Remote Management of Heart Failure in Patients with Implantable Devices.

: Heart failure (HF) is a chronic disease with a steadily increasing prevalence, high mortality, and social and economic costs. Furthermore, every hospitalization for acute HF is associated with worsening prognosis and reduced life expectancy. In order to prevent hospitalizations, it would be useful to have instruments that can predict them well in advance.

Anaplastic Large Cell Lymphoma Growing in the Pacemaker Pocket.

An 88-year-old patient underwent pacemaker generator replacement. Shortly after the replacement, the pacemaker pocket became swollen and, assuming a hematoma, underwent percutaneous drainage. However, the swelling was due to an aggressive lymphoma located in the pocket.

Optimizing remote heart failure management: First experiences with the HeartInsight score for implanted defibrillators.

We explored the results of two tests of the novel HeartInsight algorithm for heart failure (HF) prediction, reconstructing trends from historical cases. Results suggest potential extension of HeartInsight to implantable cardioverter defibrillators patients without history of HF and illustrate the importance of the baseline clinical profile in enhancing algorithm specificity.

Bridging the gap in the symptomatic heart failure patient journey: insights from the Italian scenario.

Background: The prognosis for heart failure (HF) patients remains poor, with a high mortality rate, and a marked reduction in quality of life (QOL) and functional status. This study aims to explore the ongoing needs of HF management and the epidemiology of patients followed by Italian HF clinics, with a specific focus on cardiac contractility modulation (CCM).

Research Design And Methods: Data from patients admitted to 14 HF outpatients clinics over 4 weeks were collected and compared to the results of a survey open to physicians involved in HF management operating in Italian centers.

[Artificial intelligence applied to the electrocardiogram.].

Artificial intelligence is able to read and interpret Ecg traces quickly and precisely, increasing the diagnostic capacity and offering the possibility of anticipating preventive therapies. However, there is no evidence on the clinical utility and cost-effectiveness of certain practical applications. In fact, the literature shows the prognostic importance in favor of prevention, but clear evidence is not available that correcting strokes, embolisms, heart failure early improves quality and life span of patients.

[e-Health, telemedicine and applications in cardiology: state of the art in Italy and experience of the cardiology unit of the G.B. Grassi Hospital of Rome].

e-Health (electronic health) refers to the use of information and communication technologies (ICT) to promote organizational change and facilitate new healthcare skills. In the last few years, several telemedicine services using ICT have been launched and the updating of related regulations has started, also for the increase in demand for services, their complexity and the need to offer adequate care to the patient. In cardiology, the experiences concern mainly patients suffering from heart failure or the carriers of cardiac implantable electronic devices (CIEDs), and few experiences are described in ischemic heart disease.

[50 years of electrophysiology and cardiac pacing].

During the last 50 years a continuous improvement was observed in the field of cardiac pacing and electrophysiology as for as both technological and clinical aspects were concerned. We moved from the first recording of the His bundle electrogram to the identification of the various mechanisms and sites of supraventricular and ventricular tachyarrhythmias, to three-dimensional mapping and ablation of different reentry circuits and eventually to pulmonary vein isolation for the treatment of atrial fibrillation. As far as cardiac pacing is concerned, we moved from single chamber to dual chamber pacing, to ventricular pacing and implantable automatic defibrillators provided by sophisticated diagnostic and therapeutic algorithms and by remote control.

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.

ICD-measured heart sounds and their correlation with echocardiographic indexes of systolic and diastolic function.

Background: Novel implantable defibrillators (ICDs) allow first (S1) and third (S3) heart sounds to be measured by means of an embedded accelerometer. ICD-measured S1 and S3 have been shown to significantly correlate with hemodynamic changes in acute animal models. The HeartLogic algorithm (Boston Scientific) measures and combines multiple parameters, including S3 and S1, into a single index to predict impending heart failure decompensation.

Neuro-arrhythmology: a challenging field of action and research: a review from the Task Force of Neuro-arrhythmology of Italian Association of Arrhythmias and Cardiac Pacing.

: There is a growing interest in the study of the mechanisms of heart and brain interactions with the aim to improve the management of high-impact cardiac rhythm disorders, first of all atrial fibrillation. However, there are several topics to which the scientific interests of cardiologists and neurologists converge constituting the basis for enhancing the development of neuro-arrhythmology. This multidisciplinary field should cover a wide spectrum of diseases, even beyond the classical framework corresponding to stroke and atrial fibrillation and include the complex issues of seizures as well as loss of consciousness and syncope.

Preliminary experience with the multisensor HeartLogic algorithm for heart failure monitoring: a retrospective case series report.

Aims: In the Multisensor Chronic Evaluation in Ambulatory Heart Failure Patients study, a novel algorithm for heart failure (HF) monitoring was implemented. The HeartLogic (Boston Scientific) index combines data from multiple implantable cardioverter defibrillator (ICD)-based sensors and has proved to be a sensitive and timely predictor of impending HF decompensation. The remote monitoring of HF patients by means of HeartLogic has never been described in clinical practice.

[Appropriateness criteria for the management of anticoagulant therapy in complex patients with atrial fibrillation. The opinion of a group of expert Italian cardiologists].

Atrial fibrillation (AF) is a common arrhythmia often associated with high thromboembolic risk. The purpose of this position paper is to provide clinicians with recommendations useful in managing some important issues regarding the use of anticoagulant therapy in patients with AF in particularly complex clinical situations.The RAND/UCLA appropriateness method, validated to combine the best available scientific evidence with the collective judgment of experts, was used to assess the judgment of an expert panel of cardiologists.

Preliminary experience with a novel Multisensor algorithm for heart failure monitoring: The HeartLogic index.

We report the first case of a patient in whom an implantable cardioverter-defibrillator (ICD) endowed with HeartLogic, a novel algorithm for heart failure (HF) monitoring, was implanted in clinical practice. The good temporal association between HeartLogic index threshold crossings and HF hospitalizations confirms the high sensitivity in detecting gradual worsening of HF.

[Electromagnetic interference in the current era of cardiac implantable electronic devices designed for magnetic resonance environment].

In the last decades we are observing a continuous increase in the number of patients wearing cardiac implantable electronic devices (CIEDs). At the same time, we face daily with a domestic and public environment featured more and more by the presence and the utilization of new emitters and finally, more medical procedures are based on electromagnetic fields as well. Therefore, the topic of the interaction of devices with electromagnetic interference (EMI) is increasingly a real and actual problem.

Benefit of dual-chamber pacing with Closed Loop Stimulation in tilt-induced cardio-inhibitory reflex syncope (BIOSync trial): study protocol for a randomized controlled trial.

Background: The efficacy of dual-chamber cardiac pacing in neuro-mediated reflex syncope with a cardio-inhibitory response to the Tilt-Table test (TT) has not been definitively assessed so far. The lack of reproducibility of results from previous studies may be partially explained by discrepancies in subject selection and some weaknesses in design and methods. The European Society of Cardiology (ESC) has set a class IIb indication to pacemaker implantation in this population recommending further research.

[Real life clinical management of nonvalvular atrial fibrillation: results from the Italian epidemiological survey eXperience on the use of rivaroxaban].

Background: Atrial fibrillation-related stroke prevention with anticoagulant drugs is currently evolving towards the introduction into clinical practice of the new oral anticoagulants, including rivaroxaban. Our aim was to evaluate in a real-life setting the characteristics and management of patients with nonvalvular atrial fibrillation to whom Italian doctors decided to prescribe rivaroxaban.

Methods: Between January and February 2014, a group of 95 physicians collected aggregate retrospective data, through an online questionnaire, on 1127 patients with nonvalvular atrial fibrillation receiving rivaroxaban.

Novel devices to monitor heart failure and minimize hospitalizations.

Introduction: Approximately 1-2% of the adult population in developed countries is affected by heart failure. The costs of heart failure are enormous both in Europe and in the US and are expected to rise. New technologies and remote monitoring, are valid tools for the management and treatment of these patients.

Comparison of partners-heart failure algorithm vs care alert in remote heart failure management.

Aim: To compare the utility of the partners-heart failure (HF) algorithm with the care alert strategy for remote monitoring, in guiding clinical actions oriented to treat impending HF.

Methods: Consecutive cardiac resynchronization-defibrillator recipients were followed with biweekly automatic transmissions. After every transmission, patients received a phone contact in order to check their health status, eventually followed by clinical actions, classified as "no-action", "non-active" and "active".

Standardized algorithm for cardiac pacing in older patients affected by severe unpredictable reflex syncope: 3-year insights from the Syncope Unit Project 2 (SUP 2) study.

Aims: The aim of this study was to determine the long-term effects and determinants of success of cardiac pacing in patients affected by reflex syncope enrolled in the Syncope Unit Project 2 (SUP 2) study. Initial results have validated the effectiveness of a standardized guideline-based algorithm which can be used in clinical practice in order to select suitable candidates for cardiac pacing.

Methods And Results: In this prospective, multicentre, observational study, patients aged >40 years, affected by severe unpredictable recurrent reflex syncope, underwent carotid sinus massage (CSM), followed by tilt testing (TT) if CSM was negative, followed by implantation of an implantable loop recorder (ILR) if TT was negative.

Assessment of a standardized algorithm for cardiac pacing in older patients affected by severe unpredictable reflex syncopes.

Aims: Opinions differ regarding the effectiveness of cardiac pacing in patients affected by reflex syncope. We assessed a standardized guideline-based algorithm in different forms of reflex syncope.

Methods And Results: In this prospective, multi-centre, observational study, patients aged >40 years, affected by severe unpredictable recurrent reflex syncopes, underwent carotid sinus massage (CSM), followed by tilt testing (TT) if CSM was negative, followed by implantation of an implantable loop recorder (ILR) if TT was negative.

[Management strategies and choice of antithrombotic treatment in patients admitted with acute coronary syndrome--executive summary for clinical practice. Consensus Document of the Regional Chapters of the Italian National Association of Hospital Cardiologists (ANMCO) and of the Italian Society of Emergency Medicine (SIMEU)].

This document has been developed by the Lazio regional chapters of two scientific associations, the Italian National Association of Hospital Cardiologists (ANMCO) and the Italian Society of Emergency Medicine (SIMEU), whose members are actively involved in the everyday management of Acute Coronary Syndromes (ACS). The document is aimed at providing a specific, practical, evidence-based guideline for the effective management of antithrombotic treatment (antiplatelet and anticoagulant) in the complex and ever changing scenario of ACS. The document employs a synthetic approach which considers two main issues: the actual operative context of treatment delivery and the general management strategy.

Prevention of syncope through permanent cardiac pacing in patients with bifascicular block and syncope of unexplained origin: the PRESS study.

Background: Syncope in patients with bifascicular block (BFB) is a common event whose causes might be difficult to assess.

Methods And Results: Prevention of syncope through permanent cardiac pacing in patients with bifascicular block (PRESS) is a multicenter, prospective, randomized, single-blinded study designed to demonstrate a reduction in symptomatic events in patients with bifascicular block and syncope of undetermined origin implanted with permanent pacemaker. Device programming mode (NASPE/BPEG code) at DDD with a lower rate of 60 ppm is compared with backup pacing at DDI with a lower rate of 30 ppm.