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Introduction: Micra AV Transcatheter Pacing System (TPS) represents an innovative second‐generation leadless pacemaker which represents an effective alternative to conventional devices in selected cases. Intrinsic malfunctions of these devices are rare, requiring sometimes their retrieval. When performed in experienced centers, this procedure is safe. Case Presentation: We describe a case of sudden battery malfunction of a Micra AV TPS, which required the extraction and the placement of a new pacing system in the right ventricle. Discussion: This case, which has never been reported, highlights the need to a careful fluoroscopic evaluation and the usefulness of remote monitoring. [ABSTRACT FROM AUTHOR]

Background and aim: Our aim was to evaluate the fluoroscopy time (FT), procedure time (PT) safety and efficacy when using intracardiac echocardiography (ICE) in comparison to transesophageal echocardiography (TEE) guidance for transcatheter closure of Ostium Secundum Atrial Septal Defect (OS‐ASD). Method: Ninety patients (n = 90) diagnosed with OS‐ASD underwent transcatheter closure between March 2006 and October 2021. Fifty‐seven patients were treated under ICE guidance, while 33 patients were treated under TEE guidance. Results: Mean age was 43 ± 15 years and 42 ± 10 years in the ICE and TEE groups, respectively. The majority of patients had a centrally placed defect. Median FT was 8.40 min versus 11.70 min (p <.001) in the ICE group compared to the TEE group, respectively. Median PT was 43 min versus 94 min (p <.001) in the ICE group compared to the TEE group, respectively. Both ICE and TEE provided high quality images. All interventions were completed successfully, except for one patient in the ICE group who experienced a device migration, the development of atrial tachycardia in one patient and atrial fibrillation in two patients in the ICE group which spontaneously cardioverted. There were no other complications. Conclusion: This study on a consistent cohort of patients with OS‐ASD undergoing percutaneous closure suggests that use of ICE is safe and efficacious. Compared to TEE, ICE demonstrated significantly shorter FT and PT, decreasing the entire duration of the procedure and x‐ray exposure. No relevant differences were observed in terms of success rate and complications. [ABSTRACT FROM AUTHOR]

Introduction: The importance of atrio‐ventricular synchrony pacing in sinus rhythm patients is known. To identify patients in whom leadless pacemakers are able to guarantee this atrio‐ventricular synchrony, we explored correlations among echocardiographic measures of left atrial (LA) size and function (doppler parameter and strain) with A4 amplitude in patients implanted with new generation Micra‐AV device. Methods: After implantation with Micra‐AV system, patients underwent device interrogation to evaluate AV synchrony based on the sensing of atrial mechanics and echocardiographic exam to assess LA morphology and LA function. Results: In the 21 studied patients (14 males, 72 ± 13 years), the A4 wave amplitude values inversely correlated with LA antero‐posterior diameter, LA volume, LA contraction strain and LA conduit strain, while they were positively related with LA reservoir strain. Discussion: Our results indicate a statistically significant relationship between morphological echocardiographic LA parameters and atrial contraction signal (A4), detected by leadless pacemakers and used to synchronize ventricular pacing with the atrium. Instantaneous LA function assessment obtained with LA strain provides incremental information over morphological parameters. LA strain evaluates atrial myocardial deformation during the whole cardiac cycle. We found higher value of A4 in patients that have grater absolute value of LAsr, LAscd and LAsct, that are simple and measurable parameters of LA functional capacity. Conclusion: Preimplant echocardiographic evaluation of the atrial contractility may be useful in predicting adequate A4 sensing and consequently a good atrio‐ventricular synchrony pacing. Echocardiography LA strain study seems promising in Micra‐AV patient selection. [ABSTRACT FROM AUTHOR]

This article examines the magnitude and determinants of migration from east to west (Europe) following the collapse of communism, and from south (Africa) to north (Europe). Special attention is given to assessing numbers and characteristics (including illegal) of the flows, and also to reasons for and success of bilateral agreements and cooperative projects by the governments of Italy and Spain designed to check and control the flows. Notwithstanding tighter controls on visas for Third World nationals, migration to western Europe does not seem to have abated. In Italy, illegal migration from the east (Albania in particular) is connected, directly or indirectly, with the criminal underworld. The inventory of legal texts and agreement protocols between Spain and Morocco designed to resolve many issues relating to migration, reflect long-standing relations between the two countries. Political and economic relations between Italy and Albania, on the other hand, have developed only within the framework of recent policies. While the presence of Moroccans in Spain and Albanians in Italy is not yet demographically significant, the authors predict that, in the absence of further appropriate political and economic measures, numbers will increase. [ABSTRACT FROM AUTHOR]