BackgroundPacing the right ventricle is established practice, but there remains controversy as to the optimal site to preserve hemodynamic function.AimsTo evaluate clinical and hemodynamic differences between apical and septal pacing in pacemaker-dependent patients.MethodsPatients receiving their first pacemaker for advanced atrioventricular block, with the atria in sinus rhythm, were randomized to receive apical (Group A) or septal (Group S) ventricular leads. After implant, with the device programmed VVI 70 beats/min fixed rate, patients underwent a 6-minute walk test and a transthoracic echocardiogram. Then, DDDR was programmed at nominal settings. The same tests were performed at 6 months and 12 months follow-up. If ventricular pacing was less than 98%, the patient was excluded.ResultsA total of 142 patients were included in the study. During the study year, 71 (50%) were excluded for not fulfilling the condition of 98% ventricular pacing. Groups A and S had 34 and 37 patients, respectively. Age and gender were similar in the groups. At implant, QRS duration was significantly greater in Group A (158 ms) than Group S (146 ms; P = 0.018), and the QRS axis was different: –74.5° in Group A and 1° in Group S (P < 0.001). At 1 year, the 6-minute walk improved significantly in both groups: Group A 15% (P = 0.048) and Group S 24% (P = 0.001). Left ventricular ejection fraction (LVEF) increased from 0.57 to 0.61 (P = 0.008) in Group S, without significant change in Group A.ConclusionsAfter 1 year, pacemaker-dependent patients with septal ventricular leads have better clinical and functional (LVEF) outcome.

A 53-year-old male patient with history of repaired hernia, who is admitted for 5 days of progressive dyspnea with diagnosis of abdominal sepsis, a computed tomography angiography was made, revealing pulmonary embolism in bilateral main pulmonary artery, and cardiac thrombectomy was performed.

A 53-year-old male patient with history of repaired hernia, who is admitted for 5 days of progressive dyspnea with diagnosis of abdominal sepsis, a computed tomography angiography was made, revealing pulmonary embolism in bilateral main pulmonary artery, and cardiac thrombectomy was performed.

Introduction The incidence and prevalence of Heart Failure (HF) has been increasing throughout these years, with it, the need to implement HF clinics. In Latin America, it is rare to find non-cardiovascular centers with the capacity, human resources, and infrastructure to make this project sustainable, viable and useful for patients. Our center is a highly concentrated hospital in the country, with patients referred from different areas of Mexico. This makes it a unique site of multiple rare pathologies in the general population. Objectives To determine if there is a relationship between the implementation of a HF clinic and the decrease in mortality, the rate of rehospitalization of patients with HF over 6 months, as well as to implement and optimize the therapy of mainstay drugs for HF and the timely referral of the hospitalized or ambulatory patient, for follow-up, control, and education of HF. Methods A prospective descriptive study was designed with analytical intent. 80 patients with a diagnosis of HF were included. A comprehensive system was used to collect objective and subjective patient data through a database. The information was obtained from the review of medical records and by telephone follow-up of the patients. Each patient was evaluated at the first consultation with Brain Natriuretic Peptide (BNP) values, iron profile, troponin I, blood cytometry and complete blood chemistry. Follow-up appointments included BNP, nitrogen products and VExUS protocol for drug titration, study of reversible causes of HF, assessment of ejection fraction evolution, decision making regarding the indication of devices such as implantable defibrillator and resynchronizer, and scheduled appointments according to functional class and unscheduled appointments in case of alarm signs. Results Of the 80 total patients included in our registry during the first 6 months, we found the presence of Heart failure with reduced ejection fraction (HFrEF) in 66% of our patients, of whom 46% were reclassified as recovered Heart failure with recovered ejection fraction at the end of these first 6 months. In patients with HFrEF at least 94% receive a complete scheme of 4 drugs considered pillars in the treatment of this disease, (MRA, iSGLT2, ARNI/iECA or ARA-ll and β-blocker) 6% did not tolerate this quadruple therapy mainly due to episodes of hypotension. During our first 6 months, there were no deaths due to cardiovascular causes; however, mortality due to non-cardiovascular causes was 0.8%. Rehospitalizations due to HF decompensation was 3%. Intermittent administration of levosimendan was necessary in 2% of patients to improve conditions prior to major surgical events. Conclusion The implementation of a HF clinic decreases mortality due to cardiovascular causes, rehospitalizations due to HF decompensation, and increases adherence to optimal treatment, follow-up, and patient self-care. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): The National Institute of Medical Sciences and Nutrition Dr. Salvador Zubiran Secretary of Health of Mexico

Introduction Right atrial dilation has also been established as a marker of adverse outcomes in pulmonary hypertension (PH), while right atrial mechanics remain relatively understudied. Purpose Transthoracic echocardiography is a practical and widely used tool for risk stratification in PH. We hypothesized that right atrial (RA) strain components [RA reservoir function (ƐR), peak RA contraction (ƐCT) and RA conduit function (ƐCD)] correlates better with strong prognostic parameters as 3D right ventricle ejection fraction (3D RV EF), 6 minutes walking test, systolic pulmonary artery pressure (SPAP) and B-type natriuretic peptide (BNP). Methods 19 patients with diagnostic PH, type 2 patients were excluded. RA strain was analyzed and determined a correlation with right ventricle function and pulmonary variables. Results Morphology correlation was poor with all the variables as SPAP, 6 Minutes walking test, BNP, only RA/LA index has a good correlation with BNP (R = 0.76, P = 0.0004). Right atrial mechanics with strain has good correlation: ƐR correlates with BNP (R= -0.70, P = 0.001) and with SPAP (R= -0.68, P = 0.001). ƐCD correlates with BNP (R=-0.75;P = 0,0002) and with SPAP (R=-0.68, P = 0.001). ƐCT has no correlation with E/e, 3D RV EF, SPAP, pulmonary vascular resistance (PVR), 6 minutes walking test neither BNP. Right atrial deformation sum correlations with 3D RV EF (R= -0.70, P = 0.001), with SPAP (R= -0.72, P = 0.0005), with PVR (R= -0.68, P = 0.001) and with BNP (R=-0.71, P = 0.001). Conclusion Right atrium morphological characteristics have poor correlation with variables that evaluate right ventricle function and with variables that predicts outcomes, as BNP, in this patients population. Only RA/LA index as morphology parameter has good correlation with BNP level. Meanwhile right atrial mechanics analyzed by strain has strong correlation with other variables of severity at PH. Right atrial deformation sum has better correlation than other strain parameters in our study. Abstract P634 Figure. RIGHT ATRIAL DEFORMATION SUM CORRELATION