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Background: Device follow-up is mandatory in the care of patients with a pacemaker. However, in most cases, device checks appear to be mere technical, time-consuming procedures. The aim of this research is to evaluate whether remote follow-up can replace in-clinic device checks by assessing clinical outcomes for pacemaker patients followed only via remote follow-up., Methods and Results: Consecutive pacemaker patients followed with remote monitoring were prospectively included by 6 Italian cardiology centers in an observational investigation. The workflow for remote monitoring included an initial assessment by nursing staff and, when necessary, by a responsible physician for medical decisions. No in-person visits were scheduled after the start of remote monitoring. One-thousand and two-hundred and fifty one patients (30% female, 75±11years old) were followed for a median observation period of 15months. Out of 4965 remote transmissions, 1882 (38%) had at least one clinically relevant event to be investigated further, but, only after 137 transmissions (2.8%), the patients were contacted for an in-clinic visit or hospitalization. Sixty-nine patients died and 124 were hospitalized for various reasons. Atrial fibrillation episodes were the most common clinical events discovered by remote transmissions, occurring in 1339 (26%) transmissions and 471 (38%) patients., Conclusions: Our experience shows that remote monitoring in a pacemaker population can safely replace in-clinic follow-up, avoiding unnecessary in-hospital device follow-up., (Copyright © 2016. Published by Elsevier Ireland Ltd.)

Background: Despite the fact that magnetic resonance (MR)-conditional pacemaker and lead systems have been introduced more than 5 years ago, it is still not clear whether they have actually facilitated the access of pacemaker patients to this important diagnostic tool. Factors limiting MR scans in daily practice in patients with MR-conditional cardiac implantable electronic device (CIED) systems may be related to organizational, cultural and sometimes legal aspects. The Really ProMRI registry is an ongoing survey designed to assess the annual rate of MR examinations in patients with MR-conditional implants, with either pacemakers or implantable cardioverter defibrillators, and to detect the main factors limiting MRI., Methods: The primary endpoint of the Really ProMRI registry is to assess the current access to MRI of patients with MR-conditional pacemaker or implantable cardioverter defibrillator systems during normal practice. Data in the literature reported a 17% annual incidence of medical conditions requiring MRI in CIED patients. The Really ProMRI registry has been designed to detect 4.5% absolute difference with an 80% statistical power, by recruiting 600 patients already implanted with MR-conditional CIED implant. Patients will be followed up for 1 year, during which they will be asked to refer any prescription, execution or denial of an MR examination by patient questionnaires and original source documents., Conclusion: The ongoing Really ProMRI registry will assess the actual rate of and factors limiting the access to MRI for patients with MR-conditional CIEDs.

We report the case of a patient with a previously implanted pacemaker, who suffered cardiac arrest due to ventricular fibrillation requiring cardiopulmonary resuscitation (CPR) manoeuvres and electrical cardioversion to restore sinus rhythm. Analysis of the pacemaker's stored electrograms showed the arrhythmia progression from monomorphic ventricular tachycardia to ventricular fibrillation and the electrophysiological effects of CPR manoeuvres and epinephrine administration before successful cardioversion.

Background: Dual chamber pacing (DDD) in the elderly is still a controversial issue because of its short life expectancy and the risk of atrial fibrillation. The aim of the study was 1) to evaluate the cumulative survival and the events capable of modifying it, 2) to evaluate the stability of sinus rhythm, and 3) to try to identify patients who are at a higher risk of developing permanent atrial fibrillation after DDD implantation. We evaluated clinical, electrophysiological and pacing parameters at the time of implantation., Methods: We examined retrospectively a group of 135 consecutive patients who were > 80 years old and who were treated with DDD in the last decade., Results: At the time of evaluation (mean 33.51 +/- 27.10 months, range 4-148 months) after DDD implantation, 72% of patients were still alive. Sinus rhythm was documented in 96 (71%) patients (group A). Thirty-nine (29%) patients (group B) developed atrial fibrillation after a mean period of 28.56 +/- 30.9 months (range 1-125 months). The right atrial endocavitary signal amplitude was lower in group B compared to that observed in group A (2.6 +/- 1.16 vs 3.27 +/- 1.91 mV). The pacing and sensing atrioventricular delay were not statistically different in both groups. The minimum heart rate was higher in patients who developed atrial fibrillation (64.53 +/- 7.7 vs 67.7 +/- 5.72 b/min respectively in group A and in group B, p = 0.02). Group B patients had a higher rate of atrial fibrillation pre-implantation episodes. The incidences of sick sinus disease and of atrioventricular nodal disease were similar in both groups., Conclusions: In elderly patients the benefits of DDD are maintained for a long period of time before the development of atrial fibrillation. Episodes of atrial fibrillation prior to DDD, apart from sinus dysfunction alone, are predictive of the development of a permanent atrial fibrillation. Permanent atrial fibrillation does not seem to reduce life expectancy. A higher minimum heart rate does not seem to prevent atrial fibrillation. The capability of recording a right atrial signal amplitude > 3 mV seems to identify those patients with a lower risk of developing atrial fibrillation.