512 Long-term survival in patients with post-operative atrial fibrillation after cardiac surgery: analysis from a prospective-cohort study Jacopo Marazzato 1 , Roberto De Ponti 1 , Paolo Verdecchia 2 , Federico Blasi 1 , Michele Golino 1 , Sandro Ferrarese 1 , and Fabio Angeli 1,3 1 Department of Medicine and Surgery, University of Insubria,Varese, Italy, 2 Fondazione Umbra Cuore e Ipertensione—ONLUS and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy, and 3 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS, Tradate, Italy Aims: Post-operative atrial fibrillation (POP AF) is frequent in patients who undergo cardiac surgery. However, its prognostic impact in the long-term remains unclear. Methods and results: We followed for an average of 10 6 3 years 1386 patients who underwent a variety of cardiac surgical procedures (cardiac transplantation and sur- gery for heart failure included) while they were in sinus rhythm. Among 1178 patents without a history of AF, 726 (62%) did not develop AF during the entire duration of the study and 452 (38%) developed new-onset POP AF during the first 30 peri- operative days after heart surgery. Other 125 patients with a positive history of par- oxysmal or persistent AF were in sinus rhythm at the time of surgery and 87 of them (70%) developed POPAF. Finally, 83 patients had permanent AF when they underwent surgery. All-cause mortality was the primary outcome of the study. We tested the associations of potential determinants with all-cause mortality using univariable and multivariable statistical analyses by means of Cox proportional hazard models. Overall, 473 patients (34%) died during a long-term follow-up. Compared with patients who never developed AF, neither the patients with new-onset POP AF [ad- justed HR ¼ 1.31 (95% CI: 0.90–1.89); P ¼ 0.1609], nor those with history of AF at the time of surgery (adjusted HR ¼ 1.33, 95% CI: 0.71–2.49; P ¼ 0.3736) showed a signifi- cantly increased risk of mortality (Figure 1). In new-onset POP AF patients, oral anticoagulation was not associated with mortality [adjusted HR ¼ 1.13 (95% CI: 0.83– 1.54), P ¼ 0.4299]. Conclusions: In this huge prospective cohort of patients who underwent different types of heart surgery, POPAF was not associated with an increased risk of mortality. In this setting, the role of long-term anticoagulation remains unclear. 204 Permanent his bundle pacing using stylet-driven lead in patients with right atriomegaly: a single-centre experience Leonardo Marinaccio 1 , Francesco Vetta 2 , Eros Rocchetto 3 , Paola Napoli 3 , and Domenico Marchese 1 1 Aulss 6 Euganea, Italy, 2 Saint Camillus International University, Italy, and 3 Biotronik Italia, Italy Aims: His bundle pacing (HBP) is becoming an increasing widespread approach for physiological pacing. However, successful HBP procedure could be hampered by lim- ited implantation tools especially in challenging anatomies. We aimed to report our experience with HBP technique using a novel stylet-driven lead system in patients with right atriomegaly. Methods and results: Consecutive patients with right atrium (RA) volume >25 ml/m 2 in men and >21 ml/m 2 in women who underwent permanent HBP for standard indica- tions were enrolled from March 2020 to March 2021. The tool of first choice for HBP attempt was a stylet-driven lead (Solia S 60, Biotronik) delivered via a dedicated in- troducer sheath (Selectra 3D, Biotronik). The acute, 1-month and 6-month procedural success rates were assessed. We enrolled 24 patients [median age: 75 (70–79) years, 85% men] with an average RA volume of 50.7 6 7.8 ml/m 2 . At implant, conduction system pacing using stylet-driven lead was achieved in 21 patients (87%): 12 (50%) selective HBP, 6 (25%) non-selective HBP, and 3 (12.5%) left bundle branch area pacing. In the three failures, HBP was further attempted with a lumen-less lead with fixed helix (SelectSecure 3830, Medtronic) with final procedural success in two cases. In the successful cases, there was a significant reduction of QRS duration be- tween paced and spontaneous beats [152.5 (130–167.5) ms vs. 130 (122.5–137.5) ms, P ¼ 0.003]. No lead dislodgment nor significant pacing threshold increase was ob- served at 1-month (1.30 6 0.76 V@0.4 vs. 1.32 6 0.80 V@0.4 ms, P > 0.9) and 6- month follow-up (1.30 6 0.76 V@0.4 vs. 1.38 6 0.97 V@0.4 ms, P ¼ 0.66). Conclusions: In patients with right atriomegaly, the novel stylet-driven lead system showed high implant success rates with stable pacing thresholds. 655 The valuable interaction among cardiac surgeon and electrophysiologist for transvenous rotational mechanical lead extraction Federico Migliore, Vincenzo Tarzia, Pietro Bernardo Dall’Aglio, Pasquale Valerio Falzone, Sabino Iliceto, and Gino Gerosa Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy Aims: Recent studies have shown that evolution RL bidirectional rotational mechani- cal sheath (Cook Medical, USA) is an effective and safe technique for transvenous lead extraction (TLE). We reported our experience with the bidirectional rotational mechanical tools using a multidisciplinary approach highlighting the value of a joint cardiac surgeon and electrophysiologist collaboration. Methods and results: The study population comprised 84 patients (77% male; mean age 65 6 18 years) undergoing TLE. After multidisciplinary evaluation, a combined procedure was considered. The main indication for TLE was infection in 54 cases (64%).Overall, 152 leads were extracted with a mean implant duration of 94 6 63 months (range: 6–421). Complete procedural success rate, clinical success rate, and lead removal with clinical success rate were 91.6% (77/84), 97.6% (82/84), and 98.6% (150/152), respectively. Eighteen combined procedures were performed in 12 patients (14%), such as ‘hybrid approach’ (n ¼ 2) or TLE concomitant to: (i) trans- catheter aspiration procedure for large vegetation (n ¼ 8); (ii) left ventricular assistance device implantation as bridge to cardiac transplantation (n ¼ 1); (iii) per- manent pacing with epicardial leads (n ¼ 6); and (iv) tricuspid valve replacement (n ¼ 1).One major complication (1.2%) and 11 (13%) minor complications were en- countered. No injury to the superior vena cava occurred and no procedure-related deaths were reported. During a mean time follow-up of 21 6 18 months, 17 patients (20%) died. They were more often diabetics (P ¼ 0.02), and they underwent TLE more often for infection (P ¼ 0.004). Conclusions: Our results support the finding that excellent outcomes can be achieved in performing TLE of chronically implanted leads by using the evolution RL bidirectional rotational mechanical sheath and a multidisciplinary team approach in- volving both electrophysiologist and cardiac surgeon as first line operators. 460 Assessment of long-term arrhytmic sequelae in patients recovering from COVID-19 infection Antonio Curnis 1 , Gianmarco Arabia 1 , Francesca Salghetti 1 , Manuel Cerini 1 , Antonino Milidoni 1 , Emiliano Calvi 1 , Daniele Beretta 1 , Stefano Bisegna 1 , Ashraf Ahmed 2 , Gianfranco Mitacchione 2 , and Luca Bontempi 4 1 Cardiology, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy, 2 Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt, 3 Department of Cardiology, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy, and 4 Department of Cardiology, ASSTBergamo EST, Bolognini Hospital, Seriate, Bergamo, Italy Aims: COVID-19 has been associated with acute cardiac complications including car- diac arrhythmias. We aimed to assess the prevalence of long-term cardiac arrhythmias in patients recovering from severe COVID-19 infection with proved or suspected of cardiac involvement. Methods and results: All patients with COVID-19 infection discharged from the cardi- ology department of our institution from the 1 March to the 30 April 2020 were considered eligible for this study. Patients were fitted out with an adhesive patch and a wireless single-lead 24-h electrocardiogram (ECG) Holter monitor (Rooti Rx V R System, Rooti Labs Ltd, Taipei, Taiwan). RootiRx V R is a small device consisting of an integrated sensor system, a microelectronic board with memory storage, and an in- ternal rechargeable battery. This system can provide continuous ECG and was set to monitor heart rhythm for 24 h. The Holter system provides also blood pressure meas- urements and sleep apnea data which are evaluated through chest wall motion/ cyclic variation of heart rate and reported along with the sleep efficiency (percent- age of time spent asleep while in bed). Arrhythmic findings, sleep apnea detections, and residual COVID-19 symptoms were reported. The study follow-up was performed 174 (range ¼ 166–190) days after hospital discharge in a cohort of 63 (76% males, 655 Figure Combined procedure consisting of transvenous lead extraction of a CRT-D device using the bidirectional rotational mechanical sheath, transcatheter aspi- ration using an extracorporeal circuit for large vegetations attached to the ICD lead and implantation of a permanent left ventricular epicardial pacing lead for absence of spontaneous rhythm and severe systolic dysfunction. Collaboration between electro- physiologists and cardiac surgeon during the procedure (A).Transesophageal echocar- diography view during the procedure, showing a large vegetation adhering to the ICD lead course in the right atrium (B). Fluoroscopy view during the procedure (C). CRT-D, cardiac resynchronization therapy-defibrillator and ICD, implantable cardioverter defibrillator. Abstracts G9 Downloaded from https://academic.oup.com/eurheartjsupp/article/23/Supplement_G/suab127.018/6456846 by guest on 12 June 2022