bluuebunny/crossref_metadata_2025_split huggingface dataset:
P374 MANAGEMENT OF A HOSPITAL NURSING OFFICE FOR AF AND CONTROL OF DIRECT ORAL ANTICOAGULANT THERAPY IN THE COVID EMERGENCY PHASE
Authors: Pagliani L , Colledan C , Bertoldo I , Magoga J , Modolo M , Visintin E , Nicolosi E , Di Naro A , Denas G , Antonini–canterin F 
Published: May 2022

Abstract
Anticoagulant therapy is the gold standard treatment in thromboembolic prevention in AF patients. Starting from the indications from the regional indications that give the therapeutic diagnostic path, a divisional clinic dedicated to the diagnosis and treatment of AF was born in our territory. The aim of the team (Cardiologists, Nurses, GPs, administrative secretariat) was to monitor the number of patients treated with DOACs through AIFA therapeutic plans; Verify adherence to regional guidelines, analysis of therapy adherence; Prepare a protocol for the management of complications and emergencies; Ensure that the departments and services authorized to prescribe NOA take charge, in collaboration with general practitioners who since June 2020 have become active prescribers and also actors in the follow–up of patients; Taking care of the training of the prescribers themselves and the education of patients through hospital meetings dedicated to guided counseling and, finally, monitoring the pharmaceutical expenditure of the NOA on the total prescription of the local health unit of competence in compliance with the regional indicators. In our hospital the pilot project started in 2017 (3726 currently in FU). In the three–year period 2017–19, an average of 700 therapeutic plans were collected for renewal / first prescription per year (58.3 plans / month) to be monitored in subsequent years. In the two–year period 2020–2021, which saw the difficulty of organizing activities due to the pandemic emergency, 903 and 790 PTs were analyzed with an average of 70 plans / month, keeping almost 75% of face to face visits compared to telemedicals set up in the pandemic context.
According to the data, therefore, there is a strong need for diagnostic and health assistance paths. Despite the emergency period and despite a framework in which territorial medicine could have helped the clinical and bureaucratic effort, no resistance to the care burden has occurred and on the contrary the constant increase in patients makes the complexity and difficulty of a correct clinical classification and management support for patients with AOC needs
P376 INTRACAVITARY ABLATION OF PARASYMPATHETIC ATRIAL GANGLIONATED PLEXUS, A NEW APPROACH FOR SINUS BRADYCARDIA IN YOUNG PATIENTS
Authors: Cherubini S , Castro A , Follesa F , Centurion Aznaran C , Albano B , Ciolli A 
Published: May 2022

Abstract
Sinus bradycardia might be a severe clinical problem, if symptomatic pacemaker implantation is needed. In younger patients this will lead to several battery changes, higher infectious risk and psychological issues. When sinus bradycardia seems related to vagal hypertone, intracavitary ablation of atrial ganglionated plexus has recently been proposed as an alternative to pacemaker implantation in symptomatic younger patients. A 44–year–old patient was admitted to the emergency department for lipothymia and fatigue. The ECG showed marked sinus bradycardia with a heart rate of 35 bpm and continuous ECG monitoring revealed episodes of Mobitz I second degree AV block and 2:1 AV block. The transthoracic echocardiography was normal. In order to reduce the effect of vagal hypertone on the heart, catheter ablation of parasympathetic atrial ganglionated plexus was performed. In the right atrium the electrophysiological study showed fragmented potentials near caval vein openings and coronary sinus osthium, while in the left atrium these were found in the posterior wall close to the pulmonary veins and near the left part of coronary sinus. Catheter stimulation of these zones determined asystolic pauses and induction of atrial fibrillation with spontaneous resolution. Catheter radio–frequency ablation was performed, at the end of the procedure increase of heart rate at 70 bpm was observed and atrial fibrillation was no more inducible during pacing. Atrioventricular Wenckebach point recorded before the procedure was 730 ms and it passed to 430 ms. At continuous ECG monitoring the heart rate remained higher than 65 bpm all over the hospitalization, without any other meaningful arrhythmias. Ablation of parasympathetic atrial ganglionated plexus is still an experimental technique but it is proving to be very interesting and promising. In the case we described the patient took a real advantage from the procedure that was measurable both with the improve of heart rate and reduction of Wenckebach point. During the procedure we associated the site of fragmented potentials with the position of each plexus; stimulation of these sites evocated a strong vagal response, confirming that fragmented potentials can be used to localize the plexus. Some authors affirmed that ablation only on right atrium might be sufficient; however, we preferred to ablate in both atria in order to make the procedure more effective. More studies are needed to identify the correct site.
P377 CHALLENGING RISK STRATIFICATION IN BRUGADA SYNDROME: A CASE OF VENTRICULAR TACHYCARDIA IN A LOW–RISK PATIENT
Authors: Marcon L , Zannoni J , Tundo F , Moltrasio M , Majocchi B , Fassini G , Riva S , Casella M , Tondo C , Ribatti V 
Published: May 2022

Abstract
A 22–year–old healthy athlete was referred to our hospital for electrocardiographic findings consistent with intermittent type–1 Brugada pattern. A routine electrocardiogram (ECG) performed during a check–up showed sinus rhythm, normal PR interval and QRS duration, rSR’ with a coved type ST–segment elevation in V2 lead (Figure 1).The patients denied history of syncope or palpitations and his family history did not show sudden cardiac death or Brugada syndrome (BrS). Transthoracic echocardiography was normal and a 12–lead Holter monitoring revealed the intermittence of the type–1 Brugada pattern. The patient was hospitalized for further investigation. On admission, ECG showed a type–2 Brugada pattern; therefore, Ajmaline challenge test (1 mg/kg injection in 10 minutes) was performed and resulted positive. Subsequently, the patient underwent an electrophysiological study (EPS) which was negative for induction of sustained arrhythmias. The protocol adopted consisted of double extrastimuli programmed electrical stimulation until refractoriness (drive 600/220 ms and 400/210 ms), at double sites (right ventricle apex and right ventricular outflow tract). Furthermore a genetic test was performed using next–generation sequencing, showing a heterozygous mutation in the SCN5A gene, encoding for sodium channel alpha subunit (variant c.5363delA), not previously described in the literature. Since the low arrhythmic risk, the patient was implanted with a loop recorder (ILR, Medtronic Reveal LINQ), entering a program of home monitoring. After a 15–months follow–up, an episode of ventricular polymorphic tachycardia lasting 2 minutes and 11 seconds, associated with lightheadedness and palpitations, was detected by the remote monitoring (Figure 2). The patient was therefore hospitalized. During the in–hospital stay a cardiac magnetic resonance was performed to exclude other underlying diseases, identifying an enlarged right ventricle (EDVi 114 ml/m2) and abnormal free wall motion (Figure 3), thus reaching one major criteria of arrhythmogenic cardiomyopathy (however not sufficient for the diagnosis). The patient was then implanted with a subcutaneous implantable cardiac defibrillator (Boston Scientific EMBLEM MRI S–ICD). We presented a case of complex arrhythmic risk stratification in a possible overlap of an arrhythmogenic cardiomyopathy and a Brugada Syndrome in a young athlete who experienced a sustained ventricular tachycardia during loop–recorder monitoring.
P379 CARDIAC CONDUCTION DISEASE IN YOUNG PEOPLE: DON‘T FORGET THE GENES
Authors: De Carolis B , Di Domenico A , Gualandi F , Vitali F , Bertini M , Guardigli G , Balla C 
Published: May 2022

Abstract

Introduction
Heart rhythm disorders in young individuals are often associated with mutations in genes encoding ion channels. A frequently encountered mutation is in the SCN5A gene, which encodes the alpha subunit of the sodium channel. Mutations in this gene can be expressed through a wide spectrum of phenotypic manifestations including rhythm disturbances, structural cardiac changes and/or overlap syndromes (long/short QT syndrome, Brugada syndrome, sinus node syndrome, progressive cardiac conduction disorder, dilated cardiomyopathy and arrhythmogenic cardiomyopathy).

Case Report
23–year–old boy with no relevant history. During the induction of anaesthesia for a surgical intervention of nasal polyposis, episodes of asystole with a maximum duration of about 6 seconds were documented. During the hospital stay, a syncopal episode followed, with electrocardiographic monitoring showing a sinus arrest of approximately 16 seconds (Fig. 1). Echocardiography and cardiac resonance ruled out the presence of structural alterations. In view of the documented bradyarrhythmia, the clinical findings and the absence of secondary causes, a dual–chamber pacemaker implant was performed. The patient was subsequently admitted for ectopic atrial tachycardia (Fig. 2) symptomatic for heart palpitations, treated with medical therapy. After careful reconstruction of the family tree (Fig. 3), a positive family history of bradyarrhythmias emerged (grandfather and sister of the paternal grandfather were pacemaker carriers). A blood sample was taken for genetic analysis and a mutation in the SCN5A gene (ex28 c5207 A&gt;G) was detected. The genetic study was extended to first–degree relatives (still in progress). During follow–up visits the patient reported subjective well–being and at pacemaker interrogation evidence of 29% atrial pacing, in the absence of ventricular pacing.

Conclusions
When faced with a young patient with a conduction disorder, once possible secondary causes have been excluded, genetic analysis should be included in routine examinations because it helps to define an adequate clinical–instrumental follow–up and to identify, at an early stage, the possible progression of the disease and/or the onset of concomitant structural heart disease. Family genetic screening is also essential in order to identify patients at risk of developing the disease.
P383 THIRD–DEGREE ATRIOVENTRICULAR BLOCK AND HYPERCALCEMIA: NOT ALWAYS JUST THE HEART
Authors: Reggi A , Russo M , Rubboli A 
Published: May 2022

Abstract
A 81–year–old lady was admitted to the ER due to anorexia, fever and oliguria. Previous medical history was unknown as she had arrived in Italy one month before and her son was not aware of it. Upon arrival she was soporous and bradicardic. Physical examination consisted of mild pulmonary rales, diffuse abdominal pain and leg edema. ECG showed a third–degree atrioventricular block with narrow QRS and average heart rate of 40 bpm with no signs of ischemia. X–ray showed mild congestion. She was admitted to CCU. Blood tests showed hypoglicemia (53 mg/dL), anemia (Hb 9.9g/dL), low platelet count, renal dysfunction (creatinine 1.43mg/dL), high C–reactive protein, normal potassium but high calcemia (13 mg/dL). To investigate hypercalcemia parathyroid hormone was dosed and was in range, so a CT scan was needed to rule out pancreatitis, cancer or bone lesions. Also a cardiac echo was done: it showed a hypertrophic left ventricle with preserved contractility, no significant valvular dysfunctions, normal right sections with pulmonary hypertension, no pericardial effusion. While performing the subcostal view however multiple formations were seen at the hepatic level. CT scan confirmed multiple pathological conglomerating lymphadenopathies in the abdomen towards the femoral region, reaching 5 cm of diameter; no bone lesions were found. Inguinal lymph node biopsy was performed. Due to persistent complete AV block along with persistent hypercalcemia and hypoglycemia despite medical therapy, considering the electrolyte imbalance not corrigible due to a malignancy a pacemaker was implanted. The result of the lymph node biopsy was consistent with a form of Diffuse Large B–Cell Lymphoma. This case highlights how a 3–rd degree AV block may present with non–specific symptoms. When it is found it may not always represent a pure cardiac problem as sometimes it is the epiphenomenon of a systemic disease. Particularity of this case is that cardiologists are less used to take into consideration calcium balance. Nevertheless, although infrequent, hypercalcemia is a cause of significant conduction disease. After having looked for it, searching for its etiology is mandatory as some could be reversible and thus the AV block as well. For this reason, when a complete AV block is found ruling out hypercalcemia is fundamental, taking into consideration that the conduction disease may represent the first red flag of an unknown malignancy
P384 SUDDEN CARDIAC ARREST: LET’S LOOK BEYOND CORONAROPATHY
Authors: Canovi L , De Carolis B , Di Domenico A , Berloni M , Gualandi F , Bertini M , Guardigli G , Balla C 
Published: May 2022

Abstract

Introduction
Sudden cardiac arrest (SCA) is a high mortality event. Up to 70% of SCAs are caused by an acute coronary syndrome; nevertheless, it is essential to consider also non–ischemic causes while evaluating a post–SCA patient.

Clinical Case
A 68–year–old male patient with history of hypertension and dyslipidemia, presenting to the emergency room (ER) for syncope. While waiting in the ER, another sincopal episode happened and ventricular fibrillation was detected, therefore he was treated with a DC shock. At the ECG record after SCA, any acute alteration was seen. At the blood tests, an early rise of myocardial injury markers was found. At bedside echocardiography, a slight apical hypokinesia with hypertrabeculation was reported. Hence, coronarography was performed and a multivasal ateromasic coronaropathy was treated with angioplasty and drug–eluting stenting of left main artery, left anterior descending artery and left circumflex artery. In the following days, other ventricular tachyarrhythmias episodes happened and were treated with DC shocks. Due to ventricular arrhythmias relapses and echocardiographic findings, a cardiac MRI was performed, showing subepicardial fatty infiltration in the mid–apical lateral wall with parietal bulging suggesting left ventricle arrhythmogenic cardiomyopathy. So, a cardiac defibrillator was implanted in secondary prevention. Genetic analysis was run and reported a VUS mutation on RYR2 gene, still under evaluation as a possible cause for the clinical events.

Conclusions
The present clinical case shows that many causes may lead to SCA. Our patient experienced syncopal episodes related to ventricular arrhythmias and an arrhythmic storm which were most likely caused by an ischemic event on the base of an undiagnosed left ventricle arrhythmogenic cardiomyopathy.
P386 OBESITY AND CARDIOMYOPATHY
Authors: Giofrè F , Pelle M , Zaffina I , Lucà S , Forte V , Arturi F , Cloro C , Ventura M , Trapanese V , Sciacqua A , Arturi F 
Published: May 2022

Abstract

Background
Obesity cardiomyopathy is a heart failure unexplained by others etiologies that can vary from a subclinical left ventricular dysfunction to overt dilated cardiomyopathy.

Aim
To evaluate the changes in echocardiogram in both normotensive and hypertensive obese and to evaluate obesity and/or hypertension impact on cardiomyopathy.

Methods
383 subjects (236F–147M) were enrolled. They were divided into two groups based on BMI: non–obese subjects (BMI&lt;30kg/m2) and obese subjects (BMI&gt;30kg/m2). The obese subjects were divided in different degrees (groups) of obesity according with obesity classification: group 1= BMI &gt;30&lt;35, 2= BMI &gt;35&lt;40, 3= BMI &gt;40 kg/m2. 208 of 383 enrolled subjects were hypertensive. All subjects underwent to an echocardiogram with evalutation of left atrial diameter (LAD), left ventricular end–diastolic diameter (LVEDD), left ventricular end–systolic diameter (LVESD), ventricular septum, cardiac mass and left ventricular mass index (LVMI).

Results
Obese subjects showed a progressive increase in left atrial diameter (LAD)(P = 0.000), left ventricular end–diastolic diameter (LVEDD)(P = 0.000), left ventricular end–systolic diameter (LVESD)(P = 0.001), ventricular septum (P = 0.000) and cardiac mass (P = 0.000) according to the degree of obesity. Subjects in the 3° group of obesity showed higher value of LAD and LVESD when compared with subjects in first two groups (P = 0.000; P = 0.032; P = 0.000; P = 0.001, respectively). Similarly, subjects in the 3° group of obesity showed higher value of ventricular septum and cardiac mass when compared with the first two groups of obesity (P = 0.005; P = 0.002; P = 0.000; P = 0.005; respectively). LAD, LVEDD, LVESD, ventricular septum and cardiac mass were positively related with the obesity degree. In order to avoid that echocardiographic modifications were caused by hypertension, data were adjusted for hypertension so linear regression documented that degree of obesity predicts echocardiographic changes (LAD, LVEDD, LVESD) better than hypertension.

Conclusions
Our data suggested that the in obese subjects the severity of cardiomyopathy is correlated with degree of obesity and that the degree of obesity is a better predictor than hypertension for echocardiographic changes.
P389 COVID–19 AND CARDIOVASCULAR SYSTEM: NOT ONLY HEART BUT ALSO VASCULAR. THE EFFECTS OF THE INFECTION ON ARTERIAL STIFFNESS
Authors: Maloberti A , Gualini E , Scarpellini S , Algeri M , Biolcati M , Grasso E , Tognola C , Moreo A , Giannattasio C 
Published: May 2022

Abstract

Introduction
SARS–CoV–2 determines a framework of multi–organ dysfunction that can involve the cardiovascular system creating damages of different nature. Among these, endothelial damage could play a key role in increasing arterial stiffness and thus the cardiovascular risk of infected patients. The aim of this study is to evaluate the Pulse Wave Velocity (PWV) of a population of patients after recovery from infection and to compare them with those of a group affected by arterial hypertension.

Methods
This prospective observational monocentric study involved 143 patients with previous diagnosis of Covid–19 who undergone PWV measurement during the follow–up at a median time of 3.8 months after the infection. These patients were compared to a population of 143 patients with hypertension matched by age, sex, Systolic Blood Pressure values and Body Mass Index.

Results
PWV values were higher in Covid–19 group comparing to hypertension group (10.5 ± 3.0 m/s VS 8.9 ± 2.5 m/s). Furthermore, there is a correlation between higher PWV values and lower values of SpO2% at time of admission at the Emergency Department. (R= –0.302; p &lt; 0.001).

Conclusions
SARS–CoV–2 infection seems related to increased PWV values. Moreover, higher arterial stiffness seems correlated to a worse oxygen saturation in Emergency Department. More studies with longer follow–up time are necessary to establish whether the vascular damage is reversible and whether it correlates with an increase of long–term cardiovascular risk.
P391 A ‘FAKE’ PERIPARTUM CARDIOMYOPATHY: THE KEY ROLE OF CARDIAC MRI
Authors: Occhiuzzi E , Ranfone F , Ippoliti C , Valentini G 
Published: May 2022

Abstract
K.M. Woman, 47 years old; Moroccan–born, she doesn’t speak Italian. History limited by the language barrier Medical histroy: caesarean section two months prior to admission (pluriparae with 6 births) In home therapy with estrogen–progestin pill Access to the emergency room for thoraco–abdominal pain of not exactly onset with dyspnoea (Killip II) EKG: sinus tachycardia, poor progression of the R wave in the precordial leads with mild ST–elevation in the same leads TTS echocardiographic: slightly dilated left ventricle, hypo / akinesia of the apex in its entirity with LVEF 38%; mild mitral regurgitation. Normal size and fuction of RV, PAPS slightly elevated; no pericardial effusion. Coronarography: mild non–critical atheroma of the main vessels. Occlusion of a small branch of division of OM Ventriculography (suspected Tako–Tsubo): reduced contractile function of the LV in relation to akinesia of the apex in its entirety Chest CT without contrast: diffuse areas of parenchymal nodular thickening  &gt;&gt; lower lobes, thickening of interlobular and intralobular septa, mild pericardial effusion Blood sampling: elevated cardiac troponin hs in the absence of a typical curve for ACS; high inflammation markers Admission to cardiology with diagnosis of acute heart failure in PPCM (vs myocarditis.) Pneumonia. Slow and progressive improvement of the hemodynamic status and of the septic status with diuretic and antibiotic therapy. Prolactin antagonist (cabergoline) therapy and therapy for heart failure was started. During the hospital stay the patient was asymptomatic, not more angor, no arrhythmias on the EKG monitor, hemodynamic stability. Upon completion of the diagnosis, cardiac MRI was performed which modifies the diagnosis: dilated eccentric remodeling of the left ventricle with moderate reduction of global systolic function; akinesia of the lateral segments on the mid–basal, septal and lower apical planes and of the apex which corresponds to LGE ischemic–type enhancement for MI– outcomes. No evident endoventricular thrombi. Faded reactive signs of the pericardium with a slight fluid share Acute heart failure in hypokinetic heart disease with ischemic etiopathogenesis due to undated anterior silent MI (likely due to spontaneous coronary dissection)