In the last 20 years, atrial fibrillation (AF) has become one of the most important public health problems and a significant cause of increasing health care costs in western countries. The prevalence of AF is increasing due to our greater ability to treat chronic cardiac and noncardiac diseases, and the improved ability to suspect and diagnose AF. At the present time, the prevalence of AF (2%) is double that reported in the last decade. The prevalence of AF varies with age and sex. AF is present in 0.12%–0.16% of those younger than 49 years, in 3.7%–4.2% of those aged 60–70 years, and in 10%–17% of those aged 80 years or older. In addition, it occurs more frequently in males, with a male to female ratio of 1.2:1. The incidence of AF ranges between 0.21 and 0.41 per 1,000 person/years. Permanent AF occurs in approximately 50% of patients, and paroxysmal and persistent AF in 25% each. AF is frequently associated with cardiac disease and comorbidities. The most common concomitant diseases are coronary artery disease, valvular heart disease, and cardiomyopathy. The most common comorbidities are hypertension, diabetes, heart failure, chronic obstructive pulmonary disease, renal failure, stroke, and cognitive disturbance. Paroxysmal AF occurs in younger patients and with a reduced burden of both cardiac disease and comorbidities. Generally, the history of AF is long, burdened by frequent recurrences, and associated with symptoms (in two thirds of patients). Patients with AF have a five-fold and two-fold higher risk of stroke and death, respectively. We estimate that the number of patients with AF in 2030 in Europe will be 14–17 million and the number of new cases of AF per year at 120,000–215,000. Given that AF is associated with significant morbidity and mortality, this increasing number of individuals with AF will have major public health implications.

Background Patients (pts) with heart failure and reduced ejection fraction (HFrEF) treated with resynchronization therapy (with or without defibrillator: CRT–D or CRT–P) require echocardiographic or device algorithms optimization for better clinical results. With remote control is further possible improve follow–up of these pts. Methods From 01/01/2019 42 pts treated with CRT (33 men and 9 women 30 CRT–D and 12 CRT–P) were split in 3 groups: 14 pts underwent optimization and remote control, 14 underwent optimization without remote control, 14 underwent remote control only with implant parameters. Results In the first group ejection fraction (EF) improved from 28 to 43% (p 0.0001)(median age 78.2 years) (y), 3 pts died (2 m and 1 w, for heart failure, neoplastic cause and pneumonia). In the second group (median age 83.3 y) EF improved from 29 to 45% (p 0.0001) 4 pts died (3 m, 1 w, all CRT–D 3 for heart failure and 1 for unknown causes). In the third group (median age 79.2 y) EF improved from 32 to 40% (p 0.012), 2 pts died (1 m and 1 w with heart failure). There weren’t relevant differences for device interventionts in the 3 groups (1 appropriate shock and 1 inappropriate shock for atrial fibrillation in the 1st group, 1 appropriate shock in the 2nd group, 1 appropriate shock in the 3rd group). In the groups with remote control a severe malfunction that needed immediate replacement of CRT and optimal elective replacement timing for 3 device were found. Conclusions Biventricular stimolation optimization with echocardiography and with device algorythm should be always utilized after CRT implant. In our work, although the number of pts is little, a better EF is obtained in the groups with optimization compared to the group only in remote control. In the COVID19 era early recognition of arrhytmias and malfunctions of device and of suboptimal biventricular stimolation is possible with remote control and could improve pts clinical conditions, hospitalization and survival. Further data need to evaluate if remote control can improve prognosis of pts with CRT–D and CRT–P.