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Introduction: Limited data exist on pulsed‐field ablation (PFA) in patients with persistent atrial fibrillation (PeAF) undergoing left atrial posterior wall isolation (LAPWI). Methods: The Advanced TecHnologies For SuccEssful AblatioN of AF in Clinical Practice (ATHENA) prospective registry included consecutive patients referred for PeAF catheter ablation at 9 Italian centers, treated with the FARAPULSETM‐PFA system. The primary efficacy and safety study endpoints were the acute LAPWI rate, freedom from arrhythmic recurrences and the incidence of major periprocedural complications. Patients undergoing pulmonary vein isolation (PVI) alone, PWI + LAPWI and redo procedures were compared. Results: Among 249 patients, 21.7% had long‐standing PeAF, 79.5% were male; mean age was 63 ± 9 years. LAPWI was performed in 57.6% of cases, with 15.3% being redo procedures. Median skin‐to‐skin times (PVI‐only 68 [60−90] vs. PVI + LAPWI 70 [59−88] mins) did not differ between groups. 45.8% LAPWI cases were approached with a 3D‐mapping system, and 37.3% with intracardiac echocardiography. LAPWI was achieved in all patients by means of PFA alone, in 88.8% cases at first pass. LAPWI was validated either by an Ultrahigh‐density mapping system or by recording electrical activity + pacing maneuvers. No major complications occurred, while 2.4% minor complications were detected. During a median follow‐up of 273 [191–379] days, 41 patients (16.5%) experienced an arrhythmic recurrence after the 90‐day blanking period, with a mean time to recurrence of 223 ± 100 days and no differences among ablation strategies. Conclusion: LAPWI with PFA demonstrates feasibility, rapidity, and safety in real‐world practice, offering a viable alternative for PeAF patients. LAPWI is achievable even with a fluoroscopy‐only method and does not significantly extend overall procedural times. [ABSTRACT FROM AUTHOR]

Background: The effects of lockdown on non‐COVID patients are varied and unexpected. The aim is to evaluate the burden of cardiac arrhythmias during a lockdown period because of COVID‐19 pandemics in a population implanted with cardiac defibrillators and followed by remote monitoring. Methods: In this retrospective, multicentre cohort study, we included 574 remotely monitored implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy‐defibrillator (CRT‐D) recipients implanted before January 1, 2019, at seven hospitals in the Campania region, comparing the burden of arrhythmias occurred during the lockdown period because of COVID‐19 epidemics (from March 9 to May 1, 2020) with the arrhythmias burden of the corresponding period in 2019 (reference period). Data collection was performed through remote monitoring. Results: During the lockdown period, we observed ventricular tachyarrhythmias (ventricular tachycardia or fibrillation) in 25 (4.8%) patients while in seasonal reference period we documented ventricular tachyarrhythmias in 12 (2.3%) patients; the comparison between the periods is statistically significant (P <.04). Atrial arrhythmias were detected in 38 (8.2%) subjects during the lockdown period and in 24 (5.2%) during the reference period (P <.004). Conclusion: In seven hospitals in the Campania region, during the pandemic lockdown period, we observed a higher burden of arrhythmic events in ICD/CRT‐D patients through device remote monitoring. [ABSTRACT FROM AUTHOR]

Background: In Italy, a nationwide full lockdown was declared between March and May 2020 to hinder the novel coronavirus disease 2019 (COVID‐19) pandemic. The potential individual health effects of long‐term isolation are largely unknown. The current study investigated the arrhythmic consequences of the COVID‐19 lockdown in patients with defibrillators (ICDs) living in the province of Ferrara, Italy. Methods: Both the arrhythmias and the delivered ICD therapies as notified by the devices were prospectively collected during the lockdown period (P1) and compared to those occurred during the 10 weeks before the lockdown began (P2) and during the same period in 2019 (P3). Changes in outcome over the three study periods were evaluated for significance using McNemar's test. Results: A total of 413 patients were included in the analysis. No differences were found concerning either arrhythmias or shocks or anti‐tachycardia pacing. Only the number of patients experiencing non‐sustained ventricular tachycardias (NSVTs) during P1 significantly decreased as compared to P2 (p = 0.026) and P3 (p = 0.009). The subgroup analysis showed a significant decrease in NSVTs during P1 for men (vs. P2, p = 0.014; vs. P3, p = 0.040) and younger patients (vs. P2, p = 0.002; vs. P3, p = 0.040) and for ischemic etiology (vs. P2, p = 0.003). No arrhythmic deaths occurred during P1. Conclusions: The complete nationwide lockdown, as declared by the Italian government during the first COVID‐19 pandemic peak, did not impact on the incidence of arrhythmias in an urban cohort of patients with ICDs. [ABSTRACT FROM AUTHOR]