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The Pacemaker (PM) and Implantable Cardioverter-Defibrillator (ICD) Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) collects information about demographics, clinical characteristics, main indications for PM/ICD therapy and device types from the Italian collaborating centers.For the year 2020, the main data about national PM and ICD implantation activity were obtained on the basis of European Cards and subsequently analyzed to create a standard report.PM Registry: data about 22 080 PM implantations were collected (18 027 first implants and 3803 replacements). The number of collaborating centers was 142. Median age of treated patients was 82 years (75 quartile I; 87 quartile III). ECG indications included atrioventricular conduction disorders in 31.0% of first PM implants, sick sinus syndrome in 13.8%, atrial fibrillation plus bradycardia in 9.9%, other unspecified ECG and electrophysiological abnormalities in 36.6%. Use of single-chamber PMs was reported in 29.0% of first implants, of dual-chamber PMs in 68.2%, of PM with cardiac resynchronization therapy (CRT) in 2.7%. ICD Registry: data about 11 931 ICD implantations were obtained (8266 first implants and 3665 replacements). The number of collaborating centers was 330. Median age of treated patients was 72 years [63 quartile I; 79 quartile III]. Primary prevention indication was reported in 85.0% of first implants, secondary prevention in 15.0% (cardiac arrest in 4.2%). A single-chamber ICD was used in 30.2% of first implants, dual-chamber ICD in 31.2% and biventricular ICD in 38.6%.In the calendar year 2020, the Italian PM Registry showed stable ECG and symptom indications, with an important prevalence of dual-chamber pacing. The ICD Registry documented a large use of prophylactic and biventricular ICDs, reflecting a favorable adherence in clinical practice to trials and guidelines. The ICD longevity and the number of recalls demonstrated a favorable trend. In order to increase and optimize the cooperation of Italian PM and ICD implanting centers, the online data entry (https://www.aiac.it/riprid) should be adopted at large scale.

Among dialysis patients, 40% of deaths are due to cardiovascular causes, and 60% of cardiac deaths are due to an arrhythmia. The purpose of this survey, carried out with the organizational support of the Lombard Section of the Italian Society of Nephrology, is to evaluate the frequency and mode of use of non-invasive instruments for the diagnosis of cardiac arrhythmias in the dialysis centers of Lombardy. Information on the prevalence and type of cardiac devices at December 1, 2016 in this population was also required. Data from 18 centers were collected for a total of 3395 patients in replacement renal therapy, including 2907 (85.6%) in hemodialysis and 488 (14.4%) in peritoneal dialysis. All centers use the 12-lead ECG in case of evocative symptoms of an arrhythmic event and 2/3 perform the exam with programmed cadence (usually once a year). Twenty four-hour ECG Holter is not used as a routine diagnostic tool. The proportion of cardiac devices is relatively high, compared to literature data: n=259, equal to 7.6% of the population. Pace-Maker patients are 166 (4.9%), those with intracardiac defibrillator 52 (1.5%), those with resynchronization therapy 18 (0.5%) and those with resynchronization therapy and intracardiac defibrillator 23 (0.7%). The survey provides interesting information and can be an important starting point for trying to optimize clinical practice and collaboration between nephrologists and cardiologists in front of a major problem like that of arrhythmic disease in patients on renal replacement therapy.

Cardiac resynchronization therapy is an established approach for the treatment of patients with heart failure and left ventricular systolic dysfunction. In most centers, these patients are usually evaluated by echocardiography, which allows collecting a number of cardiac anatomical and functional parameters in a non-invasive, repeatable way and without exposure to ionizing radiation. However, over the years, clinical studies have sometimes emphasized and sometimes reduced the role of this method in the setting of cardiac resynchronization therapy for cardiac dyssynchrony evaluation, prognostic stratification of patients, optimization of pacing, and follow-up. The purpose of this paper, therefore, is to review the current role of echocardiography before, during and after the implantation of a cardiac resynchronization therapy device.

Introduction to qualitative research: the main approaches and designs. The main methods (phenomenology, ethnography, Grounded, narrative enquiry and case studies) and sampling technique of qualitative research are briefly outlined. A practical example is presented for each method.

Objectives To compare Magnetic Resonance (MR) and Computed Tomography (CT) for the assessment of left (LV) and right (RV) ventricular functional parameters. Methods Seventy nine patients underwent both Cardiac CT and Cardiac MR. Images were acquired using short axis (SAX) reconstructions for CT and 2D cine b-SSFP (balanced-steady state free precession) SAX sequence for MR, and evaluated using dedicated software. Results CT and MR images showed good agreement: LV EF (Ejection Fraction) (52 ± 14% for CT vs. 52 ± 14% for MR; r = 0.73; p > 0.05); RV EF (47 ± 12% for CT vs. 47 ± 12% for MR; r = 0.74; p > 0.05); LV EDV (End Diastolic Volume) (74 ± 21 ml/m² for CT vs. 76 ± 25 ml/m² for MR; r = 0.59; p > 0.05); RV EDV (84 ± 25 ml/m² for CT vs. 80 ± 23 ml/m² for MR; r = 0.58; p > 0.05); LV ESV (End Systolic Volume)(37 ± 19 ml/m² for CT vs. 38 ± 23 ml/m² for MR; r = 0.76; p > 0.05); RV ESV (46 ± 21 ml/m² for CT vs. 43 ± 18 ml/m² for MR; r = 0.70; p > 0.05). Intra- and inter-observer variability were good, and the performance of CT was maintained for different EF subgroups. Conclusions Cardiac CT provides accurate and reproducible LV and RV volume parameters compared with MR, and can be considered as a reliable alternative for patients who are not suitable to undergo MR. Key Points • Cardiac-CT is able to provide Left and Right Ventricular function. • Cardiac-CT is accurate as MR for LV and RV volume assessment. • Cardiac-CT can provide accurate evaluation of coronary arteries and LV and RV function. Electronic supplementary material The online version of this article (doi:10.1007/s00330-011-2345-6) contains supplementary material, which is available to authorized users.

In patients with chronic renal failure undergoing dialysis the mortality rate from cardiovascular conditions is 10 to 100 fold than in general population. The higher mortality rate is due not only to the influence of traditional risk factors, such as hypertension, diabetes, obesity, dyslipidemia and cigarette smoking, but also to specific factors of uremic patients. Acute complications commonly take place during routine hemodialysis treatments (HD) due to unsteadiness in the cardiovascular system balance. We will review most important cardiovascular complications during HD from hypotension to ventricular hypertrophy, from arrhythmias to sudden death, and finally myocardial ischemia. A large number of structural and functional peripheral vascular and cardiac abnormalities including electrolyte imbalance, hemodynamic instability and neuro-humoral stress exert an overwork on myocardium and lead to occurring of a single cardiovascular complication but are always strictly correlated events.

The considerable evolution in technique and hardware, occurred over the past three decades, has greatly simplified the implantation procedure of pacemakers and cardioverter-defibrillators. Indeed, the introduction of relatively simple and safe methods of central venous access, and the miniaturization of the generator with subcutaneous placement have facilitated the implantation. However, inherent with cardiac pacing and defibrillating therapy is the potential for the occurrence of an early or delayed untoward event. Although skill, experience, and technique are all mitigating factors, every cardiologist should know potential complications and should be able to stratify overall risk related to a device implantation. Thus, both the implanting physician or the clinical cardiologist must be concerned not only with measures to avoid complications, but also with their early recognition and treatment.

Ischemia is associated with myocardial acidosis which recovers upon reperfusion. In such conditions, alpha 1-adrenergic stimulation is arrhythmogenic. We used single cardiac myocytes loaded with the pH fluorescent dye, SNARF-1, to determine if a modulation of pH could explain the effect of alpha 1-adrenergic stimulation. Cells were exposed to acidosis (CO2 15%) for 15 min and then normocapnia restored. During acidosis, alpha 1-adrenergic stimulation caused an increase in pH which was abolished by blocking Na+/H+ exchange with ethylisopropylamiloride (EIPA). After removal of acidosis aftercontractions were manifest in 8 out of 10 and 1 out of 5 cells in the presence of an alpha 1-adrenergic agonist and in control, respectively (p0.001). EIPA abolished the occurrence of after contractions. Thus, the arrhythmogenicity of alpha 1-adrenergic stimulation depends on activation of Na+/H+ exchanger.

Aim of this study was to evaluate the pattern of onset and the characteristics of ventricular arrhythmias (VA) observed during treadmill test (TT) in patients with chronic ischemic heart disease (CIHD). Two groups of patients with CIHD were retrospectively compared: group A consisted of 120 consecutive patients with premature ventricular beats (PVBs) either isolated (greater than 2/min) or repetitive during exercise, or maximal exercise, or recovery; group B consisted of 140 consecutive patients without PVBs during TT. The two groups were comparable in mean age, male/female ratio, incidence of previous myocardial infarction, of previous coronary artery by-pass graft or of percutaneous transluminal coronary angioplasty. There were no significant differences between the two groups regarding the parameters evaluated during TT: duration of exercise, maximal heart rate, heart rate-systolic blood pressure product as well as in the percentage of positive tests for acute myocardial ischemia (51.6% vs 40.7%). In the two subgroups of patients who underwent coronary arteriography and left ventricular angiography (24/120 and 23/140 patients respectively) no differences were found in the number and distribution of critical coronary stenosis and of dyskinetic or akinetic areas. In both groups A and B the QTc interval at maximal exercise was significantly longer than its value at rest (p less than 0.001), but there was no relevant difference between the two groups. In group A patients with VA during maximal exercise (n = 60) showed a higher prevalence of complex VA (class Lown greater than or equal to 3) compared to the others (p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)