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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.

A PARASOUND (3.5 kHz) sub-bottom echosounder profile acquired across the Spitsbergenbanken between Kveithola and Storfjorden troughs, NW Barents Sea, documents the lateral variation of sedimentary processes from shelf areas to troughs during the post Last Glacial Maximum (LGM) sea-level rise. In particular, while the Spitsbergenbanken and the southern margin of the Storfjorden trough are characterized by superficial glacial till and eventual post-glacial deposits reworked to a certain extent by iceberg keels, the Kveithola trough documents extensive glacimarine and bottom current sedimentation above the glacial till, only partially affected by ice movement. This evidence suggests that both the Spitsbergenbanken and the southern margin of the Storfjorden trough were mostly sediment bypass areas during the post glacial phase, whereas the Kveithola trough was a comparatively protected area in which relatively weak currents allowed the accumulation of fine-grained deposits. These findings highlight a marked lateral sedimentary variability due to local physiography and hydrodynamics in areas that were covered by thick ice sheets during the LGM, which must be taken into account to produce models that describe post-glacial depositional processes.

Large-scale submarine gravitational land movements involving even more than 1,000 m thick sedimentary successions are known as megalandslides. We prove the existence of large-scale gravitational phenomena off the Crotone Basin, a forearc basin located on the Ionian side of Calabria (southern Italy), by seismic, morpho-bathymetric and well data. Our study reveals that the Crotone Megalandslide started moving between Late Zanclean and Early Piacenzian and was triggered by a contractional tectonic event leading to the basin inversion. Seaward gliding of the megalandslide continued until roughly Late Gelasian, and then resumed since Middle Pleistocene with a modest rate. Interestingly, the onshore part of the basin does not show a gravity-driven deformation comparable to that observed in the marine area, and this peculiar evidence allows some speculations on the origin of the megalandslide.

The management of patients with a cardiac implanted electronic device (CIED) receiving radiotherapy (RT) is challenging and requires a structured multidisciplinary approach. A consensus document is presented as a result of a multidisciplinary working group involving cardiac electrophysiologists, radiation oncologists and physicists in order to stratify the risk of patients with CIED requiring RT and approaching RT sessions appropriately. When high radiation doses and beam energy higher than 6MV are used, CIED malfunctions can occur during treatment. In our document, we reviewed the different types of RT and CIED behavior in the presence of ionizing radiations and electromagnetic interferences, from the cardiologist's, radiation oncologist's and medical physicist's point of view. We also reviewed in vitro and in vivo literature data and other national published guidelines on this issue so far. On the basis of literature data and consensus of experts, a detailed approach based on risk stratification and appropriate management of RT patients with CIEDs is suggested, with important implications for clinical practice.

The interplay between high-frequency relative sea-level changes, such as those connected to late Quaternary glacio-eustasy, and regional uplift usually produces staircases of marine terraces along coastal areas. These particular settings are characterized by variable topography and gradient of the landscape due to both tectonics and wave erosion, which result in the development of subaerial unconformities during both transgressive and forced regressive stages of the high-frequency relative sea-level curve. In particular, the increased topographic gradient due to tectonic uplift results in a coastal profile steeper than the transgressive shoreline trajectory and the consequent formation of a retreating coastal cliff fronted by a transgressive wave ravinement surface, whereas subaerial exposure occurs landwards. In contrast, the relatively low-gradient wave ravinement surface formed during transgression seaward of the coastal cliff affords the deposition of a highstand shallow-marine prograding wedge characterized by a relatively low-gradient top, gentler than the forced regressive shoreline trajectory, resulting in the formation of a new subaerial unconformity at the top of highstand and forced regressive deposits during relative sea-level fall. The overall uplifting conditions favor the persistent development of the already formed transgressive and forced regressive subaerial unconformities also during the highstand and lowstand stages of the high-frequency relative sea-level curve, excepting for the accumulation of continental deposits just seaward of the uplifted paleo-coastal cliffs. The repetition of such a motif for several high-frequency relative sea-level changes will result in the formation of a long-term, higher rank subaerial unconformity expanding seaward and recording the uplift of the coastal area. The way in which the subaerial unconformity develops in contexts dominated by regional uplift and superimposed glacio-eustatic sea-level changes is not described by classic sequence stratigraphic models and this needs to be taken into account in sequence stratigraphic analysis.

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The Pliocene and Pleistocene intervals of the Neogene to Quaternary succession of the Crotone Basin, southern Italy, offer good examples of shallow-marine high-frequency sequences (fourth-order or lower rank stratigraphic frameworks) composing higher-rank units. The analysis of some representative sections from this succession has allowed performing an integrated sedimentological and micropaleontological study aimed at defining new criteria to recognize high-frequency maximum flooding surfaces. In particular, field data have been compared with some parameters derived from the micropaleontological analysis, such as the abundance, diversity and % fragmentation of benthic foraminifera, as well as the ratio between distal and proximal benthic foraminifera species and the plankton/benthos ratio. This integrated study allows to define an uncertainty interval in the high-frequency sequences, in which the maximum flooding surface should lie. This uncertainty interval is usually characterized by lower values of the % fragmentation and higher values of the abundance, diversity and distal/proximal ratio, whereas the peak of the plankton/benthos ratio allows to define a surface of maximum water depth, placed above the maximum flooding surface. Usually, the greater the magnitude of the transgression, the thinner the uncertainty interval. These results highlight the cryptic nature of the maximum flooding surface within condensed sections, even in high-resolution outcrop studies, and allow to refine the criteria based on which the position of such surface can be approximated in the field and in sediment cores.

High-frequency sequences composed of mixed siliciclastic-carbonate deposits may exhibit either vertical or horizontal changes between siliciclastics and carbonates. Vertical facies shifts occur between systems tracts and define a ‘reciprocal sedimentation’ pattern, typically consisting of transgressive/highstand carbonates and forced regressive/lowstand siliciclastics, although variations from this rule are common. Mixed systems with lateral facies change, usually typifying transgressive and/or highstand systems tracts, may exhibit proximal siliciclastics and distal carbonates or vice-versa, although variations may also occur along depositional strike. The marked variability of mixed siliciclastic-carbonate sequences makes the definition of a universal sequence stratigraphic model impossible, as the composition and geometries of systems tracts may change considerably, and sequence stratigraphic surfaces and facies contacts may vary in terms of occurrence and physical expression. However, some resemblance exists between siliciclastic sequences and mixed sequences showing lateral facies changes between siliciclastics and carbonates. In particular, these mixed sequences display 1) a stratal architecture of the clastic part of the systems tracts that is comparable to that of siliciclastic deposits, 2) a dominant role of the inherited physiography and of erosional processes, rather than carbonate production, in shaping the shelf profile, and 3) a local lateral juxtaposition of siliciclastic sandstones and carbonate bioconstructions due to hydrodynamic processes. These observations are helpful in predicting the location of porous and potential sealing bodies and baffles to fluid flow at the intra-high-frequency sequence scale, and ultimately they are useful for both petroleum exploration and production.

In contrast to high-frequency sequences driven by high-magnitude relative sea-level changes, those controlled by short-term, minor relative sea-level and/or sediment supply changes may be difficult to discriminate from sedimentological cycles (i.e., bedsets) unrelated to shoreline shifts, especially in case of limited outcrop exposures. In fact, meter-scale, fully shallow-marine high-frequency sequences and typical meter-scale bedsets may share a similar, simple facies succession documenting either an upward increase or decrease of event beds. It is therefore necessary to define a set of criteria that allows to discriminate between thin high-frequency sequences and bedsets, based on sedimentological, stratigraphic, micropaleontological, mineralogical and diagenetic data. In particular, the sedimentological and stratigraphic criteria that aid discriminating between high-frequency sequences and bedsets include: 1) occurrence of environmental changes across bounding surfaces; 2) occurrence of water-depth changes across bounding surfaces; 3) physical appearance of bounding surfaces and associated substrate-controlled ichnofacies; 4) lateral extent of bounding surfaces; 5) presence of condensed deposits; 6) cycle thickness; 7) recognition of a set of clinoforms in a regressive shoreface-shelf succession. Moreover, the formation of wave-ravinement surfaces in the shoreface is usually associated with an increase in the percentage of benthic micro-foraminifera specimens documenting energetic conditions, and in the abundance of heavy minerals. Extensive cementation may also be found just below and/or above transgressive surfaces. However, the integration of more than one of the above criteria is necessary to reliably discriminate between sequence stratigraphic surfaces (and therefore high-frequency sequences) and bedset boundaries, the latter being only related to changes of energy level and/or local sediment supply without shoreline shifts. This work is essential to correctly reconstruct the sequence stratigraphic framework of a given succession and to interpret the factors that controlled the cyclicity.

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.

Myocarditis is an inflammatory heart disease that can occur acutely, as in acute myocarditis, or persistently, as in chronic myocarditis or chronic inflammatory cardiomyopathy. Different agents can induce myocarditis, with viruses being the most common triggers. Generally, acute myocarditis affects relatively young people and men more than women. Myocarditis has a broad spectrum of clinical presentations and evolution trajectories, although most cases resolve spontaneously. Patients with reduced left ventricular ejection fraction, heart failure symptoms, advanced atrioventricular block, sustained ventricular arrhythmias or cardiogenic shock (the latter known as fulminant myocarditis) are at increased risk for death and heart transplantation. The presentation of chronic inflammatory cardiomyopathy may be more subtle, with progressive symptoms of heart failure or appearance of rhythm disturbance, not rarely preceded by an infective episode. Autoimmune disorder or systemic inflammatory conditions can be another significant predisposing substrate of myocarditis, especially in women. Emerging causes of myocarditis are drug-related like the new anticancer therapies, the immune checkpoint inhibitors. In this Italian Association of Hospital Cardiologists (ANMCO) and Italian Society of Cardiology (SIC) expert consensus document on myocarditis, we propose diagnostic strategies for identifying possible causes of the disease and factors associated with increased risk. Finally, we propose potential treatments and when referring patients to tertiary centers, especially for high-risk patients. Even if endomyocardial biopsy is the invasive diagnostic tool for making definitive diagnosis and differentiation of histological subtypes (i.e., lymphocytic vs eosinophilic vs giant cell myocarditis), it is not always readily available in all centers. Thus, we propose when this exam is mandatory or when it can be postponed or substituted by cardiac magnetic resonance imaging. This document reflects the Italian perspective on managing patients with myocarditis and their follow-up, considering also current US and European scientific position statements.

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.

Myocarditis is an inflammatory heart disease that can occur acutely, as in acute myocarditis, or persistently, as in chronic myocarditis or chronic inflammatory cardiomyopathy. Different agents can induce myocarditis, with viruses being the most common triggers. Generally, acute myocarditis affects relatively young people and men more than women. Myocarditis has a broad spectrum of clinical presentations and evolution trajectories, although most cases resolve spontaneously. Patients with reduced left ventricular ejection fraction, heart failure symptoms, advanced atrioventricular block, sustained ventricular arrhythmias or cardiogenic shock (the latter known as fulminant myocarditis) are at increased risk for death and heart transplantation. The presentation of chronic inflammatory cardiomyopathy may be more subtle, with progressive symptoms of heart failure or appearance of rhythm disturbance, not rarely preceded by an infective episode. Autoimmune disorder or systemic inflammatory conditions can be another significant predisposing substrate of myocarditis, especially in women. Emerging causes of myocarditis are drug-related like the new anticancer therapies, the immune checkpoint inhibitors. In this Italian Association of Hospital Cardiologists (ANMCO) and Italian Society of Cardiology (SIC) expert consensus document on myocarditis, we propose diagnostic strategies for identifying possible causes of the disease and factors associated with increased risk. Finally, we propose potential treatments and when referring patients to tertiary centers, especially for high-risk patients. Even if endomyocardial biopsy is the invasive diagnostic tool for making definitive diagnosis and differentiation of histological subtypes (i.e., lymphocytic vs eosinophilic vs giant cell myocarditis), it is not always readily available in all centers. Thus, we propose when this exam is mandatory or when it can be postponed or substituted by cardiac magnetic resonance imaging. This document reflects the Italian perspective on managing patients with myocarditis and their follow-up, considering also current US and European scientific position statements.

Sudden cardiac death and arrhythmia-related events in patients with non-ischaemic dilated cardiomyopathy (NICM) have been significantly reduced over the last couple of decades as a result of evidence-based pharmacological and non-pharmacological therapeutic strategies. Nevertheless, the arrhythmic stratification in patients with NICM remains extremely challenging, and the simple indication based on left ventricular ejection fraction appears to be insufficient. Therefore, clinicians need to go beyond the current criteria for implantable cardioverter-defibrillator implantation in the direction of a multiparametric evaluation of arrhythmic risk. Several parameters for arrhythmic risk stratification, ranging from electrocardiographic, echocardiographic, imaging-derived and genetic markers, are crucial for proper arrhythmic risk stratification and a multiparametric evaluation of risk in patients with NICM. In particular, integration of cardiac magnetic resonance parameters (mostly late gadolinium enhancement) and specific genetic information (ie, presence of LMNA, PLN, FLNC mutations) appears fundamental for proper implementation of the current arrhythmic risk stratification. Finally, a novel approach focused on both arrhythmic risk and prediction of left ventricular reverse remodelling during follow-up might be useful for effective multiparametric and dynamic arrhythmic risk stratification in NICM. In the future, a complete and integrated evaluation might be mandatory to implement arrhythmic risk prediction in patients with NICM and to discriminate the competing risk between heart failure-related events and life-threatening arrhythmias.

Background Parameters measured during implantable cardioverter defibrillator (ICD) implant also depend on bioelectrical properties of the myocardium. We aimed to explore their potential association with clinical outcomes in patients with single/dual‐chamber ICD and cardiac resynchronization therapy defibrillator (CRT‐D). Methods In the framework of the Home Monitoring Expert Alliance, baseline electrical parameters for all implanted leads were compared by the occurrence of all‐cause mortality, adjudicated ventricular arrhythmia (VA), and atrial high‐rate episode lasting ≥24 hours (24 h AHRE). Results In a cohort of 2976 patients (58.1% ICD) with a median follow‐up of 25 months, event rates were 3.1/100 patient‐years for all‐cause mortality, 18.1/100 patient‐years for VA, and 9.3/100 patient‐years for 24 h AHRE. At univariate analysis, baseline shock impedance was consistently lower in groups with events than without, with a 40 Ω cutoff that better identified high‐risk patients. However, 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 24 h AHRE than in those without (2.45 [IQR: 1.65‐3.85] vs 3.51 [IQR: 2.37‐4.67] mV, P 1.5 mV vs those with values ≤1.5 mV was 0.52 (95% CI: 0.33‐0.83), P = .006. Conclusions Although lower baseline shock impedance was observed in patients with events, 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 atrial arrhythmia., Some of the electrical parameters routinely measured at ICD/CRT‐D implant differed according to long‐term clinical outcome. Shock impedance values were lower in patients who experienced death and both atrial and ventricular arrhythmias during follow‐up. Subjects with atrial signal amplitude below 1.5 mV showed a significant higher risk of atrial arrhythmias as compared to those with >1.5 mV, potentially revealing the presence of a more impaired atrial tissue.

Aims Primary prevention implantable cardioverter defibrillator (ICD) is not generally recommended in New York Heart Association (NYHA) I class patients with dilated cardiomyopathy (DCM). This study sought to assess the competing risk of sudden cardiac death (SCD) in DCM patients with left ventricular ejection fraction (EF) ≤35% and NYHA I class. Methods A total of 272 DCM patients with EF ≤35% and NYHA class I–III after ≥3 months of guideline-directed medical therapy were included. The risk of SCD and SCD/malignant ventricular arrhythmias (MVA) was assessed in NYHA I vs. NYHA II and NYHA III groups by competing risk analysis. Results NYHA I patients were younger, had higher EF and smaller left atrium, were less likely receiving mineral corticoid receptor antagonists. The cumulative incidence of SCD (p = 0.92) and SCD/MVA (p = 0.42) did not differ between NYHA I vs NYHA II–III classes. NYHA class did not influence the association between ICD and SCD risk (p for interaction = 0.125). Conclusions In this cohort of DCMs, patients with EF ≤35% and NYHA I class were exposed to a risk of SCD and life-threatening arrhythmias not different from NYHA II–III. Therefore, inclusion of asymptomatic patients with DCM and systolic dysfunction should be strongly considered in future randomized studies on primary prevention ICD.

The management of patients with heart disease or suspected heart disease, who are hospitalized and/or who should undergo surgery or an invasive procedure, is very complex for the comorbidities often present, the multiple therapies taken and the frequent presence of advanced cardiac devices.The purpose of this document is to provide indications and standardize the behavior of different clinicians in the management of heart disease patients or those with suspected heart disease in order (i) to manage acute cardiac conditions with appropriate timing and accuracy, and (ii) to define the cardiovascular risk in the individual patient with appropriate timing and indications, allowing patients to face any surgery or invasive procedure with the lowest risk correlated to his heart disease.

Device interrogation and management are time consuming, representing a relevant burden for pacing centers. In several situations, patients' management requires additional follow up visits.Remote Monitoring (RM) allows an optimal recall management and a rapid diagnosis of device or lead failure, without the need of additional in office visits. Further it allows a significant delay reduction between the adverse event and the reaction to the alarm, shortening the time needed to make a clinical decision. A role in risk-predicting patient-related outcomes has also been shown. RM permits detection of the arrhythmia from 1 to 5 months in advance compared to in-office visits. Importantly, by using specific algorithms with multiparametric analysis, RM has been studied as a potential instrument to identify early patients on risk of worsening HF using specific algorithms. Although the use of RM in HF setting remains controversial, it has been proposed to improve HF clinical outcomes and survival in clinical trials. In this sense, RM success could require a standardization of process within a management model, that may involve different health care professionals. In this review, we examine recent advances of RM providing an update of this tool through different clinical scenarios. Keywords: Implantable devices, Heart failure, Atrial fibrillation, Remote telemonitoring

Background The traditional technique for subcutaneous implantable cardioverter defibrillator (S-ICD) implantation, which involves three incisions and a subcutaneous pocket, is associated with possible complications, including inappropriate interventions. The aim of this prospective multicenter study was to evaluate the efficacy and safety of an alternative intermuscular two-incision technique for S-ICD implantation. Methods The study population included 36 consecutive patients (75% male, mean age 44 ± 12 years [range 20–69]) who underwent S-ICD implantation using the intermuscular two-incision technique. This technique avoids the superior parasternal incision for the lead placement and consists of creating an intermuscular pocket between the anterior surface of the serratus anterior and the posterior surface of the latissimus dorsi muscles instead of a subcutaneous pocket. Results All patients were successfully implanted in the absence of any procedure-related complications with a successful 65-J standard polarity defibrillation threshold testing, except in one, who received a second successful shock after pocket revision. During a mean follow-up of 10 months (range 3–30), no complications requiring surgical revision were observed. At device interrogation, stable sensing without interferences was observed in all patients. Two patients (5.5%) experienced appropriate and successful shock on ventricular fibrillation and in four patients (11%), a total of seven nonsustained self-terminated ventricular tachycardias were correctly detected. No inappropriate interventions were observed. Conclusions Our experience suggests that the two-incision intermuscular technique is a safe and efficacious alternative to the current technique for S-ICD implantation that may help reducing complications including inappropriate interventions and offer a better cosmetic outcome, especially in thin individuals.

The Northern Adriatic Sea is a shallow and very flat shelf area located between the northern Apennines, the southern Alps and the Dinarides; its present day physiography is the result of the filling of a relatively deep Quaternary foredeep basin, developed due to the northeastward migration of the Apennine chain. Multichannel seismic profiles and well data have allowed documenting the stratigraphic architecture, the depositional systems and the physiographic evolution of the Northern Adriatic sea since early Pliocene time. In particular, three main depositional sequences bounded by regional unconformities were recognized. The Zanclean Sequence 1 documents first the drowning of late Messinian incised valleys and then the southward progradation of a shelf-slope system, which is inferred to be related to a tectonic phase of the Apenninic front. The Piacenzian-Gelasian Sequence 2 records a relatively rapid transgressive episode followed by minor southward progradation; the top of the sequence is associated with a major late Gelasian drowning event, linked to the NE-ward migration of the Apennine foredeep. The Calabrian to upper Pleistocene Sequence 3 testifies the infilling of accommodation previously created by the late Gelasian drowning event, and it initially accumulated in deep-water settings and then in shallow-water to continental settings. The upper part of Sequence 3, consisting of the paleo-Po deltaic system, is composed of seven high-frequency sequences inferred to record late Quaternary glacio-eustatic changes. These high-frequency sequences document the stepwise filling of the remaining accommodation, resulting in the development of the modern shelf.

Electroanatomic Mapping for CRT Implantation RegistryIntroduction Cardiac resynchronization therapy (CRT) device implantation guided by an electroanatomic mapping system (EAMS) is an emerging technique that may reduce fluoroscopy and angiography use and provide information on coronary sinus (CS) electrical activation. We evaluated the outcome of the EAMS-guided CRT implantation technique in a multicenter registry. Methods During the period 2011–2014 we enrolled 125 patients (80% males, age 74 [71–77] years) who underwent CRT implantation by using the EnSite system to create geometric models of the patient's cardiac chambers, build activation mapping of the CS, and guide leads positioning. Two hundred and fifty patients undergoing traditional CRT implantation served as controls. Success and complication rates, fluoroscopy and total procedure times in the overall study population and according to center experience were collected. Centers that performed ≥10 were defined as highly experienced. Results Left ventricular lead implantation was successful in 122 (98%) cases and 242 (97%) controls (P = 0.76). Median fluoroscopy time was 4.1 (0.3–10.4) minutes in cases versus 16 (11–26) minutes in controls (P < 0.001). Coronary sinus angiography was performed in 33 (26%) cases and 208 (83%) controls (P < 0.001). Complications occurred in 5 (4%) cases and 17 (7%) controls (P = 0.28). Median fluoroscopy time (median 11 minutes vs. 3 minutes, P < 0.001) and CS angiography rate (55% vs. 21%, P < 0.001) were significantly higher in low experienced centers, while success rate and complications rate were similar. Conclusions EAMS-guided CRT implantation proved safe and effective in both high- and low-experienced centers and allowed to reduce fluoroscopy use by ≈75% and angiography rate by ≈70%.

The sequence stratigraphic architecture includes a complex array of stratal geometries with different degrees of stratigraphic significance. The ‘non-unique’ variability of the sequence stratigraphic framework (i.e., stratal geometries which are not diagnostic for the definition of systems tracts and bounding surfaces) is irrelevant to the workflow of sequence stratigraphy. What is relevant is the observation of the ‘unique’ stratal geometries that are diagnostic for the definition of units and surfaces of sequence stratigraphy. In downstream-controlled settings, these unique stratal stacking patterns relate to the forced regressive, normal regressive, and transgressive shoreline trajectories. Multiple controls interact during the formation of each type of stacking pattern, including accommodation, sediment supply, and the energy of the sediment-transport agents. This interplay explains the non-unique variability, but does not change the unique criteria that afford a consistent application of sequence stratigraphy. The distinction between unique and non-unique stratal geometries is critical to the sequence stratigraphic methodology. Failure to rationalize the non-unique variability within the context of unique stratal geometries is counterproductive, and obscures the simple workflow of sequence stratigraphy. This is the case with uncalibrated numerical modeling, which may overemphasize non-unique or even unrealistic stratigraphic scenarios. While useful to test the possible controls on stratigraphic architecture, modeling requires validation with real data, and plays no role in the sequence stratigraphic methodology.

PARASOUND (3.5 kHz) subbottom echosounder profiles acquired on the southern Spitsbergenbanken, NW Barents Sea, show iceberg-keel scouring features which are buried by sediment that accumulated during the post Last Glacial Maximum (LGM) sea-level rise. Four acoustic units (Units 1 to 4 in stratigraphic order) were differentiated, based on the characterization of their acoustic facies and reflection surfaces. Unit 1 shows a chaotic internal structure and is interpreted as a glacial till, whereas the laminated Units 2 to 4 accumulated by sediment settling from suspension clouds and bottom currents during the last deglaciation phase. The top of Unit 2 was frequently incised by iceberg keels, resulting in up to 12 m deep ploughmarks which were later filled and buried by Unit 3 and 4 sediments. Three main paleo-evironmental changes controlled the evolution of the facies succession: (1) The major shift from till formation (Unit 1) below grounded ice to the accumulation of laminated sediments (Unit 2) which are inferred to reflect ice lifting and meltwater release; (2) Iceberg-keel scouring after sedimentation of Unit 2; (3) the probable abrupt termination of iceberg-keel scouring related to the glacio-eustatic sea-level rise. A linkage between these episodes of changes and short-lasting phases of rapid post LGM sea-level rise, such as meltwater pulses, is inferred, although further studies are needed to better understand the temporal and genetic relationships between the sedimentary events recognized in the Barents Sea and climate changes.

During the last 0.45 Ma, the Crotone Basin, a forearc basin located on the Ionian side of Calabria, southern Italy, experienced a phase of uplift that persists today. The transition from subsidence to uplift occurred close to the Marine Isotope Stage (MIS) 11 (ca. 0.4 Ma). The subsequent progressive emergence of the area was punctuated by several marine transgressions linked to high-frequency, high-magnitude glacio-eustatic changes, which are recorded as coastal terraces. These high-frequency sequences show a variable stacking pattern due to the interplay between glacio-eustasy, uplift and local physiography. In particular, a progressive SE-ward migration of the shoreline is documented in the study area since MIS 11. This trend was enhanced during the MIS 5.5 to MIS 2 time interval, due to the combined effect of uplift and lowering glacio-eustatic sea level until the Last Glacial Maximum. Moreover, the regional uplift also led to a physiographic change from relatively low-gradient to high-gradient settings between MIS 7.1 and MIS 5.5. A comparison between the late Quaternary geological record of the Crotone Basin and that of other basins is crucial to improve the present knowledge on past sea levels related to MISs. This ultimately will help to better understand the Holocene sea-level history and the human contribution to sea-level change, in order to predict future scenarios.

In the geological record, high-frequency sequences at the scale of fourth-order and lower rank stratigraphic frameworks are usually stacked to compose higher rank (lower frequency) systems tracts (i.e., sequence sets) along dip-oriented transects. Higher rank transgressive, normal regressive (highstand and/or lowstand) and falling-stage systems tracts are defined by retrogradational, upstepping progradational, and downstepping progradational stacking patterns of component high-frequency sequences, respectively. However, these stacking patterns may vary markedly along depositional strike due to lateral changes in the rates of accommodation and sedimentation, resulting in the coeval deposition of different types of higher rank systems tracts. In this case, surfaces bounding such systems tracts are diachronous along depositional strike. Moreover, if the high-frequency sequences that compose the lower frequency systems tracts are laterally continuous, the higher rank bounding surfaces are discontinuous along depositional strike, consisting of a series of stepped surfaces that can be observed in high-resolution studies. These aspects have important implications for petroleum exploration and need to be considered in high-resolution sequence stratigraphic analysis.

Parasequences were introduced as the building blocks of seismic-scale systems tracts in the context of low-resolution seismic stratigraphy. Pitfalls of this concept relate to the definition of parasequence boundaries as lithological discontinuities that mark episodes of abrupt water deepening. With this general meaning, ‘flooding surfaces’ may be facies contacts within transgressive deposits, or may coincide with different types of sequence stratigraphic surfaces (maximum regressive, transgressive ravinement, or maximum flooding). In all cases, flooding surfaces are allostratigraphic contacts restricted to coastal and shallow-water settings, where evidence of abrupt water deepening can be demonstrated. Flooding surfaces may also be absent from the shallow-water systems, where conformable successions accumulate during gradual water deepening. It follows that (1) parasequences have smaller extent than systems tracts, and (2) systems tracts do not always consist of stacked parasequences. These limitations prevent the dependable use of the parasequence concept in sequence stratigraphy. Advances in high-resolution sequence stratigraphy show that the scales of sequences and parasequences are not mutually exclusive; the two types of units define different approaches to the delineation of stratigraphic cycles at high-resolution scales. Sequences that develop at parasequence scales provide a more reliable alternative for correlation, both within and outside of the coastal and shallow-water settings, rendering parasequences obsolete. Every transgression that affords the formation of a flooding surface starts from a maximum regressive surface and ends with a maximum flooding surface observed at the scale of that transgression. These systems tract boundaries are invariably more extensive than any facies contacts that may form during the transgression. Flooding surfaces remain relevant to the description of facies relationships, but their stratigraphic meaning needs to be assessed on a case-by-case basis. The use of sequences and systems tracts in high-resolution studies provides consistency in methodology and nomenclature at all stratigraphic scales, irrespective of geological setting and the types and resolution of the data available.

The Crotone Basin is a Neogene-Quaternary depocenter developed along the Ionian margin of Calabria, southern Italy. The basin opening was concomitant with the onset of spreading of the Tyrrhenian backarc Basin during late Serravallian and the subduction of the Ionian lithosphere below the Calabrian Arc. The adoption of modern sequence stratigraphic principles to subdivide the basin fill into stratigraphic sequences of different rank, bounded by subaerial unconformities, has allowed cycles of creation and loss of accommodation mainly related to tectonics to be recognized. In particular, an alternation between phases of basin subsidence, concomitant with spreading of the Tyrrhenian backarc Basin and forward migration of the Arc, and phases of compressional or transpressional tectonics, accompanied by basin uplift and stopping of Arc migration, are well recognizable in the basin fill, in particular for the late Messinian to late Pleistocene part of the succession. The present study highlights the effectiveness of the sequence stratigraphic method in basin analysis to decipher the effects of large-scale tectonic events on sedimentation and ultimately to reconstruct the geodynamic evolution of the central Mediterranean.

The aim of this study is to better define the scale, timing and driving mechanisms of a seaward-gliding landmass currently affecting the Crotone Basin, a forearc basin on the Ionian side of Calabria (southern Italy). An integrated approach of seismic, well and field data, together with literature information, have revealed that the slide includes an onshore updip extensional domain compatible with the presence of a curved seaward-dipping fault system to the NW, which is connected southward to an offshore downdip compressional domain through a buried detachment surface lying at a Messinian halite layer. The landmass, which involves Messinian-Pleistocene deposits, has started to slide since the Zanclean, and experienced a paroxysmal episode between late Zanclean and early Piacenzian linked to transpressional tectonics. After a phase of inactivity during the Calabrian, the gravitational collapse underwent a second reactivation since middle Pleistocene due to regional uplift, which seems to be restricted to the offshore sector, the Crotone peninsula and probably the eastern coastal area.

Background Left bundle branch block (LBBB) negatively affects prognosis in heart failure patients with a reduced left ventricular ejection fraction (LVEF). Less is known about the prognostic role of LBBB in dilated cardiomyopathy (DCM) with intermediate LVEF (between 36% and 50%). We sought to assess the role of LBBB in optimally treated DCM patients with mildly to moderately reduced LVEF and to determine the possible variables associated with subsequent LVEF reduction. Methods We retrospectively analyzed DCM patients with LVEF >35% after 3-to-9 months of optimal medical treatment (OMT) consecutively evaluated from 1990 to 2010. All-cause mortality or heart transplantation (D/HTx) and sudden cardiac death (SCD) or major ventricular arrhythmias (MVA) were considered as outcome measures. LVEF deterioration during follow-up was also considered. Results Among 280 (49%) patients that met the study criteria, 76 had LBBB (27%). During a mean follow-up of 151 months, the rates of D/HTx and SCD/MVA were similar between LBBB and not LBBB patients (p value = 0.52 and p = 0.39, respectively). Twenty-six out of 76 (34%) patients with LBBB experienced LVEF deterioration below 36%. The persistence of moderate-severe mitral regurgitation (MR), left atrial end-systolic area index and LV end-diastolic volume index emerged as independent predictors of LVEF deterioration and were associated with an increased risk of D/HTx during follow-up. Conclusions LBBB does not affect mortality in DCM patients with intermediate LVEF after OMT. However, among these patients those with persistent significant MR, left atrial and LV remodeling carries a higher risk of LVEF deterioration during follow-up.

Aims Remote monitoring is an effective strategy to improve patients' outcomes and reduce hospitalization in patients with cardiac implantable electronic devices. However, data on patients' satisfaction are scarce. The aim of the current study was to assess patients' satisfaction, ease of use and impact on daily activities of the remote monitoring and to investigate whether there are differences among different devices and different manufacturers. Methods A modified Home Monitoring Acceptance and Satisfaction Questionnaire telephone survey on the perceived quality of the different systems was performed with all patients followed with remote monitoring for at least 3 months. Results Among 604 patients with remote monitoring screened by telephone, 466 patients (77%) answered the questionnaire [142 patients (30.5%) had a pacemaker, 317 patients (68%) had an implantable cardioverter defibrillator, and seven patients (1.5%) had an implantable loop recorder]. Ninety-seven percent of patients were satisfied by the remote monitoring system during the entire follow-up and found it easy to use. Similarly, 85% of patients did not experience any restriction in daily activities, and for 99% of patients it did not affect their privacy. Importantly, for the vast majority of patients, remote monitoring gave a great (56.7%) or moderate (33.4%) sense of security. Conclusion Daily impact of cardiac implantable electronic devices still remains a challenging issue for caregivers. The introduction of remote monitoring allowed closer follow-up and improved outcomes. Our results highlighted patients' satisfaction, who also felt safer, with the remote monitoring, its ease of use, and the absence of any disturbances in patients' everyday activities or in their privacy.

In patients with dilated cardiomyopathy (DCM), it is possible to find a broad range of bradyrhythmias and tachyarrhythmias. Bradyrhythmias and supraventricular arrhythmias can frequently occur in some familial forms such as lamin A/C mutations. Nonsustained ventricular arrhythmias (VA) are observed in about 40% of patients with DCM, but their prognostic role is not clear, and conflicting data have been published in the last 30 years. Multiple mechanisms can explain atrial and ventricular tachyarrhythmias in DCM. Reentry is associated with slow conduction across surviving muscle bundles within regions of interstitial fibrosis, but other mechanisms can be involved, as nonuniform anisotropy of impulse propagation, ion channel dysfunction, and reduced gap junction function.

Background Implantable cardioverter‐defibrillators ( ICDs ) are widely employed for the prevention of sudden cardiac death. Despite technological improvements, patients often need to undergo generator replacement, which entails the risk of periprocedural complications. Our aim was to estimate the service life of ICD s over a 10‐year interval and to assess the main causes of replacement on the basis of data from the National ICD Registry of the Italian Society of Arrhythmology and Cardiac Pacing (AIAC). Methods and Results The registry includes data from over 400 hospitals in Italy. We included all patients who underwent device replacement from calendar years 2007 to 2016. The median service life of the ICD s and its trend over the years was estimated across the 3 types of devices (single‐chamber, dual‐chamber, cardiac resynchronization therapy defibrillator) and the indication to implantation. The causes of replacement were also analyzed. We included 29 158 records from 27 676 patients (80.9% men; mean age at device replacement 65.8±12.0 years). The median service life was 57.3 months (interquartile range 27.8 months). Over the years, service life showed an increasing trend. The majority of patients underwent elective replacement because of battery end of life, and over the years there was a significant reduction of replacement for recalls, erosion/infections, and cardiac resynchronization therapy upgrading. Conclusions Our data from a large single‐nation population showed that the trend of ICD service life, independently from ICD type, indication, and settings, significantly improved over time. Moreover, there was a striking reduction of interventions for upgrading and infection/erosion. This favorable trend has important clinical, organizational, and financial implications.

Background: Implantable cardioverter-defibrillators (ICD) have a pivotal role in preventing major arrhythmic events in patients with severely reduced left ventricular ejection fraction (LVEF). Device replacement strategy is still controversial in patients without severely reduced left ventricular ejection fraction (LVEF) at the end of battery life. Objective: To evaluate the long-term arrhythmic outcome of patients with ICD or and cardiac resynchronization therapy defibrillators (CRT-D) with normal or intermediate LVEF at the time of device replacement. Methods: All consecutive patients with reduced ejection fraction heart failure, both from ischemic and non-ischemic origin, implanted with ICD or CRT-D for primary prevention from 2002 to 2009, were considered. The study population included patients without previous ICD interventions and without severe dysfunction (i.e. LVEF ≥ 35%) 60 [53–65] months after implantation (average battery duration). The outcome measure was the occurrence of appropriate ICD interventions in the long-term. Results: Among the 255 patients (150 ICDs; 105 CRT-D) evaluated, 45 (18%) had LVEF ≥ 35% without ICD interventions 5-year follow-up after implantation (15 ICD [10%]; 30 CRT-D [29%]). In the long term, ICD interventions were 4 (27%) in the ICD group and 5 (17%) in the CRT-D group. Conclusions: Despite the absence of severe left ventricular dysfunction at the time of battery replacement, a not negligible number of patients with ICD and CRT-D maintained a high risk of appropriate interventions in the long term, suggesting the opportunity of replacing the ICD regardless the amount of LV dysfunction. © 2019 Elsevier B.V.

Aims: Despite continuous efforts in improving the selection process, the rate of non-responders to cardiac resynchronization therapy (CRT) remains high. Recent studies on intraventricular blood flow suggested that the alignment of hemodynamic forces (HDFs) may be a reproducible biomarker of mechanical dyssynchrony. We aimed to explore the relationship between pacing-induced realignment of HDFs and positive response to CRT. Methods and results: We retrospectively analyzed 38 patients from the CRT database of our institution fulfilling the inclusion criteria for HDFs-related echocardiographic assessment early pre and post CRT implantation, with available mid-term follow-up (≥ 6 months) evaluation. Standard echocardiographic and deformation parameters early pre and post CRT implantation were integrated with the measurement of HFDs through novel methods based on speckle-tracking analysis. At midterm follow-up 71% of patients were classified as responders (reduction of Left Ventricular Systolic Volume Indexed ≥ 15%). Patients did not display significant changes between close evaluations pre and post-implant in terms of ejection fraction and strain metrics. A significant reduction of the ratio between the amplitudes of transversal and longitudinal force components was found. The variation of this ratio strongly correlates (R2 =0.60) with Left Ventricular (LV) end-systolic volume variation at mid-term follow up. Conclusion: Pacing-induced realignment of HDFs is associated with CRT efficacy at follow up. These preliminary results claim for dedicated prospective clinical studies testing the potential impact of HDFs study for patient selection and pacing optimization in CRT.

The interpretation of approximately 1300 km of multichannel seismic data, acquired in the northern Adriatic Sea, revealed that the Apennine foredeep in the northern Adriatic does not show any evidence of tilting since Early Pliocene, suggesting that slab retreat cannot be the geodynamic driving force for the northern Adriatic subsidence and for the northern Apennine kinematic since that time. Moreover, the presence of two fault systems that developed since the Pliocene indicates that the northern Adriatic underwent intraplate deformation during the Plio-Pleistocene. These considerations suggest that, since Early Pliocene, subduction below the northern Apennine ceased, and that the Adria Plate movements were mainly driven by the kinematics of the adjacent plates, particularly by the Nubia-Europe convergence. At present, on the basis of the foredeep setting, four distinct sectors can be recognized in the Adriatic foreland: Po Plain, northern, central and southern Adriatic, separated by major tectonic lineaments. The northern Adriatic differs from the two adjoining sectors because its foredeep deposits are still well preserved. In the Po Plain in fact, the Adriatic foredeep is almost totally incorporated into the Alpine and Apennine chains while in the central Adriatic, it is affected by a considerable intraplate deformation (e.g. the Mid Adriatic Ridge). In this framework, the northern Adriatic region may be regarded as a triangular shaped sector indented below the Southern Alps to the north and the northern Dinarides to the north-east and bounded to the west by the Schio-Vicenza fault system and to the south-east by the Kvarner fault.

The Serra Mulara canyon is a middle Pleistocene submarine canyon developed along the Ionian coast of Calabria, southern Italy, now exposed on land due to the long-term regional uplift of the area. New data have allowed recognizing three depositional sequences in the upper part of the succession, probably glacio-eustatic in origin, documenting an evolution of depositional systems that reflect the emergence of the canyon. Sequence 1 shows a rapid shift from turbidites and hemipelagites accumulated in the upper part of the canyon fill to forced regressive deltaic deposits, which reflect a marked shallowing of the area. Sequence 2 consists of estuarine transgressive and deltaic highstand deposits, whereas Sequence 3 is fully composed of fluvial deposits, testifying the emergence of the area. The upper part of the Serra Mulara succession is an useful example showing the transition from submarine canyon to continental settings, a situation that is not adequately documented in the literature, and is also relevant to better reconstruct the timing of the uplift of this part of Calabria.

Introduction The recently developed second‐generation subcutaneous implantable cardioverter defibrillator (S‐ICD) and the intermuscular two‐incision implantation technique demonstrate potential favorable features that reduce inappropriate shocks and complications. However, data concerning large patient populations are lacking. The aim of this multicentre prospective study was to evaluate the safety and outcome of second‐generation S‐ICD using the intermuscular two‐incision technique in a large population study. Methods and Results The study population included 101 consecutive patients (75% male; mean age, 45 ± 13 years) who received second‐generation S‐ICD (EMBLEM; Boston Scientific, Marlborough, MA) implantation using the intermuscular two‐incision technique as an alternative to the standard implantation technique. Twenty nine (29%) patients were implanted for secondary prevention. Twenty four (24%) patients had a previously implanted transvenous ICD. All patients were implanted without any procedure‐related complications. Defibrillation testing was performed in 80 (79%) patients, and ventricular tachycardia was successfully converted at less than or equal to 65 J in 98.75% (79/80) of patients without pulse generator adjustments. During a median follow‐up of 21 ± 10 months, no complications requiring surgical revision or local or systemic device‐related infections were observed. Ten patients (9.9%) received appropriate and successful shocks for ventricular arrhythmias. Three (2.9%) patients experienced inappropriate shocks due to oversensing the cardiac signal (n = 1), noncardiac signal (n = 1), and a combination of both cardiac and noncardiac signals (n = 1), with one patient requiring device explantation. No patients required device explantation due to antitachycardia pacing indications. Conclusions According to our multicentre study, second‐generation S‐ICD implanted with the intermuscular two‐incision technique is an available safe combination and appears to be associated with a low risk of complications, such as inappropriate shocks.

Highlights • A structural map of the northern part of the Capo Granitola-Sciacca strike-slip Fault Zone (Sicilian Channel) has been produced. • Numerous magmatic manifestations in addition to those already known in the Graham and Terrible banks, have been recognized. • A relationship between magmatism and structures associated with the Capo Granitola-Sciacca Fault Zone, has been documented. • A mechanism of non-plume origin is proposed for the magmatism observed in the study area. The tectonic framework of the northern sector of the Capo Granitola-Sciacca Fault Zone (CGSFZ), a NNE-oriented lithospheric strike-slip fault zone located in the Sicilian Channel (southern Italy), has been reconstructed with the aim to clarify the relationships between geometry and kinematics of the structures and the occurrence and distribution of the magmatic manifestations observed in the area. This has been achieved by the interpretation of a large dataset composed of 2-D multichannel seismic profiles, Chirp profiles, magnetic data and borehole information. In addition to the volcanic edifices known in the Graham and Terribile banks, this study has allowed to recognize several other magmatic manifestations. The magmatic occurrences consist of small volcanic cones, buried magma ascents and potential igneous sills. The CGSFZ is bounded by two strike-slip fault systems, the Capo Granitola Fault System (CGFS) to the west and the Sciacca Fault System (SFS) to the east, dominated by positive flower structures generated by tectonic inversion of NNE-oriented late Miocene extensional faults. Only the southern part of the CGFS shows the presence of a sub-vertical, N-S oriented strike-slip master fault. The sector between the two fault systems does not show a significant Pliocene-Quaternary tectonic deformation, except for its southern part hosting the Terribile Bank, which is dissected by WNW to NW-trending normal faults developed during late Miocene and later reactivated. This set of faults is currently active at the Terribile Bank, whereas is buried by Pliocene-Quaternary deposits in the central and northern sectors of the CGSFZ. The observed magmatism is driven by a mechanism of non-plume origin. Magmas have used as open paths the faults of the CGFS and SFS, which cut the whole lithosphere reaching the asthenosphere and producing partial melting by simple pressure release. Most of the magmatism develops along the strike-slip master fault associated with the CGFS and the normal faults affecting the Terribile Bank. The magmatic feeding of the Terribile Bank would be related to lateral magma migration coming from the structures of the SFS, which would use the open pathways represented by active normal faults. In the central-northern part of the CGSFZ, magmas migrate upward along lithospheric faults, then move laterally and rise toward the surface through NNE and NW-trending buried normal faults. These late Miocene faults do not reach the surface, and this may have favoured the emplacement of igneous sills, which in turn may explain the observed volcanic centres.

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 2016 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 23 496 PM implantations were collected (19 003 first implant and 4493 replacements). The number of collaborating centers was 204. Median age of treated patients was 81 years (75 quartile I; 86 quartile III). ECG indications included atrioventricular conduction disorders in 39.8% of first PM implants, sick sinus syndrome in 22.1%, atrial fibrillation plus bradycardia in 14.1%, other in 24.0%. Among atrioventricular conduction defects, third-degree atrioventricular block was the most common type (22.18% of first implants). Use of single-chamber PMs was reported in 26.9% of first implants, of dual-chamber PMs in 65.0%, of PMs with cardiac resynchronization therapy (CRT) in 1.5%, and of single lead atrial-synchronized ventricular stimulation (VDD/R PMs) in 6.6%. ICD Registry: data about 20 350 ICD implantations were collected (14 763 first implants and 5587 replacements). The number of collaborating centers was 430. Median age of treated patients was 72 years (63 quartile I; 78 quartile III]. Primary prevention indication was reported in 79.0% of first implants, secondary prevention in 21.0% (cardiac arrest in 7.9%). A single-chamber ICD was used in 32.2% of first implants, dual-chamber in 31.1% and biventricular in 36.7%.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.

A peculiar type of marine rocky outcrops is generated under temperate conditions through the cementation of carbonate and siliciclastic sediments on the northwestern Adriatic shelf. The lithification process results into the genesis of punctiform outcrops (tegnue) that serve as substrate to substantial coralligenous epibenthic growth. These buildups have been often described as beachrock. More recently, an alternative genetic mechanism, implying precipitation of carbonate cements in the marine phreatic zone, has been hypothesized for the rocky outcrops off the coast of Chioggia (south of Venice). These rocky outcrops are settled along the levee of meandering channels inherited from Pleistocene fluvial systems. Petrographic analyses of the Chioggia rocky outcrops allowed distinguishing three (3) main lithofacies: 1) biofouled sandstone blocks; 2) cross-stratified slabs and 3) bioclastic carbonates. These lithofacies have a common substrate mainly made by allochemic sandstone and sandy allochem limestone consisting in rounded grains of limestones and dolostones. The host sediments are cemented by a thin micrite coating followed by isopachous rims of scalenohedral and bladed calcite. Geochemical analyses revealed a sensible decrease in Mg contents between the early and late generations of isopachous cements. Vadose cements are missing suggesting that the precipitation of calcite cements occurred in marine phreatic zone without supra-tidal exposure. The lack of aragonite cements suggests that seawater was mixing with meteoric groundwater. The mixing of groundwater induced a partial dissolution of high-Mg calcite and precipitation of a later stage low-Mg calcite. The lithification of the morphologies inherited from Pleistocene fluvial systems provided the nucleus for the development of the coralligenous buildups observed in the North Adriatic Sea shelf. It is possible that diagenetic processes, other than those normally responsible for the formation of beachrocks worldwide, have been active in the northern Adriatic Sea starting from the post-Last Glacial Maximum transgression. It is therefore likely that these processes are more relevant for the coralligenous epibenthic growth in temperate siliciclastic shelves than previously thought.

Aims Right ventricular (RV) dysfunction has been associated with a worse outcome in heart failure patients undergoing CRT. However, evidence on the RV response to CRT is controversial and there are no data regarding the early effects of CRT on RV function (RVF). We sought to investigate whether a CRT device favourably influences the RVF acutely after implantation, impacting on long-term outcomes. Methods and results Patients who successfully underwent CRT device implantation from January 2005 to January 2014 were retrospectively analysed. RV dysfunction was defined by an RV fractional area change

High-frequency clastic shelf sequences deposited in high-latitude settings display marked differences, in term of facies and stratigraphic architecture, with respect to their lower latitude counterparts. This is due to the presence of ice which (1) leads to the accumulation of glacigenic and glacimarine deposits; (2) provides an additional control on accommodation; and (3) determines the position of the shoreline. Transgressions and regressions in glaciated settings are controlled respectively by the retreat and advance of the ‘ice’ shoreline (i.e., the water/ice contact) irrespective of relative sea-level changes; once the ice retreats across the land, the traditional ‘land’ shoreline is exposed and the control on sequence architecture is exerted by the interplay between relative sea-level changes and sediment supply as in low- and middle-latitude settings. A general model that includes both glacial and non-glacial climatic regimes is provided by this paper. In this frame, the classic sequence stratigraphic model represents one (ice-free) end member, which is opposed to an ice-permanent end member. Between these end members, sequences may accumulate in part under ice-free conditions and in part under conditions dominated by ice on the shelf. The main implication of this is that the classic sequence stratigraphic model may be viewed as only a possible scenario in the stratigraphic record rather than the rule.

Heart failure is a leading cause of hospitalization and a significant medical burden in our society. Implantable medical devices are nowadays established therapies in heart failure patients that not only provide cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICDs) therapy but are also able to continuously and remotely monitor diagnostic information of various physiologic parameters. The value of combining individual diagnostic variables to predict worsening of heart failure is still largely unclear but could eventually become a valuable tool towards a better heart failure management.SELENE HF (Selection of potential predictors of worsening Heart Failure) is an observational, multicentre study designed to prospectively collect follow-up and home monitoring data trends from a population of individuals with ICDs with or without resynchronization therapy (CRT-D), to document heart failure hospitalizations and deaths and to correlate these events with Home Monitoring data in order to identify the combination with the greatest sensitivity and specificity in predicting heart failure events.The purpose of this study is to describe the design of the study focusing on the Heart Failure Predicting model and statistical approach that will be used to analyse the data.The results of the SELENE HF study could help to select and define potential predictors of worsening heart failure in patients with remotely monitored ICD or CRT-D devices.ClinicalTrials.gov Identifier NCT01836510.