Funding Acknowledgements Type of funding sources: None. Background Transcatheter therapy of bioprothesis in tricuspid position and the native tricuspid valve are a growing field in interventional cardiology. Yet, the presence of pacing leads can demand a different approach. We performed a systemic review of this topic to understand the risks and the potential impact on the pacing leads. Objective Review the evidence regarding the efficacy and safety of pacing leads with the transcatheter tricuspid valve implantation. Methods A systemic research on MEDLINE and PUBMED with two the following terms "transvenous pacing", "transcatheter valve", "transcatheter tricuspid", "transvalvular leads", "tricuspid valve-in-valve" and "transvalvular pacemaker". 120 results were identified. However, just 5 papers were selected since are the only ones that described the implantation of a transcatheter tricuspid valve in patients with pacing leads and had some follow up, yet one of the papers lacks data and was excluded. The majority of papers reported the success of the procedure yet without a follow-up or the potentials complications on the pacing leads. Results Four studies were selected, including a total of 33 patients. The studies were performed with different techniques and procedures, as well as the reports regarding the echocardiogram and pacing data before the procedure and during the follow-up. Mean age 59.51 years old, 78.78% were female, 72.72% had NYHA class ≥ III, 21.21% was hospitalized in the previous 6 months, 21.21% had acute or chronic renal insufficiency, 18.18% had cirrhosis or liver disease, 51.52% had other prosthetic valves and 12.12 had history of endocarditis. Acquired etiology for tricuspid valve disease in 63.64%, atrial fibrillation in 60.60%, 78.79% had a tricuspid bioprosthetic valve, one patient had a catheter valve and the rest had a ring with or without homograft valve. 60.60% had moderate or severe tricuspid regurgitation and 15.15% had mixed tricuspid regurgitation and stenosis, with a mean tricuspid valve gradient of 7.22 mmHg. SAPIEN transcatheter valve was used in 78.79% and Melody valve in the rest. The transcatheter tricuspid implantation was a success in 32 patients, without any interference in the pacing leads. Of them, the follow-up period was diverse and heterogeneous with a mean of 13.51 months, a mean tricuspid valve gradient of 5.00 mmHg, and a register of 3 death without any relationship with the transcatheter valve or pacing complications. Was reported three complications during the follow-up regarding the pacing leads, two patients had a marked increase in the right ventricle leads impedance and stimulation threshold and one patient developed a right ventricle lead fracture. Conclusions 9.28% of the patients submitted to transcatheter tricuspid valve had pacing lead complications. Considering the small sample, further investigation regarding the impact of this procedure in the pacing leads is required for a clear assessment.

Funding Acknowledgements Type of funding sources: None. Background Endocardial left ventricular pacing is a technique used in cardiac resynchronization therapy (CRT), when a coronary sinus implant is not possible, conventional CRT was an unsuccess and in CRT nonresponders. We performed a systemic review to evaluate its risks and benefits. Objective Review the evidence regarding the efficacy and safety of endocardial left ventricular pacing. Methods A systemic research on MEDLINE and PUBMED with the term "endocardial left ventricular pacing", "biventricular pacing" or "endocardial left pacing". 1038 results were identified, however, just publish papers (excluding abstract) with more than 16 patients was admitted in these analyses. Comparisons pre and post CRT regard New York Heart Association (NYHA) functional classification, left ventricular ejection fraction (LVEF) and QRS width was performed. Mean differences (MD) and confidence interval (CI) was used as a measurement of treatment. Results Eleven studies were selected, including a total of 560 patients. The studies were performed with different techniques, trans-atrial septal technique, trans-ventricular septal technique and transapical technique. Mean age 66.93 years old, 90.54% male, median ejection fraction of 28.86%, NYHA class of 3.03, QRS width 167,50 mseg. Ischemic etiologic in 43.88%, atrial fibrillation in 45.35% and left bundle branch block in 55.20%. Was reported several complications after the procedure, 8 pocket infection (7 studies), 17 transient ischemic attacks (10 papers), 17 ischemic stroke (all), 35 tromboembolic events (all) and 115 deaths, nevertheless, follow up in the different studies was diverse and heterogeneous. Significant improvement was registered in NYHA class (MD 0.64, CI 0.56-0.72, p < 0.00001, I2 = 89%) (reported in 7 studies), LVEF (MD 6.20, CI 5.09-7.32, p = 0.002, I2 = 69%) %) (reported in 8 studies) and QRS width (MD 31.35, CI 26.11-36.60, p < 0.00001, I2 = 89%) %) (reported in 5 studies), (all p < 0.00001). Conclusions Left ventricular endocardial pacing is a feasible alternative to conventional CRT, when the last one is not possible. With clinical, electrocardiogram and echocardiogram improvement in several series. First data regarding this procedure were associated with higher stroke incidence, something contrary to the last study’s results. Nevertheless, at the moment just small series present this technique with heterogenous results and different approaches, being important further investigation.

75-year-old woman with past medical history of ischemic stroke in 2019, when complementary diagnostic tests were performed and it was found that the patient had a patent foramen ovale (PFO). Current hospitalization due to COVID-19 pneumonia, which was complicated by bacterial co-infection and intermediate-low risk right main pulmonary artery thromboembolism. The patient was successfully treated, with improvement of the clinical condition and evident imaging resolution of pulmonary cavitations and recanalization of the right pulmonary artery. However, something intriguing was observed: the patient presented dyspnea in the upright position and a decline in transcutaneous oxygen saturation from 96% in the supine position to 85% in orthostatism, with reversal of these findings with the recumbency. This led to the suspicion of platypnea-orthodeoxia syndrome. A transesophageal echocardiogram with bubble test was then performed, revealing an atrial shunt in the supine position without Valsalva maneuver. With these evidences, the diagnosis of platypnea-orthodeoxia syndrome was made. Even though the patient was >60 years, due to important right-to-left shunt, the history of stroke and the current platypnea-orthodeoxia, it was decided to close the PFO. The day after the procedure, the patient was placed in the upright position, maintaining an oxygen saturation of 96%. This case is an example that the decision of closing PFO must be individualized, not focusing only on patient's age, but also on his medical history and current situation, as indicated in the 2022 Guidelines for the Management of Patent Foramen Ovale. Figure 1Transesophageal echocardiogram showing interatrial communication.

Kontext: S akutními koronárními syndromy (AKS) a s fi brilací síní (FS) se lze v portugalské populaci setkat často. V některých případech může první epizoda FS proběhnout v rámci AKS. Zdá se přitom, že nově vzniklá FS (nFS) v přítomnosti AKS je spojena s nepříznivou prognózou. Cíle: Popsat různé charakteristiky pacientů s nFS při AKS a posoudit prediktory nFS. Metody: Multicentrická prospektivní studie používající údaje portugalského Národního registru akutních koronárních syndromů získané od 29 851 pacientů přijatých pro AKS v období od 1. října 2010 do 4. září 2019 a klasifi kovaných podle přítomnosti nebo nepřítomnosti nFS během hospitalizace. Pacienti s dřívějšími epizodami FS nebyli do studie zařazeni. Výsledky: K nFS došlo u 1 067 pacientů (4,1 %), většinou starších osob, s několika komorbiditami jiné než kardiovaskulární etiologie, se sníženou ejekční frakcí levé komory (EF LK) a s komplexnějším postižením koronárních tepen. U pacientů s nFS se častěji prováděla antiarytmická terapie, avšak pouze 21,5 % jich užívalo trojkombinaci antitrombotik a 30,3 % duální antitrombotickou léčbu. Tato skupina vykazovala i vysoký výskyt komplikací a úmrtí během hospitalizace. Podle vícečetné logistické regrese byly prediktory nFS v přítomnosti AKS věk nad 75 let, prodělaná cévní mozková příhoda, vysoká třída klasifi kace podle Killipa a Kimballa, hemoglobin < 12 g/dl a EF LK < 50 %. Při kontrolním vyšetření po jednom roce predikovalo skóre CHA 2 DS 2 -VASc nový vznik FS v rámci AKS (poměr šancí 2,07; p < 0,001), opětovný příjem do nemocnice z kardiovaskulárních příčin (p < 0,001) a opětovnou hospitalizaci z jakýchkoli příčin (p < 0,001). Závěr: Prognóza pacientů s nFS v přítomnosti AKS je nepříznivější než prognóza pacientů se sinusovým rytmem. Ukázalo se, že skóre CHA 2 DS 2 -VASc použité pro hodnocení rizika vzniku tromboembolie představuje středně spolehlivý prediktor nFS.

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Funding Acknowledgements Type of funding sources: None. OnBehalf on behalf of the Investigators of " Portuguese Registry of ACS " Introduction Regarding prognosis, acute coronary syndromes (ACS) are heterogeneous. Post-hospitalization (PH) risk stratification is crucial. The Get With The Guidelines Heart Failure score (GWTG-HFS) predicts in-hospital mortality (M) of patients (P) admitted with acute heart failure. Objective To validate GWTG-HFS as predictor of PH early and late M and readmission (RA) rates, in our center population, using real-life data. Methods Based on a single-center retrospective study, data collected from admissions between 1/01/20168 and 11/12/2019. Patients who survived the ACS and were discharged from the hospital were included. Concerning prognosis, we assessed 1-month M and RA (1mM and 1mRA), 6-month M and RA (6mM and 6mRA), 1-year M and RA (1yM and 1yRA). Statistical analysis used non-parametric tests, logistic regression and ROC curve analysis. Results 268 patients with ACS, mean age was 66.4 ± 12.5 years old and 59.7% were male. The diagnosis was unstable angina in 2.6%, non-ST elevation myocardial infarction (NSTEMI) in 66.4% and ST elevation myocardial infarction (STEMI) in 31%. 41.8% of the P were or had been smokers, 68.5% had hypertension, 34.5% were diabetic and 50.9% had dyslipidaemia. Concerning coronary artery disease, 250 were submitted to coronary angiography – 18.8% had no lesions or non-significant lesions (stenosis &lt;50%), 34.8% had one significant lesion, 23.2% had 2 significant lesions and 23.2% had 3 or more. Regarding left ventricle (LV) function, 70.5% of the P had no LV dysfunction, 15.7% had mild LV impairment (LVI), 9.3% moderate LVI and 4.5% had severe LVI. 1mM rate was 1.9% and 1yM rate was 7.8%. Age (p = 0.034), diabetes (p = 0.031), KKC (p &lt; 0.001), BUN (p = 0.003) and LV function (p &lt; 0.001) were predictors of 1mM. Age (p &lt; 0.001), HR (p = 0.009), KKC (p = 0.032), BUN (p &lt; 0.001), sodium (p &lt; 0.001), creatinine (p &lt; 0.001), Hb (p &lt; 0.001), LV function (p &lt; 0.001), de novo AF (p &lt; 0.001) and number of arteries with significant disease (p = 0.044) were predictors of 1yM. Logistic regression and ROC curve analysis showed that GWTG-HFS was able to predict 1mM (Odds ratio (OR) 1.18, p = 0.005, confidence interval (CI) 1.05-1.33; area under curve (AUC) 0.872) and 1yM (OR 1.16, p = 0.001, CI 1.09-1.24, AUC 0.838) with excellent accuracy, and 1mRA (OR 1.10, p = 0.006, CI 1.03-1.18, AUC 0.677) and 1yRA (OR 1.04, p = 0.024, CI 1.01-1.08, AUC 0.580) with poor accuracy. A sub-analysis regarding NSTEMI P showed that GWTG-HFS was able to predict 1mM (OR 1.20, p = 0.010, CI 1.05-1.39, AUC 0.902) and 1yM (OR 1.15, p &lt; 0.001, CI 1.07-1.23, AUC 0.817) with excellent accuracy. On the other hand, sub-analysis regarding STEMI showed that GWTG-HFS was not able to predict 1mM (p = 0.495) but was accurate at predicting 1yM (OR 1.18, p = 0.048, CI 1.00-1.39, AUC 0.881). Conclusion This study confirms that, in our population, GWTG-HFS is a valuable tool in PH risk score stratification in ACS, particularly NSTEMI.