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The Ionian Calabrian and Apulian margins are severely incised by a dense network of submarine canyon systems, that have formed in response to ongoing km-scale uplift of Calabria over the last ca. 1Ma. Despite their young age (Pleistocene) they incise the continental shelf and slope over lengths of tens of kilometres, with thalwegs up to 2 km wide, walls higher than 200m and headwalls, that can extend over more than 50 km.Some of the canyon headwalls are very close to the coastline and in some cases, retrogressive features are observed from morphology and sub-bottom observations, representing a potential hazard for population and coastal infrastructures. Some of the canyons are isolated, others form hierarchic systems with five or more canyons merging into dendritic (cauliflower) systems that may or may not be connected to onshore drainage networks. They exhibit different characteristics in terms of headwall geometry, profile concavity and sinuosity.We present new information on their geomorphic attributes to gain new understanding about the dynamic and evolution of the different canyon systems in the last 1Ma. In addition, we aim at extracting information regarding the grain size and sediment type from vintage backscatter geophysical data and subbottom data, to analyse canyon headwall enlargement and their erosive activity. The overall purpose of my study is to bring new insights about the inception and evolution of the different canyon systems in relation to tectonic and sea level changes and thus be able to assess the potential geohazards that retrogressive canyon headwalls may represent today for coastal areas and infrastructures.

This work addresses the tectonic significance of a NW-SE strike-slip fault zone in the Calabrian Arc of Southern Italy, the Rossano-San Nicola Fault Zone (RSFZ). High-quality seismic reflection and 1D forward models of exploration boreholes and pseudo-wells show that the RSFZ experienced multiple Miocene phases of contractional/transpressional tectonics. These were followed by crustal extension during the Pliocene in association with the oceanisation of the Tyrrhenian Sea, Apennine orogenesis, and collision between the Calabrian Arc and adjacent tectonic plates. Such a setting had a profound influence on the Crotone Basin and its economic potential: 1) tectonic reactivation allowed reservoir units of the Crotone Basin to be charged by gas derived from Triassic/Lower Jurassic source rocks, and 2) source rocks reached their maximum depth and remained in the gas generation window after the emplacement of a large mass-transport complex in the Pliocene. In the surrounding areas, tectonic activity near the RSFZ contributed to source-rock maturation by enhancing local sedimentation rates, particularly during Langhian (Middle Miocene) and Zanclean (early Pliocene) tectonics. This work is important as it demonstrates the tectono-stratigraphic evolution of the Crotone Basin to be closely related to the structural evolution of the RSFZ. Crucially, the study area reveals the first example of a gas field fully sealed by a large mass-transport complex. As a corollary, we tie the Late Cenozoic geological history of the Crotone Basin to the geodynamic evolution of the central Mediterranean region, namely the Ionian and Tyrrhenian seas. We identify new prospects in the Crotone Basin and provide a time frame for gas generation and accumulation in Southern Italy.

In the wide phenotypic spectrum of cardiomyopathies, sudden cardiac death (SCD) has always been the most visible and devastating disease complication. The introduction of implantable cardioverter-defibrillators for SCD prevention by the late 1980s has moved the question from how to whom we should protect from SCD, leaving clinicians with a measure of uncertainty regarding the most reliable option to guide identification of the highest-risk patients. In this review, we will go through all the available evidence in the field of arrhythmic expression and arrhythmic risk stratification in the different phenotypes of cardiomyopathies to provide practical suggestions in daily clinical management.

A 55-years old sporty man, without any cardiovascular risk factors nor previously known cardiological history, presented for a cardiological evaluation due to extra-systolic palpitations and dyspnea. The ECG documented a new onset of right bundle branch block, left anterior fascicular block and first degree of atrio-ventricular block. Echocardiography revealed severe left ventricular (LV) systolic dysfunction (LV ejection fraction -EF- 34%), showing also right ventricular (RV) dilatation and disfunction. A 24-hour Holter monitoring did not show any significant arrhythmias and maximal stress test did not reveal any ECG changes nor arrhythmias. Cardiac magnetic resonance (CMR) confirmed the presence of severe biventricular dysfunction; multiple areas of edema and late gadolinium enhancement (LGE) were observed, with ischemic and nonischemic pattern and extensive involvement of the RV and the interventricular septum. In the suspicion of cardiac sarcoidosis a 18-fluorodeoxyglucose positron emission tomography (PET) was performed, confirming the presence of an inflammatory cardiomyopathy in an active phase. A subsequent endomyocardial biopsy was performed, which demonstrated the presence of non-caseating granulomas, signs of inflammation and fibrosis, consistent with the diagnosis of cardiac sarcoidosis. No signs of extra-cardiac involvement were present. The patient started anti-inflammatory therapy with Prednisone and Metotrexate, along with anti-neurohormonal therapy. However, due to a significant increase in ventricular arrhythmic burden, an implantable cardioverter defibrillator was placed during early follow-up, and Amiodarone therapy was started. After 5 months of medical therapy, PET scan showed a marked reduction of cardiac inflammation and echocardiography showed a significant LVEF improvement (from 34% to 43%). After slow tapering of steroid therapy Prednisone was stopped, whereas Metotrexate, Amiodarone and anti-neurohormonal therapy were maintained. Follow-up is still ongoing without clinical events. Sarcoidosis is a systemic inflammatory disease characterized by the presence of non-caseating granulomas in multiple organs. Cardiac involvement is associated with higher incidence of heart failure, ventricular arrhythmias and all-cause mortality. Isolated cardiac involvement is rare but associated with worse prognosis. Multimodality imaging is of paramount importance for the diagnosis and monitoring therapy.

A 60-year-old man with a previous myocardial infarction was admitted to our ICU for acute pulmonary edema in the context of an acute antero-lateral non-ST elevation myocardial infarction. Echocardiography showed severe left ventricular (LV) dilatation with extensive wall motion abnormalities, large apical aneurysm and severe systolic dysfunction. Coronary angiography showed a triple-vessel disease with proximal occlusion of the left anterior descending artery. During the hospitalization, multiple episodes of drug-resistant monomorphic ventricular tachycardias occurred, requiring repeated DC Shock. After Heart Team discussion, the patient underwent coronary artery bypass grafting, LV restoration according to the procedure described by Guilmet and surgical cryoablation. The Guilmet septoexclusion is indicated when the interventricular septum is more involved than the free wall. After aneurysm incision, cryolesions were applied at the septum and at the transitional zone of the scar and viable tissue. Thus, the anterior free wall was sewn obliquely to the septum. Finally, the edges of the incision, anterior and septal, were sewn together to assure a definitive hemostasis (overcoat technique). After surgery, an implantable cardioverter-defibrillator was implanted in secondary prevention. The postoperative course and subsequent cardiological follow-up were characterized by a gradual clinical improvement with mild increasing in LV function and reduction in ventricular arrhythmias. Nowadays, combined aneurysmectomy and endocardial ablation are rarely performed, but should be considered in patients with LV aneurysm who manifest drug-resistant ventricular arrhythmias. Encircling cryoablation in a remodelled ventricle is safe and effective in reducing ventricular arrhythmias which are a negative prognostic factor.

The spectacular water outburst occurring semi-periodically when the ice-dam formed by the external front of the Perito Moreno glacier collapses, is one of the most attracting events in the UNESCO ‘Parque Nacional Los Glaciares’ of southern Patagonia. These occurrences have been documented since 1936. Instead, evidence of previous events has been only indirectly provided by dendrochronology analysis. Here we show for the first time radiocarbon-dated sediment cores collected within a small inlet of Brazo Sur, that is, the southern arm of Lago Argentino that record ice-dammings in the Little Ice Age, at 324–266 cal yrs BP, as measured on a vegetal fragment sampled at ca. 14 cm from the top of a core. A common characteristic of the three sediment cores is the abrupt change in the stratigraphic record found at variable depths of 14–18 cm from the top of the cores. This change is marked by a hiatus spanning ca. 3200 years, separating planar-laminated sediments below from an alternation of erosional and depositional events above it, indicating recurring high-energy conditions generated by the emptying of the lake basin. In addition, we observed significant changes in the abundance of environmental indicators as testate amoebae below and above the hiatus. These well-preserved stratigraphic records highlight the key role of glaciolacustine deposits in reconstructing the glacial dynamics and palaeoclimate evolution of a glaciated region.

Aims Although increasingly recognized as a distinct pathological entity, left bundle branch block‐induced cardiomyopathy (LBBB‐ICMP) is not included among the possible aetiologies of acquired dilated cardiomyopathies (DCM). While diagnostic criteria have been proposed, its recognition remains principally retrospective, in the presence of clinical and instrumental red flags. We aimed to assess the prevalence and clinical and instrumental features of LBBB‐ICMP in a large cohort of patients with DCM. Methods and results We analysed a cohort of 242 DCM patients from a two‐centre registry. Inclusion criteria were age > 18, non‐ischaemic or non‐valvular DCM, and LBBB on electrocardiogram. LBBB‐ICMP was defined according to previously proposed diagnostic criteria: (i) neither family history nor clinically identifiable potential causes for DCM; (ii) negative genetic testing; (iii) echocardiographic features including non‐severe chamber dilation, normal absolute and relative wall thickness, marked dyssynchrony, and normal right ventricular function; and (iv) absence of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR). From the entire cohort, we identified 30 subjects (similar in terms of New York Heart Association class I or II in 80% vs. 75%, P = 0.56; QRS width of 150 ± 22 vs. 151 ± 24 ms, P = 0.82; and cardiac remodelling of baseline end‐diastolic diameter 66 ± 8 vs. 65 ± 10 mm, P = 0.53) with a comprehensive dataset including CMR and genetic testing, required to verify the presence of the diagnostic criteria proposed for LBBB‐ICMP. The main characteristics of this subgroup were 73% males, age 45 ± 13 years, left ventricular ejection fraction (LVEF) 30 ± 10%, LGE in 38% of patients, and QRS complex of 150 ± 22 ms. Patients were under guideline‐directed medical therapy, and 57% of them were treated with cardiac resynchronization therapy (CRT). Two patients (6.67%, 50% males, age 53 ± 13 years) fulfilled the diagnostic criteria proposed for LBBB‐ICMP. After a follow‐up of 44 (12–76) months, LVEF was normal and QRS width significantly reduced (from 154 ± 25 to 116 ± 52 ms) in patients with LBBB‐ICMP. Both patients were under optimal medical treatment, and one was implanted with CRT‐D. Neither of the two patients experienced death, malignant ventricular arrhythmia, or heart failure hospitalization at follow‐up. Conclusions Left bundle branch block‐induced cardiomyopathy emerges as a distinct pathological entity, promptly identifiable in a minority but not negligible proportion of patients with newly diagnosed DCM and LBBB, using a series of diagnostic criteria including CMR and genetic testing. Further studies are needed to better elucidate the clinical course of LBBB‐ICMP.

With the regional law n. 26 of December 30, 2020, the Friuli Venezia Giulia Region wanted to promote the establishment of the Regional Register of Sudden Cardiac Death, with the aim of favoring the study of all those deaths that occurred suddenly and unexpectedly under the age of 50 years in which it is not possible to trace the cause of death with certainty. Such dramatic events, difficult to quantify considering the complexity of data collection, are often accepted with resignation without any further investigation of the possible causes. The Regional Register of Sudden Cardiac Deaths of Friuli Venezia Giulia was born from this premise and from the awareness of the importance of going back with a rigorous scientific methodology and through a multidisciplinary approach, to the diagnosis of hereditary heart diseases which, when determined, allow the enrollment of relatives in a cardiological screening process and, therefore, primary prevention of potentially fatal events. The authors describe the operating procedures feeding the Regional Register and present the results of the first year of activity on 26 cases.

The number of patients with cardiac implantable electronic devices (CIEDs) undergoing radiotherapy (RT) for cancer treatment is growing. At present, prevalence and predictors of RT-induced CIEDs malfunctions are not defined.Systematic review and meta-analysis conducted following the PRISMA recommendations. PubMed, Scopus and Google Scholar were searched from inception to 31/01/2022 for studies reporting RT-induced malfunctions in CIEDs patients. Aim was to assess the prevalence of RT-induced CIEDs malfunctions and identify potential predictors.Thirty-two out of 3962 records matched the inclusion criteria and were included in the meta-analysis. A total of 135 CIEDs malfunctions were detected among 3121 patients (6.6%, 95% confidence interval [CI]: 5.1%-8.4%). The pooled prevalence increased moving from pacemaker (PM) to implantable cardioverter defibrillator (ICD), and cardiac resynchronization therapy and defibrillator (CRT-D) groups (4.1%, 95% CI: 2.9-5.8; 8.2% 95% CI: 5.9-11.3; and 19.8%, 95% CI: 11.4-32.2 respectively). A higher risk ratio (RR) of malfunctions was found when neutron-producing energies were used as compared to non-neutron-producing energies (RR 9.98, 95% CI: 5.09-19.60) and in patients with ICD/CRT-D as compared to patients with PM/CRT-P (RR 2.07, 95% CI: 1.40-3.06). On the contrary, no association was found between maximal radiation dose at CIED2 Gy and CIEDs malfunctions (RR 0.93; 95% CI: 0.31-2.76).Radiotherapy related CIEDs malfunction had a prevalence ranging from 4% to 20%. The use of neutron-producing energies and more complex devices (ICD/CRT-D) were associated with higher risk of device malfunction, while the radiation dose at CIED did not significantly impact on the risk unless higher doses (10 Gy) were used.

The design of critical facilities needs a targeted computation of the expected ground motion levels. The Trans Adriatic Pipeline (TAP) is the pipeline that transports natural gas from the Greek-Turkish border, through Greece and Albania, to Italy. We present here the probabilistic seismic hazard analysis (PSHA) that we performed for this facility, and the deaggregation of the results, aiming to identify the dominant seismic sources for a selected site along the Albanian coast, where one of the two main compressor stations is located. PSHA is based on an articulated logic tree of twenty branches, consisting of two models for source, seismicity, estimation of the maximum magnitude, and ground motion. The area with the highest hazard occurs along the Adriatic coast of Albania (PGA between 0.8 and 0.9 g on rock for a return period of 2475 years), while strong ground motions are also expected to the north of Thessaloniki, Kavala, in the southern Alexandroupolis area, as well as at the border between Greece and Turkey. The earthquakes contributing most to the hazard of the test site at high and low frequencies (1 and 5 Hz) and the corresponding design events for the TAP infrastructure have been identified as local quakes with MW 6.6 and 6.0, respectively.

Aims: To analyze temporal trends (2001 -2017) of Pacemakers (PM) and Implantable Cardioverter-Defibrillators (ICD) procedures in Italy, according to the national Hospital Discharge Database (HDD). Methods: Frequency and implant rate (IR) in the Italian population were analyzed by age groups (

Implantation of pacemakers and cardiac defibrillators is a life-saving treatment but can put our patients at risk of infections, increasing morbidity and mortality and prolonging hospitalization with a significant financial healthcare burden. A preventive strategy is crucial but, while several strategies such as administration of intravenous antibiotic therapy before implantation are well recognized, other uncertainties remain. The main gaps regard the use of periprocedural measures, including antibacterial envelope to prevent device infection, the appropriate management of antithrombotic therapy before and after device implantation and timing of device reimplantation. To address these issues, some important randomized clinical trials and a European Heart Rhythm Association consensus document have recently been published. The aim of this article is to review current knowledge on the management of infections in patients with cardiac implantable electronic devices to help not only electrophysiologists, but also physicians in their daily practice.

The aim of this document is the management and organization of patients in need of urgent access to electrophysiology (EP) and pacing procedures during the COVID-19 emergency. Specifically, non-deferrable procedures or irreplaceable with a drug therapy prior to the resolution of the COVID-19 virus emergency [pacemaker (PM) implant/replacement/urgent defibrillator (implantable cardioverter-defibrillator, ICD) or arrhythmic storm or other indication of non-deferrable ablation]. The pacing and electrophysiological procedures urgent as they may be, less and less frequently represent situations of emergency, therefore for almost all cases, it is possible to perform a swab test to determine the positivity to COVID-19 of the patient. In cases where this is not possible, due to situations of emergency, the recommendations and procedures we have indicated are advisable, if not mandatory, in order to avoid the spreading of the virus to healthcare personnel and other patients.

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.

Since about 20,000 years ago, the geography of the Earth has been profoundly modified by the gradual sea-level rise caused by the melting of continental ice sheets. Flat areas and regions characterized by very low gradients experienced, more than others, rapid flooding, with the progressive disappearance of vast coastal territories. Here we present a recon- struction of the late Quaternary coastline evolution of the north-western sector of the Sicilian Channel, constrained by high-resolution seismic profiles where the marker of the post-Last Glacial Maximum (LGM) marine transgression has been clearly identified and mapped. The locations of the post-LGM seismic horizon have been compared with predictions of a Glacial Isostatic Adjustment (GIA) model, which accounts for the migration of the shorelines in response to sea-level rise and for Earth’s rotational and deformational effects associated with deglaciation. We have verified that most of the points mapped through seismic data interpretation fall along the palaeo-coastline that the GIA model predicts for the 21 kyrs B.P. time frame. However, the model shows a misfit in the marine sector between Mazara del Vallo and Sciacca, where the available data indicate a Quaternary tectonic uplift. The analy- sis of the seismic profiles provides useful constraints to current GIA models. These add on existing histories of relative sea level in the Mediterranean Sea, allowing to gain new insight into the evolution of the palaeo-geography of the region of study and of the whole Sicilian Channel since the LGM, even in areas where direct geophysical observations are not avail- able yet. In this respect, one of the most attractive implications of the ancient coastline evo- lution is linked with the underwater archaeology. The sea-level rise heavily impacted the distribution of human settlements, possibly forcing site abandonment and migrations, and this is particularly relevant in the Mediterranean basin, the cradle of the western civilization. The underwater traces left by these ancient populations represent the fundamental proofs to reconstruct the early history of our precursors.

This critical review illustrates the pathophysiological aspects and available scientific evidence about cardiac contractility modulation therapy. A useful algorithm dealing with the essential decisional knots to consider for device implantation in patients with heart failure in NYHA classII and ejection fraction ≤45% is presented. The present review paves the way for the development of an Italian registry aiming at analyzing the characteristics of implanted patients based on a multiparametric approach, including cardiac biomarkers, to identify clinical profiles and predictors of response to therapy. The "Answers and Questions" section provides useful insights into pathophysiology, technical specifications, clinically relevant scenarios and future perspectives.

Objective The objective was to provide an exhaustive characterization of ECG features in a large cohort of dilated cardiomyopathies (DCMs) and then investigate their possible prognostic role in the long term. Background ECG is an accessible, reproducible, low-cost diagnostic and prognostic tool. However, an extensive description of ECG features and their long-term prognostic role in a large cohort of DCM is lacking. Methods All available baseline ECGs of DCM patients enrolled from 1992 to 2013 were systematically analysed. Patients underwent to a complete clinical-laboratory evaluation. The study outcome measures were death or heart transplant (D/HT) and sudden death or malignant ventricular arrhythmias (SD/MVA). Results Four hundred and fourteen DCM patients were enrolled. During a median follow-up of 125 months, 55 and 57 patients experienced D/HT and SD/MVA, respectively. At multivariate analysis, left ventricular hypertrophy (P = 0.017), heart rate (HR, P = 0.005) and anterolateral T-wave inversion (P = 0.041) predicted D/HT. Regarding SD/MVA, S wave amplitude in V2 (P = 0.008), R wave amplitude in DIII (P = 0.007), anterolateral T-wave inversion (P = 0.017) emerged as predictors. At receiver-operating curve analyses, the addition of ECG models to the clinical-laboratory evaluation significantly increased the area under the curve both for D/HT (from 0.68 to 0.74, P = 0.042) and SD/MVA (from 0.70 to 0.77, P = 0.048). Conclusion The exhaustive systematic evaluation of ECG has an incremental impact in the prognostication of a large cohort of DCM patients, also regarding the arrhythmic stratification.

AIMS: Arrhythmic risk stratification is a challenging issue in patients with dilated cardiomyopathy (DCM), particularly when left ventricular ejection fraction (LVEF) is more than 35%. We studied the prevalence and predictors of sudden cardiac death or malignant ventricular arrhythmias (SCD/MVAs) in DCM patients categorized at low arrhythmic risk because of intermediate left ventricular dysfunction under optimal medical treatment (OMT). METHODS: DCM patients considered at low arrhythmic risk (LVEF >35% and New York Heart Association class I-III after 6 ± 3 months of OMT) were analysed. An arrhythmogenic profile was defined as the presence of at least one among a history of syncope, nonsustained ventricular tachycardia, at least 1000 premature ventricular contractions/24 h, at least 50 ventricular couplets/24 h at Holter ECG monitoring. SCD/MVAs was considered as the study end-point. RESULTS: During a median follow-up of 152 months (interquartile range 100-234), 30 out of 360 (8.3%) patients at low arrhythmic risk (LVEF 47 ± 7%) experienced the study end-point [14 (3.9%) SCD and 16 (4.4%) MVA]. Compared with survivors, patients who experienced SCD/MVAs had more frequently an arrhythmogenic profile and a larger left atrium. Their LVEF at the last available evaluation before the arrhythmic event was 36 ± 12%. At multivariable analysis, left atrial end-systolic area [hazard ratio 1.107; 95% confidence interval (95% CI) 1.039-1.179, P = 0.002 for 1 mm increase] and arrhythmogenic profile (hazard ratio 3.667; 95% CI 1.762-7.632, P = 0.001) emerged as predictors of SCD/MVAs during follow-up. CONCLUSION: A consistent quota of DCM patients with intermediate left ventricular dysfunction receiving OMT experienced SCD/MVA during follow-up. Left atrial dilatation and arrhythmogenic pattern were associated with a higher risk of SCD/MVA.

The wave-ravinement surface (WRS) is a surface of sequence-stratigraphic significance that forms in shallow-water settings during transgression. It develops progressively landward during shoreface retreat due to wave action, which erodes the substrate and leads to sediment bypass in the offshore direction. The WRS may rework previously formed surfaces, such as the maximum regressive surface (also known as the transgressive surface) and the subaerial unconformity, becoming a systems tract and/or sequence boundary. Due to the associated lithological contrast between underlying and overlying deposits and the presence of lags and/or shell pavements, the WRS has a very good appearance in both outcrop and cores and is often used as the boundary of shallow-marine stratigraphic sequences. The WRS, therefore, represents an important lithological and paleo-environmental break, and its recognition is significant for reconstructing stratigraphic architectures and the history of relative sea-level change, as well as for reservoir characterization. Several controlling factors govern the development of the WRS and of the associated deposits; they include the accommodation to sedimentation (A/S) ratio, environmental energy, topographic gradient, roughness and lithology of the substrate. Relatively low rates of relative sea-level rise and sediment supply, high wave energy, steep topographies and easily erodible substrates favor the development of the WRS. These factors interact, leading to a high variability in the amount of erosion, shape, length along depositional dip and deposits associated with these surfaces. WRSs may be classified based on either underlying or overlying deposits, or a combination of both. A classification based on the deposits that underlie the WRS helps to determine the location of the studied outcrop along depositional dip, whereas a classification based on the deposits that overlie the WRS afford insights into the physical conditions that accompanied its formation. However, the best description of the WRS in terms of location of a considered outcrop, physical conditions under which the WRS developed and their lateral variability, type of substrate, as well as its practical significance for reservoir modeling is achieved with a combination of the two criteria.

Neuromuscular diseases (NMD) are a broadly defined group of disorders that all involve injury or dysfunction of peripheral nerves, neuromuscular junction or muscle, often with dominant or recessive pattern of inheritance. Cardiac involvement is uncommon, in particular with cardiomyopathies and brady/tachyarrhythmias. The causes of cardiac involvement are unclear: replacement fibrosis, alteration of membrane permeability, sympathetic hyperactivity, or accumulation of toxic metabolites can play a role in the pathogenesis of cardiac disorders. The early diagnosis is of pivotal importance to prevent evolution of the disease: electrocardiographic alterations and arrhythmias, particularly if associated with family history for cardiomyopathy or sudden death, can be an early signal of cardiomyopathy associated with NMD. Genetic analysis can improve prognostic stratification, particularly related to arrhythmic risk, and guide to a tailored therapy.

The Adriatic basin represents one of several restricted basins located in the Mediterranean Area. It consists of the foreland of three different orogenic belts: the Dinarides to the East, active during the Eocene, the Southern Alps to the North, active since the Cretaceous time, and the Apennines to the West, active since the Paleogene. The Apennines had a primary role during the Messinian Salinity Crisis (MSC), conditioning the connection between the Adriatic basin, the Ionian basin, and the proto-Tyrrhenian basin. During the Messinian, the present Adriatic Sea was characterized by shallow water domains, where gypsum evaporites initially deposited and often successively incised or outcropped. In the past 50 years, a massive dataset, composed of 2D multichannel seismic data and boreholes, was collected, covering almost the whole Adriatic basin in the Italian offshore. In this work, we interpreted the Plio-Quaternary base (PQb), based on available public datasets and on seismic profiles present in literature, which provided regional information from the northernmost Trieste Gulf (Northern Adriatic Sea) to the Otranto Channel (Southern Adriatic Sea). Here, we propose the PQb time-structural map, obtained by analyzing more than 600 seismic profiles. The PQb represents both the Messinian erosion and/or the top of the Messinian evaporites. It is characterized by a high-amplitude reflector, commonly called “horizon M” in the old literature. Principal findings concerning the Messinian event are summarized as below: -The Northern Adriatic (Gulf of Trieste, Gulf of Venice, Po delta, Kvarner Area) reveals widespread channelized systems produced by the initial decrease of the sea level, followed by subaerial erosion, related to further sea level decrease. High-grade erosion involved the nearby Adriatic carbonate platform in the Croatian offshore, where deep valleys, filled with Last Messinian or post- Messinian sediments, cut through the limestones.-The Central Adriatic (from the Po delta to the Gargano Promontory) displays a higher evaporites accumulation than the northern sector. Meanwhile, the Mid-Adriatic Ridge was already developing, along with the Apennine Chain, which was in a westernmost position. Erosional features in the deeper area are related to channelized systems, which followed the evaporites deposition. Meanwhile, also the Mid-Adriatic Ridge was affected by erosion.-The Southern Adriatic (from the Gargano Promontory to the Otranto Channel) is characterized by the Mesozoic Apulia carbonate platform, covered by a thin Cenozoic sequence affected by subaerial erosion or non-deposition. The platform margin and the slope leading to the deepest South Adriatic basin, where a Messinian gypsum layer, also recorded in the Albanian and Croatian offshore, shows a lower level of upper erosion.In general, we notice strongly variable thicknesses of the horizon M, which is related to submarine erosion (channels), subaerial erosion (discontinuous surfaces), non-deposition (possible unconformity), and tilting toward the surrounding chains (deepening horizons). In this work, we evaluate these different components from a regional point of view.

The Plio-Quaternary tectonic evolution of the central sector of the Sicilian Channel and the resulting morphostructural setting have been analyzed using a large geophysical dataset consisting of multichannel seismic profiles, which some of them never published, and available bathymetric data. This area hosts two regional-scale tectonic domains that registered the complex pattern of deformation occurred since the Early Pliocene: (1) the Sicilian Channel Rift Zone (SCRZ), which can be divided into a western sector formed by the Pantelleria graben (PG) and in a eastern one represented by the Linosa and Malta grabens (LG and MG) and (2) the Capo Granitola-Sciacca Fault Zone (CGSFZ), a NNE-oriented lithospheric transfer zone that crosses the Sicilian Channel from the Sicily coast to the Linosa Island, of which only its northern part has been studied to date. Data interpretation has allowed achieving the following outcomes: (i) the presence of an alternation of basins and structural highs forming a NNE-oriented separation belt between the western and eastern sectors of the SCRZ, and interpreted as the shallow expression of the southern part of the CGSFZ; (ii) a NE-oriented tectonic lineament separating the MG in a northern and southern part, and interpreted as the southern prosecution of the Scicli-Ragusa Fault System; (iii) the presence of syn-rift deposits in the Plio-Quaternary fill of the grabens, suggesting that the opening of the grabens of the SCRZ was coeval, and started since Early Pliocene in the framework of a NW-oriented right-lateral transtensional mega-shear zone; (iv) continental rifting ended around the Early Calabrian, during which extensional tectonics dominated along the separation belt; (v) the CGSFZ conditioned the SCRZ configuration at a regional scale, leading to the development of the PG in the western sector and of the LG and MG in the eastern one; and (vi) after the Early Calabrian, the PG and the southern MG followed a different tectonic evolution with respect to the LG and northern MG. The syn-rift deposits of the PG and southern MG were sealed by an undeformed post-rift succession, while the LG and the northern MG suffered a basin inversion that ended around the Latest Calabrian time. During this stage, the separation belt was affected by a transpressional tectonics. At present, the grabens of the Sicilian Channel seem to be tectonically inactive, while the CGSFZ represents an active tectonic domain.

Background Sleep apnea, as measured by polysomnography, is associated with adverse outcomes in heart failure. The DASAP-HF (Diagnosis and Treatment of Sleep Apnea in Patient With Heart Failure) study previously demonstrated that the respiratory disturbance index (RDI) computed by the ApneaScan algorithm (Boston Scientific) accurately identifies severe sleep apnea in implantable cardioverter-defibrillator (ICD) patients. Objective The purpose of the long-term study phase was to assess the incidence of clinical events after 24 months and investigate the association with RDI values. Methods Patients with left ventricular ejection fraction ≤35% implanted with an ICD were enrolled and followed-up for 24 months. The RDI calculated at 1 month after implantation was used to stratify patients (below or above 30 episodes/h). The endpoints were all-cause death and a combination of all-cause death or cardiovascular hospitalization. Results Of the 265 enrolled patients, 224 had usable RDI values. Severe sleep apnea (RDI ≥30 episodes/h) was diagnosed in 115 patients (51%). These patients were more frequently male (84% vs 72%; P = .030) and had higher creatinine levels. During median follow-up of 25 months, 19 patients (8%) died. Cardiovascular hospitalizations were reported in 19 patients (8%). The risk of all-cause death was higher in patients with RDI ≥30 episodes/h (hazard ratio [HR] 3.33; 95% confidence interval [CI] 1.35–8.21; P = .023), as well as the risk of all-cause death or cardiovascular hospitalization (HR 1.94; 95% CI 1.01–3.76; P = .048). At multivariate analysis, independent predictors of death were RDI ≥30 episodes/h (HR 4.02; 95% CI 1.16–13.97; P = .029) and creatinine levels (HR 2.36; 95% CI 1.26–4.42; P = .008). Conclusion In heart failure patients implanted with an ICD, higher RDI values are associated with death and cardiovascular hospitalizations. Device-detected severe sleep apnea independently predicts death.

Aims We developed and validated an algorithm for prediction of heart failure (HF) hospitalizations using remote monitoring (RM) data transmitted by implanted defibrillators. Methods and results The SELENE HF study enrolled 918 patients (median age 69 years, 81% men, median ejection fraction 30%) with cardiac resynchronization therapy (44%), dual-chamber (38%), or single-chamber defibrillators with atrial diagnostics (18%). To develop a predictive algorithm, temporal trends of diurnal and nocturnal heart rates, ventricular extrasystoles, atrial tachyarrhythmia burden, heart rate variability, physical activity, and thoracic impedance obtained by daily automatic RM were combined with a baseline risk-stratifier (Seattle HF Model) into one index. The primary endpoint was the first post-implant adjudicated HF hospitalization. After a median follow-up of 22.5 months since enrolment, patients were randomly allocated to the algorithm derivation group (n = 457; 31 endpoints) or algorithm validation group (n = 461; 29 endpoints). In the derivation group, the index showed a C-statistics of 0.89 [95% confidence interval (CI): 0.83–0.95] with 2.73 odds ratio (CI 1.98–3.78) for first HF hospitalization per unitary increase of index value (P Conclusion With the developed algorithm, two-thirds of first post-implant HF hospitalizations could be predicted timely with only 0.7 false alerts per patient-year.

Cardiomyopathies are primary myocardial disorders, genetically determined, with clinical onset between the third and the fifth decade of life. They represent the main causes of sudden cardiac death and heart failure in the youth. The more common myocardial diseases in clinical practice are dilated cardiomyopathy, arrhythmogenic cardiomyopathy and hypertrophic cardiomyopathy. Next generation sequencing techniques, recently available for genetics researches, together with the diffusion of advanced imaging techniques, permitted in the last years a deeper knowledge of these pathologies. Nevertheless, diagnosis, etiology and several aspects of patients' clinical management remain complex and controversial. This review paper aims to propose some operative flow-charts, derived from scientific evidences and the internal protocol of the Cardiothoracovascular Department of Trieste Hospital, Italian referral Center for cardiomyopathies and heart failure, with more than 30 years of experience in diagnosis and management of patients who suffer from primary myocardial disorders.

A 64-year-old man underwent catheter ablation (CA) of atrial fibrillation with intracardiac echocardiography (ICE) assistance. As the probe was advanced toward the right atrium, sudden abdominal pain was felt by the patient with hypotension and tachycardia requiring fluids and vasopressors for hemodynamic stabilization. The inferior vena cava (IVC) was injured by the passing probe and open repair was then performed. To our knowledge, this is the first reported case of symptomatic IVC laceration by the probe used for ICE during CA.

Funding Acknowledgements This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Background/Introduction: Parameters routinely measured during cardiac devices implantation also depend on bioelectrical properties of the myocardial tissue. Purpose To explore the potential association of electrical parameters with clinical outcomes in implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillators (CRT-D) recipients. Methods In the framework of the Home Monitoring Expert Alliance, baseline electrical parameters for all implanted leads were compared by occurrence of all-cause mortality, adjudicated ventricular arrhythmia (VA) and atrial high rate episode lasting ≥7 days (7day-AHRE). Results In a cohort of 2,976 patients (58.1% ICD) with a median follow-up of 25 months, events rates were 3.1/100 patient-years for all-cause mortality, 18.1/100 patient-years for VA and 8.9/100 patient-years for 7day-AHRE. At univariate analysis baseline shock impedance was consistently lower in groups with events than in those without, with a 40 Ohm cut-off better identifying patients at high risk, but at multivariable analysis the adjusted-hazard ratios (HRs) lost statistical significance for any endpoint. Baseline atrial sensing amplitude during sinus rhythm was lower in patients with 7-day AHRE as compared to those without (2.40 [IQ: 1.62-3.71] Vs 3.50 [IQ: 2.35-4.66] mV, p 1.5 mV versus those with values ≤1.5 mV was 0.44 (95% CI:0.27-0.72), p = 0.001. Conclusion Despite in patients with events a lower baseline shock impedance was observed at univariate analysis, the association lost statistical significance at multivariable analysis. Conversely, low sinus rhythm atrial sensing (≤1.5 mV) measured with standard transvenous leads could identify subjects at high risk of long-lasting atrial arrhythmia. Abstract Figure. AHRE occurrence by atrial sensing

Background: Little is known about the role of different types of atrial fibrillation (AF) in dilated cardiomyopathy (DCM). We investigated the epidemiological and prognostic impact of different types of AF in DCM during long-term follow-up. Method: We evaluated consecutive DCM patients enrolled in the Trieste Muscle Heart Disease Registry. Uni- and multivariable, extended Kaplan-Meier and propensity score-matching analyses were performed for a composite outcome including death/heart transplantation/ventricular-assist device implantation. Results: Out of 1181 DCM patients (71% males, age 49 ± 15 years, left ventricular ejection fraction 33 ± 11%), 46 (3.9%) had baseline permanent AF (permAF), while 66 (5.6%) had a history of paroxysmal/persistent AF. Compared with sinus rhythm (SR) patients, permAF patients were older (48 ± 15 vs. 61 ± 11 respectively, p = 0.001), were more frequently in NYHA class III-IV (18% vs. 30%, p = 0.002) and had larger left atrium diameter (40 ± 8 vs. 50 ± 10 mm, respectively). Paroxysmal/persistent AF patients had intermediate characteristics between permAF and SR. During a median follow-up of 135 (75–210) months, 63 patients developed permAF (0.45 new cases/100patients/year). At multivariable analysis, permAF as a time-dependent variable was an independent outcome predictor (HR 2.45; 95% C.I. 2.61–3.63, p < 0.001), together with creatinine, NYHA class, restrictive filling pattern and moderate-severe mitral regurgitation, while paroxysmal/persistent AF was neutral. Propensity score-matching analysis confirmed the higher rate of primary outcome events in patients with baseline or incident permAF versus patients without permAF during a very long-term follow-up (70% vs. 20%, p < 0.001). Conclusions: PermAF in a large DCM cohort had low prevalence and incidence but had a relevant. prognostic role on hard outcomes.

Aim: Contemporary survival trends in dilated cardiomyopathy (DCM) are largely unknown. The aim of this study is to investigate clinical descriptors, survival trends and the prognostic impact of aetiological characterization in DCM patients. Methods and results: Dilated cardiomyopathy patients were consecutively enrolled and divided into four groups according to the period of enrolment (1978-1984; 1985-1994; 1995-2004; and 2005-2015). A subset of patients with DCM of specific aetiology, enrolled from 2005 to 2015, was also analysed. Over a mean follow-up of 12 ± 8 years, 1284 DCM patients (52 in the 1978-1984 group, 326 in the 1985-1994 group, 379 in the 1995-2004 group, and 527 in the 2005-2015 group) were evaluated. Despite older age (mean age 51 ± 15, 43 ± 15, 45 ± 14, and 52 ± 15 years for the 1978-1984, 1985-1994, 1995-2004, and 2005-2015 groups, respectively; P < 0.001), most of the baseline clinical characteristics improved in the 2005-2015 group, suggesting a less advanced disease stage at diagnosis. Similarly, at competing risk analysis, the annual incidence of all outcome parameters progressively decreased over time (global P < 0.001). At multivariable analysis, the last period of enrolment emerged as independently associated with a reduction in all-cause mortality/heart transplantation (HTx)/ventricular assist device (VAD) implantation (1.46 events/100 patients/year), cardiovascular death/HTx/VAD implantation (0.82 events/100 patients/year) and sudden cardiac death (0.15 events/100 patients/year). Lastly, in 287 patients with DCM of specific aetiology, patients with environmental, toxic, or removable factors appeared to have different phenotypes and prognosis compared to those with genetic, post-myocarditis, or idiopathic DCM (P < 0.001). Conclusions: Contemporary survival trends in DCM significantly improved, mainly due to a reduction of cardiovascular events. Appropriate aetiological characterization might help in prognostication of DCM patients.

The pacemaker (PM) and implantable cardioverter-defibrillator (ICD) Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) monitors the main epidemiological data in real-world practice. The survey for the 2018 activity collects information about demographics, clinical characteristics, main indications for PM/ICD therapy and device types from the Italian collaborating centers.The Registry collects prospectively national PM and ICD implantation activity on the basis of European cards.PM Registry: data about 23 912 PM implantations were collected (20 084 first implants and 3828 replacements). The number of collaborating centers was 180. Median age of treated patients was 81 years (75 quartile I; 86 quartile III). ECG indications included atrioventricular conduction disorders in 34.5% of first PM implants, sick sinus syndrome in 18.3%, atrial fibrillation plus bradycardia in 13.0%, other in 34.2%. Among atrioventricular conduction defects, third-degree atrioventricular block was the most common type (19.2% of first implants). Use of single-chamber PMs was reported in 24.9% of first implants, of dual-chamber PMs in 67.6%, of PMs with cardiac resynchronization therapy (CRT) in 1.6%, and of single lead atrial-synchronized ventricular stimulation (VDD/R PMs) in 5.9%. ICD Registry: data about 18 353 ICD implantations were collected (13 944 first implants and 4359 replacements). The number of collaborating centers was 433. Median age of treated patients was 71 years (63 quartile I; 78 quartile III). Primary prevention indication was reported in 84.3% of first implants, secondary prevention in 15.7% (cardiac arrest in 5.3%). A single-chamber ICD was used in 27.9% of first implants, dual-chamber ICD in 31.9% and biventricular ICD in 40.2%.The PM and ICD Registry appears fundamental for monitoring PM and ICD utilization on a large national scale with rigorous examination of demographics and clinical indications. The PM Registry showed stable electrocardiographic and symptom indications, with an important prevalence of dual-chamber pacing. The use of CRT-PM regards a very limited number of patients. The ICD Registry documented a large use of prophylactic and biventricular ICD, reflecting a favorable adherence to trials and guidelines in clinical practice. In order to increase and optimize the cooperation of Italian implanting centers, online data entry (http://www.aiac.it/riprid) should be adopted at large scale.