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Funding Acknowledgements Type of funding sources: None. Introduction COVID-19 pandemic has caused a necessary reorganization of the elective outpatient device clinic. Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has already been validated as a safe and effective tool to follow patients, limiting the need for in-person visits. Aim of our study was providing a snapshot of the current clinical practice in a tertiary electrophysiology center in Italy and suggesting a potential model of care for patients with CIEDs. Methods and Results Before the COVID-19 pandemic, patients with implantable cardioverter defibrillators/cardiac resynchronization therapy (ICD/CRTs) were evaluated in the device clinic twice a year and patients with pacemakers (PMs) once a year; loop recorder (ILR) patients were followed remotely only. In the COVID-19 period (March 2020-February 2021) RM was implemented for all compatible CIEDs. Patients with RM were not seen in clinic anymore and were followed with RM. In the COVID-19 period, 100% of newly implanted devices received RM (82 ILR, 194 PMs, 80 ICDs/CRTs), compared to 68% in the same months of 2019 (106/106 ILR, 83/203 PMs, 78/82 ICD/CRTs), p By the end of February 2021, a total of 1676 patients were remotely monitored at our Institution, with a potential saving of outpatient visits of 1683 visits/year, against an average of 8514 RM transmissions/year needing evaluation. During the study period, we observed 213 clinical events that triggered an urgent manual transmission and/or required physician’s intervention (table 1), successfully resolved over the following 24 h. None of the 1676 patients presented to the emergency room with a problem that went unnoticed by the RM system. Conclusion RM of CIEDs is an essential tool to reduce in-person visits during the COVID-19 pandemic and seems to be safe in terms of events detection. The potential for elective outpatient appointments reduction has to be counterbalanced by the sustainability of a large number of transmissions and data to analyze.

Funding Acknowledgements Type of funding sources: None. Background COVID-19 pandemic, limiting the availability of anesthesiologists, has impacted heavily on the organization of invasive cardiac procedures such as transcatheter atrial fibrillation (AF) ablation. Purpose We compared the safety and efficacy of deep sedation with dexmedetomidine administered by electrophysiologists without anesthesiologist supervision, against the standard protocol performed with propofol. Methods We retrospectively included all AF ablation procedures performed in 2020: 23 patients sedated with 1% propofol (2 ml bolus followed by infusion starting at 1 mg/Kg/h), 26 patients with dexmedetomidine (infusion starting at 0.7 mcg/Kg/h). Both groups additionally received 1 mcg/Kg of midazolam as a single bolus and 0.05 mg single boluses of fentanyl prior to ablation on each pair of pulmonary veins (PV). Primary outcomes were oxygen desaturation (< 90%) or need for assisted ventilation/intubation, bradycardia (heart rate < 45 bpm) and persistent hypotension (systolic blood pressure < 90 mmHg). Results Baseline characteristics and hemodynamic variables did not differ between the two groups (all p > 0.05). In 8/23 (35%) patients propofol infusion velocity reduction was necessary to maintain the hemodynamic values, compared to 7/26 (27%) with dexmedetomidine. Inter-group comparison of hemodynamic variables during the procedure showed no statistically significant difference, despite a trend in favor of dexmedetomidine (3 respiratory depressions and 3 persistent hypotension episodes with propofol vs. 0 with dexmedetomidine; p = 0.057). Conclusion Deep sedation with dexmedetomidine administered by electrophysiologists without anesthesiologist supervision is safe and effective for AF transcatheter ablation. A trend towards a lower incidence of hypotension and respiratory depression was noted when compared to propofol.

Background Due to the current CoViD-19 pandemic, the number of outpatient hospital visits has significantly decreased, creating a fundamental need for telemedicine. Remote monitoring of implantable cardiac devices has emerged as a powerful and well-validated tool to follow patients with heart failure (HF) and cardiac resynchronization therapy (CRTs) devices. Purpose The aim of our study was to evaluate the CRT HeartLogic algorithm performance in the detection of HF episodes in a real-life population followed with remote monitoring. Methods Fifty-four patient (mean age 73±7 years, 72% males) with HF and reduced left ventricular ejection fraction were implanted with a HeartLogic-enabled CRT device and were enrolled in the Boston Scientific Latitude remote monitoring platform. Remote data were reviewed every month and at the time of an alert. The HeartLogic nominal value of 16 was used to trigger an alert episode. Patients were then contacted by phone and actions were taken to manage the potential HF condition detected by the alert. Results During a median follow-up of 12 (6–18) months, the HeartLogic alert was triggered in 9 patients (9/54, 17%). The median time between threshold crossing and a HF clinical event was 11 (2–19) days. The maximum HeartLogic index value was 43 (mean 29±8). Three events occurred after inappropriate discontinuation of HF therapy. All the events required clinical action. Four out of 9 patients required diuretic dosage increase, 1/9 electrical cardioversion for new onset atrial fibrillation, 3/9 hospitalization for i.v. therapy. One patient showed only mild HF symptoms but was found to have concomitant CoViD-19 infection. Conclusion The HeartLogic algorithm is useful to detect HF worsening and undertake appropriate clinical actions. Telemedicine and device remote monitoring are very helpful tools allowing early detection of HF-related clinical conditions. This is of utmost importance in the era of CoViD-19 pandemic, when scheduled access to the hospital for routine follow-up appointments might be limited. Funding Acknowledgement Type of funding sources: None.

Additional file 1: Table S1. Sequencing and mapping results. The table reports the RNA-Seq libraries sequenced including for each of them i) the number of raw reads obtained, ii) the number of reads after trimming and rRNAs removal iii) the number of mapped reads (and the percentage of mapped reads). Table S2. GSEA results. Enriched BIOCARTA Gene Sets (GS) at both the highest (up-regulation in “diet Y” condition) and lowest (up-regulation in “diet C” condition) part of the genes ranking are reported. ES: enrichment score; NES: normalized enrichment score; NOM p-val: nominal P-value.