P328Satisfaction towards clinical training and academic activities among residents and early-career cardiologists

Background: Because of the progress in diagnostic and therapeutic cardiovascular disease, the skills to be acquired during fellowship train ing has increased significantly. In particular, the evolution in arrhythmology and electrophysiology was fast in the last years. This could have created a gap between the training program during the fellowship and the new technologies, growing demand for re-defined educational re quirements to ensure uniformity of knowledge and competence of those practicing in electrophysiology. Purpose: The AIAC (Italian Association of Arrhythmology and Cardiostimulation) Young Pacing committee conducted a survey to obtain in formation the satisfaction on the educational and training obtained during the residency course by residents and young cardiologists (arbitra rily defined as age ≤ 40 years). Methods: The survey was conducted from January to May 2019. Residents and young cardiologists were contacted to complete the survey by e-mail. They were asked to answer a questionnaire containing information about scholarly activity included satisfaction of educational and clinical proficiency in arrhythmology and electrophysiology and educational in electrophysiology after the residency. Results: We obtained 334 answers to the survey. One hundred forty-six individuals (43.7%) were residents and 188 (56.2%) were young cardiologist. In Electrophysiology Department, 3-6 months were dedicated to Clinical Arrhythmology for 135 partecipants (40.4%), 1-2 months to cardiac pacing for 132 partecipants (39.5%) and 1-2 months to EP Lab for 139 partecipants (41.6%). Three hundred twenty-nine people responded to questions about satisfaction in educational. In terms of educational in Clinical Arrhythmolo gy, 100 responders (30.4%) were "very satisfied", 105 (31.9%) were "satisfied" and 124 (37.7%) were "dissatisfied". About Cardiac Pacing, 84 responders (25.5%) were "very satisfied", 93 (28.3%) were "satisfied" and 152 (46.2%) were "dissatisfied". Only 51 (15.5%) participants were "very satisfied" with their training in Electrophysiology, whereas 81 (24.6%) were "satisfied" and 197 (59.9%) were "dissatisfied". About self-assessed clinical proficiency in Arrhythmology at the end of fellowship, 30 responders (9%) defined themselves as completely confident in Clinical Arrhythmology, 126 (37.7%) in Ambulatory Electrophysiology (ECG Holter and device check), 28 (8.4%) in cardiac pac ing, 10 (3%) in performing electrophysiological study and nobody in catheter ablation. One hundred twenty-one (36.8%) participants improved their competence in Cardiac Arrhythmia Management attending courses after fellow ship. Conclusion: The survey underlines the need to fill a gap in order to address the needs of young interventional cardiologists and it may serve as a starting point for developing tailored educational initiative

Factors affecting signal quality in implantable cardiac monitors with long sensing vector

Purpose: Electrical artefacts are frequent in implantable cardiac monitors (ICMs). We analyzed the subcutaneous electrogram (sECG) provided by an ICM with a long sensing vector and factors potentially affecting its quality. Methods: Consecutive ICM recipients underwent a follow-up where demographics, body mass index (BMI), implant location, and surface ECG were collected. The sECG was then analyzed in terms of R-wave amplitude and P-wave visibility. Results: A total of 84 patients (43% female, median age 68 [58-76] years) were enrolled at 3 sites. ICMs were positioned with intermediate inclination (n\ua0=\ua044, 52%), parallel (n\ua0=\ua035, 43%), or perpendicular (n\ua0=\ua05, 6%) to the sternum. The median R-wave amplitude was 1.10 (0.72-1.48) mV with P waves readily visible in 69.2% (95% confidence interval, CI: 57.8%-79.2%), partially visible in 23.1% [95% CI: 14.3%-34.0%], and never visible in 7.7% [95% CI: 2.9%-16.0%] of patients. Men had higher R-wave amplitudes compared to women (1.40 [0.96-1.80] mV vs 1.00 [0.60-1.20] mV, P\ua0=.001), while obese people tended to have lower values (0.80 [0.62-1.28] mV vs 1.10 [0.90-1.50] mV, P\ua0=.074). The P-wave visibility reached 86.2% [95% CI: 68.3%-96.1%] in patients with high-voltage P waves ( 650.2\ua0mV) at surface ECG. The sECG quality was not affected by implant site. Conclusion: In ordinary clinical practice, ICMs with long sensing vector provided median R-wave amplitude above 1\ua0mV and reliable P-wave visibility of nearly 70%, regardless of the position of the device. Women and obese patients showed lower but still very good signal quality

Cardiac electrophysiology and pacing educational and training needs among early-career cardiologists: a national survey of the Young Committee of the Italian Association of Arrhythmology and Cardiac Pacing

BACKGROUND: Over the past three decades, cardiac electrophysiology and pacing, including device therapy and catheter ablation of arrhythmias, has rapidly developed as a subspecialty in cardiology. Currently, there is no clear perception about the needs in cardiac electrophysiology and pacing among early-career cardiologists. METHODS: To address these concerns, the Young Committee of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) carried out a survey among those under the age of 40 years to obtain detailed information on practical activities and formal lessons during the fellowship in cardiology and their satisfaction and proficiency level at the end of the fellowship. RESULTS: We obtained 334 answers to the survey. In invasive cardiac electrophysiology and pacing, the percentage of participants attending the activity for a longer time (3-6 months) is lower compared with those in noninvasive subspecialties. About 40% of participants did not receive lessons on interventional cardiology, cardiac electrophysiology and pacing. On the contrary, 71% of participants received an adequate number of lessons on clinical arrhythmology. The vast majority of the participants expressed satisfaction for the education received in the echocardiographic, cardiac interventional laboratories and clinical arrhythmology, but about half of the participants were unsatisfied with the education received in cardiac electrophysiology and pacing. In interventional arrhythmology, the majority of the participants declare their lack of proficiency with two peaks for more complex procedures, namely interventional electrophysiology procedures (82%) and cardiac resynchronization therapy (CRT) procedures (76%). CONCLUSION: The present survey among Italian early-career cardiologists suggests that the majority of participants consider themselves not confident in performing cardiac electrophysiology and pacing procedures. Due to the complexity of the treatment for heart rhythm disorders and the long learning curve, structured additional training in cardiac electrophysiology and pacing procedures is required after cardiology fellowship

Multiparametric Implantable Cardioverter-Defibrillator Algorithm for Heart Failure Risk Stratification and Management: An Analysis in Clinical Practice

BACKGROUND: The HeartLogic algorithm combines multiple implantable cardioverter-defibrillator sensors to identify patients at risk of heart failure (HF) events. We sought to evaluate the risk stratification ability of this algorithm in clinical practice. We also analyzed the alert management strategies adopted in the study group and their association with the occurrence of HF events.METHODS: The HeartLogic feature was activated in 366 implantable cardioverter-defibrillator and cardiac resynchronization therapy implantable cardioverter-defibrillator patients at 22 centers. The median follow-up was 11 months [25th-75th percentile: 6-16]. The HeartLogic algorithm calculates a daily HF index and identifies periods IN alert state on the basis of a configurable threshold.RESULTS: The HeartLogic index crossed the threshold value 273 times (0.76 alerts/patient-year) in 150 patients. The time IN alert state was 11% of the total observation period. Patients experienced 36 HF hospitalizations, and 8 patients died of HF during the observation period. Thirty-five events were associated with the IN alert state (0.92 events/patient-year versus 0.03 events/patient-year in the OUT of alert state). The hazard ratio in the IN/OUT of alert state comparison was (hazard ratio, 24.53 [95% CI, 8.55-70.38], P<0.001), after adjustment for baseline clinical confounders. Alerts followed by clinical actions were associated with less HF events (hazard ratio, 0.37 [95% CI, 0.14-0.99], P=0.047). No differences in event rates were observed between in-office and remote alert management.CONCLUSIONS: This multiparametric algorithm identifies patients during periods of significantly increased risk of HF events. The rate of HF events seemed lower when clinical actions were undertaken in response to alerts. Extra in-office visits did not seem to be required to effectively manage HeartLogic alerts. Registration: URL: ; Unique identifier: NCT02275637

Impact of COVID-19 pandemic on the clinical activities related to arrhythmias and electrophysiology in Italy: results of a survey promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

COVID-19 outbreak had a major impact on the organization of care in Italy, and a survey to evaluate provision of for arrhythmia during COVID-19 outbreak (March\u2013April 2020) was launched. A total of 104 physicians from 84 Italian arrhythmia centres took part in the survey. The vast majority of participating centres (95.2%) reported a significant reduction in the number of elective pacemaker implantations during the outbreak period compared to the corresponding two months of year 2019 (50.0% of centres reported a reduction of > 50%). Similarly, 92.9% of participating centres reported a significant reduction in the number of implantable cardioverter-defibrillator (ICD) implantations for primary prevention, and 72.6% a significant reduction of ICD implantations for secondary prevention (> 50% in 65.5 and 44.0% of the centres, respectively). The majority of participating centres (77.4%) reported a significant reduction in the number of elective ablations (> 50% in 65.5% of the centres). Also the interventional procedures performed in an emergency setting, as well as acute management of atrial fibrillation had a marked reduction, thus leading to the conclusion that the impact of COVID-19 was disrupting the entire organization of health care, with a massive impact on the activities and procedures related to arrhythmia management in Italy