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Background Out of millions of patients (pts) screened every year for chest pain in emergency departments (EDs) only 10% to 20% are affected by an acute coronary syndrome (ACS) or angina due to ischemic heart disease (IHD). Unless ECG recording and serum markers are clearly positive, most of them must undergo complete clinical workout to exclude IHD prior to discharge. Moreover, since even effort-ECG and echocardiography don't exhaustively rule-out IHD, second-level exams are frequently needed, enhancing hospitalization time and related costs. Magnetocardiography (MCG) is increasingly reported as a sensitive, non-invasive, radiation-free method with high negative predictive value (PV) to rule out IHD. Purpose Retrospective cohort study to evaluate the reliability likelihood of unshielded MCG (uMCG) as a tool for rapid rule-out of IHD. Method Rest uMCG data of 263 patients (pts), all chest-pain free at the moment of MCG scan, were retrospectively analyzed. uMCG was recorded with a 36-channel SQUID system (intrinsic sensitivity 30 fT/√Hz, above 1Hz), for 90 seconds. With proprietary software, 13 MCG parameters were automatically calculated from T-wave magnetic field (T-MF): 5 parameters quantifying the dynamics of the MF extrema and eight, obtained from inverse solution with the equivalent magnetic dipole (EMD) model, quantifying the spatial dynamics of the T-wave effective magnetic vector (T-EMV). Pts were stratified as follows: – Group A, chest pain pts, with IHD confirmed by subsequent SPECT and coronary angiography (mean age 66±11 years, 36.7% female); – Group B, chest pain pts, with IHD excluded by subsequent SPECT or coronary angiography (mean age 59±10 years, 28.8% female); – Group C, healthy control subjects (mean age 25±7 years, 48.6% female). Only 60 pts in each group were randomly selected for the analysis. Non-parametric Kruskal-Wallis tests were used to compare the 13 MCG predictors among groups. Linear discriminant analysis was employed to assess likelihood ratios (LHR) and PVs, considering a mean IHD prevalence of 13% (range 10–20%) in chest-pain pts. Results Positive LHR was 9, while the negative LHR was 0.3, resulting in a helpful reduction of the pre-test probability of IHD. Whereas positive PV ranges from 51 to 70%, hardly confirming IHD diagnosis, negative PV ranges from 92 to 96%, giving confidence for a safe IHD rule-out. Conclusions Automatic analysis of T-MF and of T-EMV dynamics from rest MCG provided impressive negative LHR and PV values that, if confirmed in prospective multicenter trials, would rank MCG as a useful tool for quick and early triage of pts with acute chest pain and still non-diagnostic ECG and enzyme patterns, to rule-out those whose symptoms are of non-ischemic origin. Interestingly, a similar high negative PV has been recently reported using MCG QRS predictors. Thus, even better results could be expected by combining algorithms for automatic assessment of both T-wave and QRS predictors. Funding Acknowledgement Type of funding sources: None.

Background and aims Inadequate pain control affects morbidity and hospitalization length of stay. Post-operative pain is commonly managed with opioids with important side effect. Recent data has shown that the novel erector spinae plane (ESP) block, can be employed as a safe regional analgesic technique for acute post-surgical and chronic neuropathic pain. The aim of the present study was to investigate the capacity of ESP block to provide successful post-operative pain management undergoing spinal surgery. Methods 29 patients undergoing open lumbar decompression surgery were randomized in two groups. ESP group (n=12) received ESP block with 0,5% levobubivacain 20 ml. In the control group (n=17) no intervention was performed and postoperative analgesia was achieved with IV morphine plus ketorolac. The primary outcome was represented by postoperative numerical rate scale (NRS) score at various time periods during the first 24 hours following surgery. The secondary outcomes included opioid consumption, rescue analgesia and opioid related side effects. The study protocol was approved by the local review board. Results Compared with control group, the NRS score of ESP block patients did not show any statistically significant differences in the measured time periods. Twenty-four-hour opioid consumption in group control was significantly higher compared to group ESP (30±2.6 mg and 10±2.08 mg, p Conclusions Our preliminary findings suggest that ESP block is not inferior compared to opioid in the management of post-operative acute pain, has reduced opioid consumption and may play a key role in the prevention of post-surgical chronic pain.

Background and aim Obesity plays a dominant role in the etiology of atrial fibrillation (AF), and the maintenance of a normal body mass index (BMI) seems to prevent and even reduce the incidence of the arrhythmia's recurrence. We selected 270 patients (pts) to assess whether this therapeutic effect was statistically significant even in Mediterranean patients. Method and results In this retrospective cohort study, we analyzed every symptomatic AF relapse during a total follow-up of 657 patient-years. Clinical data, BMI variations, and pts' history were available in our clinical database. We divided the pts in four groups (Gs), according to their BMI variation during the follow-up: G1, normal weight pts, maintaining their weight; G2, overweight pts, losing weight; G3, overweight pts, maintaining their weight; G4, pts gaining weight. Their follow-up (in months) was normalized according to their AF relapses, thus obtaining a mean AF-free period for each patient. Among the overweight groups, G2 showed the best AF-free period (9.7 months). However, G3 and G4 showed a reduced AF-free interval (4.6 and 1.7 months, respectively). G1, predictably, had the longest AF-free period (10 months). Conclusion The results of the present study confirm that simple non-invasive intervention aimed to normalize BMI and to control risk factors through appropriate lifestyle can be highly effective in reducing the AF burden, by acting on comorbidities and proarrhythmic mechanisms. Therefore, serious attempt should be made to correct risk factors before an ablation therapy is proposed.