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Funding Acknowledgements Type of funding sources: None. Background Remote monitoring of implantable cardiac devices (CIEDs) has proven to be reliable, more efficient and even safer than conventional in-office follow-ups However, its implementation has not been as desired. The COVID 19 pandemic and the need to keep patients away from hospitals may have been the final boost for this form of monitoring. Purpose We sought to evaluate the pre and post-pandemic trends in CIEDs remote monitoring activations from a large nationwide database in order to determine the global effect of the COVID-19 pandemic on CIEDs implants in Spain. Methods The Covid-19 Remote Monitoring Spain Registry (Covid-19 RM-Spain) is a survey supported by the Heart Rhythm Association of the Spanish Society of Cardiology to request the whole national data, regarding the number of CIED´s implants and remote monitoring activations from the five main manufacturers classified according to each autonomous community (not by institutions).All data were aggregated and anonymized to analyse the total sample. Appropriate permissions were granted to use the data and a confidentiality agreement was signed in order to avoid any transmission of sensitive information. Results The percentage of devices for which remote monitoring was activated was 24.5%; 28.4%, 42% and 49% in 2018, 2019 ,2020 and 2021, which implies that remote monitoring is now activated on more than twice as many devices in Spain as in 2018. The table shows the differences in the percentages of remote monitoring activation between three different periods for each type of device. (Period 1 /pre-lockdown January 2018-February 2021; Period 2/ lockdown: March-June 2020 and Period 3/ lockdown: July 2020-December 2021. Footnotes: Period A vs. B p Abbreviations : CRT-D: Cardiac resynchronization Therapy -Desfibrillator; CRT-P: Cardiac resynchronization Therapy -pacemaker; ICD: Implantable cardiac defibrillators; ILR: Implantable Loop recorders; LLPM: Leadles Pacemakers; PM: Pacemakers; S-ICD: Subcutaneous Implantable cardiac defibrillator.

Funding Acknowledgements Type of funding sources: None. Background The Covid-19 pandemic has meant a very significant reduction in all urgent and non-urgent activity, including the implants of Cardiac Implantable electronic devices (CIEDs) throughout 2020. From the end of 2020 and throughout the year 2021, hospital activity has normalised, but it is uncertain whether the devices that were not implanted within 2020 have been delayed in time or actually lost. Purpose We sought to evaluate the pre and post-pandemic trends in CIEDs implantations from a large nationwide database in order to determine the global effect of the COVID-19 pandemic on CIEDs implants in Spain. Methods The Covid-19 Remote Monitoring Spain Registry (Covid-19 RM-Spain) is a survey supported by the Heart Rhythm Association of the Spanish Society of Cardiology to request the whole national data regarding the number of CIED´s implants and remote monitoring activations from the five main manufacturers classified according to each autonomous community (not by institutions).All data were aggregated and anonymized to analyse the total sample. Appropriate permissions were granted to use the data and a confidentiality agreement was signed in order to avoid any transmission of sensitive information. Results No institution objected to the use of their data, so the total number of devices implanted in Spain were obtained, which were 50258, 52994, 47330 and 54490 in 2018, 2019, 2020 and 2021 respectively. When we try to balance the drop in implants during 2020 and the subsequent increase experienced during 2021 against the average of 2018 and 2019, we have observed that approximately 2600 pacemakers (7%) and about 150 defibrillators (3.1%) have been "lost". With regard to the rest of the devices, adding up the differences between 2020 and 2021 and comparing them with the average for 2018-19, an increase of 419 Cardiac Resynchronization defibrillators (18%), 130 Cardiac Resynchronization Pacemakers (9.4%) and 1189 Implantable Loop recorders ( 26%) have been observed. Conclusion(s) In 2020 there was a large reduction in all CIEDs implants. In the most numerous devices (pacemakers), unlike the rest, the increment has not compensated for the reduction in implants that occurred in 2020 by the end of 2021. The marked increase in the number of cardiac resynchronization implants may suggest that the indication for single or dual-chamber defibrillator implantation may have finally evolved in a significant number of patients into an indication for cardiac resynchronization. Abbreviations: CRT-D: Cardiac resynchronization Therapy -Desfibrillator; CRT-P: Cardiac resynchronization Therapy -pacemaker; ICD: Implantable cardiac defibrillators; ILR: Implantable Loop recorders; LLPM: Leadles Pacemakers; PM: Pacemakers; S-ICD: Subcutaneous Implantable cardiac defibrillator.

Funding Acknowledgements Type of funding sources: None. Introduction There is little evidence regarding if the electrocardiographic pattern following CRT has impact on morbidity and mortality. In a previous study, a specific group of patterns in three leads of the ECG (Rs in V1, Qr in aVL or rS in I) was associated with lower incidence of the composite endpoint of death from any cause and heart failure hospitalization at 1 year. Purpose In this historical cohort study we analyzed if the specific pattern (Rs in V1, Qr in aVL or rS in I) was associated with outcomes at 2 years follow up. Methods Patients with CRT devices were consecutively included from January 2012 to April 2019. The primary endpoint was a composite of death from any cause and heart failure hospitalization at 2 years. Secondary endpoints included the individual components of the primary endpoint at 2 years. Survival analysis was performed using Kaplan-Meier test, comparing survival graphics through Log-Rank test. For multivariate analysis, Cox regression was performed. Results We included 111 patients. Baseline characteristics are reported in Table 1. Presence of any of the three patterns was not significantly associated with the primary endpoint (p=0.182). Patients who presented any of these patterns had not a significantly lower incidence of death from any cause (p=0.303), but had a significantly lower incidence of HF hospitalization (4.7% vs. 17.6%, hazard ratio 0.207, 95% confidence interval 0.046-0.93, p=0.04). Previous atrial fibrillation was independently associated with a higher incidence of primary and secondary endpoints. QRS duration postimplantation was independently associated with incidence of the primary endpoint. Conclusion The presence of the patterns Rs in V1, Qr in aVL or rS in I is an independent predictor of reduced HF hospitalizations at 2 years in patients with CRT. Previous atrial fibrillation and QRS duration were also associated with outcomes.

Introduction Following cardiac resincronization therapy (CRT), QRS duration is the most important prognostic factor in the 12-lead electrocardiogram (ECG). However, there is little evidence regarding if the electrocardiographic pattern following CRT has impact on morbidity and mortality. Purpose In this historical cohort study we analysed if a certain pattern in three leads of the ECG (Rs in V1, Qr in aVL or rS in I) is associated with lower incidence of adverse outcomes in a population of CRT patients within 1 year of implant. Other variables previously associated with success or failure of CRT were analysed. Methods Patients with CRT devices (pacemaker or defibrillator) with left ventricle lead in the coronary sinus were included from January 2012 to April 2019. One year clinical follow-up was performed. The primary endpoint was a composite of death of any cause and heart failure hospitalization. Differences in categorical data were reported as frequencies then compared using χ2 tests. Continuous variables were reported as means ± standard deviation with differences between groups tested using independent samples t-tests. Survival analysis was performed using Kaplan-Meier test, comparing survival graphics through Log-Rank test. For multivariate analysis, Cox regression was performed. Variables that showed significance in the univariate analysis were included. Results 111 patients were included. Sample was divided into 2 groups according to the presence of the pattern in any of the three ECG leads. Two patients (1.8%) presented Rs in V1 and Qr in aVL simultanously and two patients (1.8%) presented Rs in V1 and rS in I. None of the patients presented all three patterns simultaneously. Baseline characteristics are reported in Table 1. Presence of any of the three patterns was independently associated with a lower incidence of the primary endpoint (2.3% vs. 17.6%, hazard ratio 0.1, 95% confidence interval 0.013–0.774, p=0.016). Previous atrial fibrillation was also independently associated with a higher incidence of the primary endpoint. QRS duration postimplantation did not showed prognostic value. Conclusion The presence of the patterns Rs in V1, Qr in aVL or rS in I is an independent predictor of good prognosis in patients with CRT. Funding Acknowledgement Type of funding sources: None. Baseline characteristicsKaplan Meier survival curves

Funding Acknowledgements Type of funding sources: None. Introduction following cardiac resincronization therapy (CRT), QRS duration is the most important prognostic factor in the 12-lead electrocardiogram (ECG). However, there is little evidence regarding if the electrocardiographic pattern following CRT has impact on morbidity and mortality. Purpose In this historical cohort study we analysed if a certain pattern in three leads of the ECG (Rs in V1, Qr in aVL or rS in I) is associated with lower incidence of adverse outcomes in a population of CRT patients within 1 year of implant. Other variables previously associated with success or failure of CRT were analysed. Methods patients with CRT devices with left ventricle lead in the coronary sinus were included from January 2012 to April 2019. The primary endpoint was a composite of death of any cause and heart failure hospitalization at 1 year. Survival analysis was performed using Kaplan-Meier test, comparing survival graphics through Log-Rank test. For multivariate analysis, Cox regression was performed. Results 111 patients were included. Sample was divided into 2 groups according to the presence of the pattern in any of the three ECG leads. Baseline characteristics are reported in Table 1. Presence of any of the three patterns was independently associated with a lower incidence of the primary endpoint (2.3% vs. 17.6%, hazard ratio 0.1, 95% confidence interval 0.013-0.774, p = 0.016). Previous atrial fibrillation was also independently associated with a higher incidence of the primary endpoint. QRS duration postimplantation did not showed prognostic value. Conclusion the presence of the patterns Rs in V1, Qr in aVL or rS in I is an independent predictor of good prognosis in patients with CRT. Baseline characteristicsPattern Rs-V1/Qr-aVL/rS-INo patternp-valueAge (years)69 ± 1767 ± 210.257Women8 (18.6)17 (25)0.432Atrial fibrillation18 (41.9)22 (32.4)0.309- Ischemic cardiomyopathy- Non ischemic cardiomyopathy18 (41.9)25 (58.1)26 (38.8)41 (61.2)0.75Indication- HFrEF + NYHA II-IV + wide QRS- rEF + indication of cardiac stimulation- LV dysfunction secondary to stimulation 35 (81.4)7 (16.3)1 (2.3) 58 (85.3)9 (13.2)1 (1.5) 0.5870.6560.741Preimplantation LVEF (%)28 ± 1328 ± 150.882Up-titrated treatment17 (39.5)26 (38.2)0.891- LBBB- RBBB36 (83.7)5 (11.6)61 (89.7)6 (8.8)0.3550.63QRS duration postimplantation (ms)144 ± 35142 ± 500.657HFrEFheart failure with reduced ejection fraction; NYHA: New York Heart Association; rEF: reduced ejection fraction; LV: left ventricle; LVEF: left ventricle ejection fraction; LBBB: left bundle branch block; RBBB: right bundle branch block.Abstract Figure. Kaplan Meier survival curves