COVID19 pulmonary infection with LATITUDE. Case report and literature review.

A 78 year-old patient with postischaemic dilated cardiomyopathy and severely reduced ejection fraction was implanted with a Boston Scientific RESONATE X4 CRT-D and followed by LATITUDE remote monitoring platform. From the end of January to the end of March 2021 he was hospitalized for COVID19 pneumonia followed by two episodes of acute heart decompensation with bilateral pleural effusion. We remotely followed the patient and identified a typical Heart Logic sensor pattern linked to the COVID19 pneumonia, different from the one linked to the heart failure (HF).

Implantable Cardioverter Defibrillator Multisensor Monitoring during Home Confinement Caused by the COVID-19 Pandemic.

Aims: The utilization of remote monitoring platforms was recommended amidst the COVID-19 pandemic. The HeartLogic index combines multiple implantable cardioverter defibrillator (ICD) sensors and has proved to be a predictor of impending heart failure (HF) decompensation. We examined how multiple ICD sensors behave in the periods of anticipated restrictions pertaining to physical activity.

[Pulmonary embolism and SARS-CoV-2: analysis of patients hospitalized for pulmonary embolism and COVID-19 in a Northern Italian center].

Background: Coronavirus disease 2019 (COVID-19) has shown high morbidity and mortality and the relationship between pulmonary embolism (PE) and COVID-19 is well established in the literature.

Methods: We describe the characteristics of a cohort of COVID-19 patients (EP-COV) hospitalized at our Centre with PE, investigating how COVID-19 may have influenced their outcomes, as compared to patients without COVID-19 hospitalized for PE in the same months of 2020 (EP-2020) and 2019 (EP-2019).

Results: EP-COV patients (n=25) were younger (60.

Multiparametric Implantable Cardioverter-Defibrillator Algorithm for Heart Failure Risk Stratification and Management: An Analysis in Clinical Practice.

Background: The HeartLogic algorithm combines multiple implantable cardioverter-defibrillator sensors to identify patients at risk of heart failure (HF) events. We sought to evaluate the risk stratification ability of this algorithm in clinical practice. We also analyzed the alert management strategies adopted in the study group and their association with the occurrence of HF events.

Does the Age Affect the Outcomes of Cardiac Resynchronization Therapy in Elderly Patients?

Background: More and more heart failure (HF) patients aged ≥ 75 years undergo cardiac resynchronization therapy (CRT) device implantation, however the data regarding the outcomes and their predictors are scant. We investigated the mid- to long-term outcomes and their predictors in CRT patients aged ≥ 75 years.

Methods: Patients in the Cardiac Resynchronization Therapy Modular (CRT MORE) Registry were divided into three age-groups: <65 (group A), 65-74 (group B) and ≥75 years (group C).

Catheter Ablation of Atrial Fibrillation in Heart Failure: from Evidences to Guidelines.

Purpose Of Review: Catheter ablation of atrial fibrillation in heart failure seems to be the way to improve the quality of life, life expectance, and prognosis. In this review, we outline the growing role of this therapy and which patients can benefit from it.

Recent Findings: While previous studies comparing rate control and rhythm control had not demonstrated the superiority of rhythm control in the prognosis of patients with atrial fibrillation and heart failure, recent findings seem to demonstrate that catheter ablation of atrial fibrillation reduces mortality and hospitalization for heart failure and improves the quality of life, when compared to medical therapy alone.

Minimal fluoroscopy approach for right-sided supraventricular tachycardia ablation with a novel ablation technology: Insights from the multicenter CHARISMA clinical registry.

Background: No data exist on the ability of the novel Rhythmia 3-D mapping system to minimize fluoroscopy exposure during transcatheter ablation of arrhythmias. We report data on the feasibility and safety of a minimal fluoroscopic approach using this system in supraventricular tachycardia (SVT) procedures.

Methods: Consecutive patients were enrolled in the CHARISMA registry at 12 centers.

Advantages of the integration of ICE and 3D electroanatomical mapping and ultrasound-guided femoral venipuncture in catheter ablation of atrial fibrillation.

Purpose: To evaluate how the integration of intracardiac echocardiography (ICE) and ultrasound-guided femoral venipuncture (USGVC) may affect the safety of catheter ablation (CA) of atrial fibrillation (AF).

Methods: From a single center 374 patients with AF underwent 3D electroanatomic mapping-guided CA with or without the integration of ICE and USGVC. The primary endpoints were periprocedural complications, fluoroscopy time, and procedure time between the two groups.

[An unusual presentation of cardiac involvement during the COVID-19 pandemic].

Severe acute respiratory syndrome coronavirus 2 may affect the cardiovascular system and cause acute cardiac injury. Other authors described cases of myocarditis with reduced systolic function and/or a life-threatening presentation. We describe the clinical course of an unusual presentation with isolated reversible high degree atrioventricular block in a patient with COVID-19.

Prospective evaluation of the multisensor HeartLogic algorithm for heart failure monitoring.

Background: The HeartLogic algorithm measures data from multiple implantable cardioverter-defibrillator-based sensors and combines them into a single index. The associated alert has proved to be a sensitive and timely predictor of impending heart failure (HF) decompensation.

Hypothesis: We describe a multicenter experience of remote HF management by means of HeartLogic and appraise the value of an alert-based follow-up strategy.

Catheter ablation of atrial fibrillation in heart failure: clinical, prognostic, and echocardiographic outcome.

Purpose: Catheter ablation (CA) for atrial fibrillation (AF) in heart failure (HF) patients is associated with a lower rate of cardiac events compared with medical therapy. This study deals with the clinical, echocardiographic, and prognostic outcomes in these patients. Prognostic scores, as MAGGIC (Meta-analysis Global Group in Chronic Heart Failure) score, may help to predict the outcomes.