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The progressive aging of the population and the consequent growth of individuals with neurological diseases and related chronic disabilities, will lead to a general increase in the costs and resources needed to ensure treatment and care services. In this scenario, telemedicine and e-health solutions, including remote monitoring and rehabilitation, are attracting increasing interest as tools to ensure the sustainability of the healthcare system or, at least, to support the burden for health care facilities. Technological advances in recent decades have fostered the development of dedicated and innovative Information and Communication Technology (ICT) based solutions, with the aim of complementing traditional care and treatment services through telemedicine applications that support new patient and disease management strategies. This is the background for the REHOME project, whose technological solution, presented in this paper, integrates innovative methodologies and devices for remote monitoring and rehabilitation of cognitive, motor, and sleep disorders associated with neurological diseases. One of the primary goals of the project is to meet the needs of patients and clinicians, by ensuring continuity of treatment from healthcare facilities to the patient’s home. To this end, it is important to ensure the usability of the solution by elderly and pathological individuals. Preliminary results of usability and user experience questionnaires on 70 subjects recruited in three experimental trials are presented here.

Social gamification systems have shown potential for promoting healthy lifestyles, but applying them to occupational settings faces unique design challenges. While occupational settings offer natural communities for social interaction, fairness issues due to heterogeneous personal goals and privacy concerns increase the difficulty of designing engaging games. We explored a two-level game-design, where the first level related to achieving personal goals and the second level was a privacy-protected social competition to maximize goal compliance among colleagues. The solution was strengthened by employing occupational physicians who personalized users’ goals and coached them remotely. The design was evaluated in a 5-month study with 53 employees from a Dutch university. Results suggested that the application helped half of the participants to improve their lifestyles, and most appreciated the role of the physician in goal-setting. However, long-term user engagement was undermined by the scalability-motivated design choice of one-way communication between employees and their physician. Implications for social gamification design in occupational health are discussed.

Purpose Catheter-tissue contact is critical for effective lesion creation in radiofrequency catheter ablation (RFCA). In a multicenter prospective study, we assessed the relationship between catheter contact force (CF) during RFCA for paroxysmal atrial fibrillation (AF) and clinical recurrences over a mid-term follow-up. Methods All patients underwent RFCA for paroxysmal AF by antral pulmonary vein (PV) isolation, aiming at entry and exit conduction block in all PVs. A new open-irrigated tip catheter with CF sensing (SmartTouch TM , Biosense Webster Inc. CA) was used. All patients were followed for at least 12 months and the relationship between CF and clinical outcomes assessed. Results One year follow-up was available in 92/95 of the patients enrolled. Acute PV isolation was achieved in 100 % of the veins. Mean CF during RFCA was 12.2 ± 3.9 g. Mean force-time integral (FTI) was 733 ± 505 gs. Following the 3-month blanking period, 17 (18 %) patients experienced at least 1 atrial tachyarrhythmia relapse. There was no statistical difference in mean CF (13 ± 3.4 g vs 12 ± 4 g, p  = 0.32) and mean FTI (713 ± 487 gs vs 822 ± 590 gs, p  = 0.42) between patients with and without arrhythmia recurrences. Recurrences were recorded in 22 % of patients achieving a mean FTI value below the median of 544 gs and in 15 % of patients with a mean FTI value above the median ( p  = 0.64). Conclusions RFCA with CF data during PV isolation for paroxysmal AF improves physician’s knowledge on catheter-tissue contact. In the present dataset, however, higher CF values did not impact mid-term clinical RFCA outcome.

To test the role of necrosis, ischemia or both in bone marrow cells (BMC) mobilization in patients with cardiovascular disease. We studied three groups of patients: group 1, Iatrogenic Necrosis, with pure necrosis (28 patients undergoing transcatheter radiofrequency ablation); group 2, Ischemic Necrosis (30 patients with myocardial infarction); group 3, Pure Ischemia (24 patients with unstable angina). As control groups, we studied 27 patients with stable coronary artery disease (CAD), and 20 patients without CAD undergoing angiography for valvular diseases or cardiomiopathy. CD34 + cells and cytokines were evaluated at: T 0 (baseline), 48 h and 5, 7, 10, 14 days thereafter. We observed a significant increase of CD34 + cells at T 3 and T 4 only in Iatrogenic Necrosis and Ischemic Necrosis group. The peak of mobilization was observed ten days after the necrotic event (2.8 ± 1.4 vs. 5.9 ± 1.9 in the group 1, P  = 0.03; and 3 ± 1.5 vs. 5.6 ± 2 in the group 2, P  = 0.04; respectively). We found a good correlation between CD34 + and vascular endothelial growth factor (VEGF) and stromal derived factor (SDF-1α) peak values ( r  = 0.77 and r  = 0.63, respectively). At multivariable analysis, myocardial necrosis (OR 3.5, 95%CI 2.2–4.2, P  < 0.01), VEGF (OR 2, 95%CI 1.1–3, P  = 0.01 as above versus below median value), and SDF-1α (OR 1.6, 95%CI 1.1–2.5, P  = 0.02 as above versus below median value) emerged as independent predictors of C34 + cells increase. Myocardial necrosis with simultaneous elevation of VEGF and SDF-1α causes a significant CD34 + cells mobilization in patients with cardiovascular disease.

Introduction Pulmonary veins isolation usually requires a multielectrode catheter for mapping in addition to the ablation catheter. We describe our experience with a new multipolar catheter designed for simultaneous mapping and ablation (MESH, Bard). Methods and results We tested the catheter in 15 patients (mean age 61.1 ± 7.9; eight men) scheduled for paroxysmal atrial fibrillation ablation. The catheter was positioned in front of the pulmonary vein ostia. A pulmonary vein potential was demonstrated in 63.5% of the veins, which were disconnected with a mean of 1.6 radiofrequency applications with a mean time of 351 ± 125.8 s (range 180–650) for each vein. Mean procedural time was 93 ± 17.1 min (range 65–120), and fluoroscopy time was 13.7 ± 4.0 (range 5–15) min. No complications occurred during and after or procedures. Conclusion Pulmonary veins disconnection with MESH ablator catheter is feasible with short procedural and X-ray exposure time. Further studies are needed to compare this new device to standard multipolar mapping catheters in order to evaluate its ability to correctly identify pulmonary vein potentials and to compare its safety and efficacy.

Radiofrequency ablation of fast and unstable left ventricular tachycardia (VT) usually requires non-contact mapping. The procedure is usually performed by a retrograde-transaortic route, requiring a double femoral artery puncture, for the 9F multielectrode catheter and the 7F ablation catheter which are advanced through the aorta and aortic valve into the left ventricle (LV). Reported limitations of the procedure are due to the stiffness of the balloon catheter, particularly in patients with tortuous peripheral arteries, atherosclerotic aorta, or with aortic stenosis. The aim of our study was to test the feasibility and assess the safety of a transseptal approach for left VT non-contact mapping and ablation. Ten patients with multiple cardiac defibrillator shocks because of fast and unstable VT were selected for non-contact mapping and ablation. After a double transseptal puncture the multielectrode catheter (Ensite Array, St. Jude Medical) was advanced through a standard 10F introducer to a stable position in the LV apex over a 260 cm length 0.035 J-tip guidewire. The ablation catheter (Celsius Thermo-cool, Biosense Webster) was then inserted through the second 8F introducer. Twenty-five monomorphic sustained ventricular tachycardia were induced and ablated at the level of the diastolic pathway or exit point revealed by unipolar isopotential mapping. The total procedural and fluoroscopy times were 209 +/- 32 min and 28.5 +/- 9.27 min, respectively, which were comparable to those described with the traditional retrograde-transaortic approach. No major complication related with the transseptal approach were reported. A transseptal approach can be a feasible and effective alternative approach for mapping and ablation of fast and unstable left VT with a non-contact mapping system.

Cardiac resynchronization therapy (CRT) is currently used for treatment of refractory heart failure and is effective in reducing symptoms and increasing quality of life and exercise tolerance. Data from the literature also show that CRT may prolong event-free survival and reduce heart failure mortality. This therapy is also highly cost-effective as compared to optimized medical treatment. The reduction of the risk of death occurs in both nonischemic and ischemic heart failure, although in this latter group CRT benefit seems to be less. It is still controversial whether a back-up defibrillator should be implanted to all patients undergoing CRT. Finally, left ventricular reverse remodeling occurring after 3 to 6 months of treatment predicts long-term benefit of CRT on mortality.

La terapia di resincronizzazione cardiaca (TRC) è attualmente utilizzata per il trattamento dello scompenso cardiaco refrattario ed è efficace nel migliorare i sintomi, la qualità della vita e la tolleranza all’esercizio. I dati della letteratura mostrano anche che la TRC prolunga la sopravvivenza libera da eventi e riduce la mortalità per scompenso cardiaco; inoltre, questa terapia è altamente costo-efficace in confronto alla sola terapia medica ottimizzata. La riduzione del rischio di morte si verifica nei pazienti con scompenso di eziologia ischemica e non ischemica, anche se nel gruppo dei pazienti ischemici il beneficio della TRC sembra minore. È ancora controverso se a tutti i pazienti sottoposti a TRC debba essere impiantato anche un defibrillatore automatico. Infine, l’inversione del rimodellamento ventricolare sinistro che si verifica dopo 3-6 mesi di TRC nei pazienti che rispondono a tale terapia predice il beneficio a lungo termine della TRC sulla mortalità.