Antonio Gianluca Robles

Background and Objectives: ICD implantation is associated with psychological distress, but longitudinal patterns of anxiety and depression remain incompletely characterized. To evaluate the prevalence and longitudinal evolution of anxiety and depressive symptoms in patients undergoing first-time ICD implantation. Materials and Methods: This prospective study included 96 patients undergoing first ICD implantation. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) at implantation (T0), one week post-discharge (T1), and six months later (T2). Data distribution was assessed using the Shapiro–Wilk test. Changes over time were analyzed using the Friedman test, Wilcoxon signed-rank tests, and Linear Mixed-Effects Models (LMM), with effect size (Kendall’s W) and Spearman correlations. A sensitivity analysis evaluated severe distress thresholds (HADS ≥ 11). Results: Significant longitudinal changes were observed for both anxiety (Friedman Q = 63.32, p < 0.001; Kendall’s W = 0.34) and depression (Q = 68.36, p < 0.001; W = 0.37). Mean HADS-A scores increased from 7.40 ± 2.70 at T0 to 9.22 ± 3.35 at T1 and 8.55 ± 2.78 at T2. Mean HADS-D scores increased from 6.53 ± 2.47 to 8.06 ± 3.02 and 8.24 ± 2.41, respectively. Clinically relevant anxiety (HADS-A ≥ 8) increased from 41.7% to 66.3% and 58.7%, while clinically relevant depression (HADS-D ≥ 8) increased from 27.1% to 54.3% and 56.5%. Sensitivity analyses for severe cases (HADS ≥ 11) confirmed consistent temporal trajectories (p < 0.001). Subgroup analyses (sex, indication, age) revealed no significant differences (p > 0.15), and no ICD shocks were delivered during follow-up. Anxiety and depression were strongly correlated at all time points (p < 0.001). Conclusions: Anxiety and depression symptoms are highly prevalent among ICD recipients and follow distinct temporal trajectories during the post-implantation course, with anxiety peaking early and depressive symptoms showing a more sustained increase in the absence of device therapies. Routine psychological screening and stage-specific psychosocial support strategies should be evaluated for integration into standard ICD care.

Background/Objectives: Patient-reported outcome after treatment is an important factor that positively correlates with the quality of care and can influence the patient’s future health choices. Both radiofrequency ablation (RFA) and cryoballoon ablation (CBA) are effective techniques for pulmonary vein isolation in patients with atrial fibrillation (AF) and have shown similar results in efficacy and safety, but they have not been thoroughly compared in terms of patient satisfaction. The aim of this study is to assess the satisfaction of paroxysmal AF patients who underwent RFA and CBA after their first procedure. Methods: Consecutive patients who underwent their first procedure of pulmonary vein isolation with RFA or CBA in eight international centres were included. A ten-point Likert scale was used for measuring patient-reported outcomes, evaluating anxiety before procedure, pain during and after ablation, motivation to repeat the procedure in future if necessary, and real and perceived procedural time. Results: A total of 483 patients were enrolled. Median age was 63 [56–69] years, and 281 (58.1%) patients were men. In total, 385 (79.7%) patients underwent RFA and 98 (20.3%) underwent CBA. RFA and CBA were equivalent in terms of the satisfaction of the patient, with the only exception being groin pain, which was lower in the CBA group (2 [0–3] vs. 3 [1–4], p = 0.002). Conscious sedation was used in 414 (86.7%) patients and general anaesthesia in 69 (14.3%) patients. The use of general anaesthesia reduced the perceived pain during and after the procedure in both techniques (p < 0.05), but it resulted in lower pre-procedural anxiety only in RFA patients compared to those under conscious sedation (4 [2–6] vs. 5 [3–7], p = 0.007). Anaesthetic management alone did not affect the willingness to repeat the procedure in RFA patients, while CBA patients under general anaesthesia were more motivated to repeat the procedure than those under conscious sedation (10 [8–10] vs. 7 [6–8], p < 0.001). The perceived procedure time was shorter than the actual time in all settings. Conclusions: Anaesthetic management seems to have a greater impact on patient-reported outcome than the technique used during ablation. Despite this, patients most motivated to repeat the procedure were those who underwent CBA under general anaesthesia.

Atrial fibrillation (AF) is the most common sustained supraventricular arrhythmia, affecting 2–3% of the adult population and contributing significantly to morbidity, mortality, and healthcare burden. Catheter ablation has become a cornerstone in the treatment of symptomatic, drug-refractory AF, with pulmonary vein isolation (PVI) established as the standard approach, especially in paroxysmal AF. Over the past three decades, ablation technologies have evolved considerably—from radiofrequency and cryoballoon to the recent advent of pulsed field ablation—enhancing procedural safety, efficiency, and lesion durability. Despite these technological advancements, long-term outcomes have plateaued, suggesting that success may depend not just solely on the energy source used, but also on a more individualized, mechanism-based approach. The classification of AF based on duration alone fails to capture the complexity of its underlying pathophysiology. Tailored strategies that consider arrhythmic mechanisms, electrophysiological triggers, and patient-specific substrates—especially in persistent AF—are increasingly recognized as essential for durable results. Tools such as high-density mapping, autonomic modulation, and substrate-targeted ablation are expanding therapeutic horizons. Moreover, special populations, such as athletes, present unique arrhythmic profiles influenced by structural and autonomic remodeling, requiring nuanced management. The integration of lifestyle interventions, neuromodulation techniques, and emerging genetic and pharmacological insights further supports a comprehensive, personalized approach. In this paper, we explore whether future success in AF ablation lies more in refining technology or in advancing our understanding of arrhythmic mechanisms to guide patient-specific therapy.

Background: Intermittent ventricular pre‐excitation has long been considered a low‐risk marker for sudden death. Accessory pathways (APs) with high‐risk intermittent antegrade conductive properties may exist, but this still represents a gray area in current guidelines. We evaluated differences in risk characteristics between symptomatic and asymptomatic patients with intermittent pre‐excitation (IPX) and those with persistent pre‐excitation (PPX) in a multicenter international registry. Methods: 392 consecutive patients [IPX: 79 (20.15%); PPX: 313 (79.85%)] underwent electrophysiological (EP) study. Data on arrhythmia inducibility (AVRT/AF), AP antegrade conduction properties (ERP/SPERRI), site, and number were collected. Results: No significant differences were found in demographic characteristics and EP features between PPX and IPX patients, including antegrade conductive properties, prevalence of multiple APs, and AP locations, except for AVRT inducibility which was more frequent in IPX group. Similarly, no differences were detected between symptomatic and asymptomatic IPX patients. Conclusions: Except for AVRT inducibility, our study shows no significant differences in demographic and other electrophysiological features between PPX and IPX patients. Likewise, no differences in demographic and EP features were detected between symptomatic and asymptomatic IPX patients. Therefore, intermittent pre‐excitation is an unreliable noninvasive marker of arrhythmic risk and it warrants an invasive risk assessment via EP study.

Introduction: Inappropriate sinus tachycardia (IST) is a syndrome characterized by unexpectedly fast and prolonged sinus rates at rest or with minimal physical activity. Epidemiologic characteristics are uncertain, but most patients are young and female. When IST occurs in athletes, its management (controlling symptoms and reducing heart rate) can present additional challenges. We designed an observational pilot study to investigate whether a food supplement can be useful in the treatment of IST when standard therapy is refused. Methods: We enrolled 50 consecutive recreational athletes affected by frequent recurrences of IST. Twelve-lead ECG and Holter ECG parameters were recorded at enrollment (T0) and after a 6-month treatment (T1) with the food supplement. Symptoms and quality of life were also evaluated through specific questionnaires. The study population was compared to a historical control group of 25 patients receiving ivabradine as treatment for the same clinical condition. Results: The resting ECG heart rate was 88.7 ± 12.4 bpm (T0) and 73.6 ± 6.6 bpm (T1) (p < 0.00001); Holter average heart rate was 88.4 ± 3.3 bpm and 74.9 ± 4.8 bpm (p < 0.0001). Holter ECG maximum heart rate was 147.1 ± 16.7 bpm and 139.2 ± 16.8 bpm (p = 0.06); Holter minimum heart rate was 49.9 ± 6.5 bpm and 50.5 ± 6.9 bpm (p = 0.33). Finally, the number of sustained episodes decreased from 3.3 ± 1.7 to 0.8 ± 0.8 (p < 0.00001). The following variations in ASTA scores were observed: ASTA symptom scale (range: 0–27) decreased from 14.9 ± 2.1 to 5.8 ± 1.4 (p < 0.00001), while ASTA HR QoL (range: 0–39) decreased from 24.1 ± 2.1 to 10.8 ± 2.3 (p < 0.00001). Conclusions: The findings of our pilot study suggest that this food supplement could play a beneficial role in managing symptoms and improving quality of life in recreational athletes affected by IST who refuse standard medical therapy. These clinical effects appear to correlate with significant improvements in resting ECG parameters and some Holter ECG parameters.

Introduction The allostatic load (AL) is a framework for conceptualising the physiological multisystemic impact of prolonged exposure to stress and its related side effects on mental health. Stress due to AL can influence the development and outcomes of cardiovascular diseases. AL increases the risk of coronary and peripherical artery diseases. AL emerges from the detection of emotional dimensions related to the disease, low psychosocial functioning and high rates of psychopathological signs in patients with hypertension or coronary heart disease. Method and analysis The primary endpoint of the PLAY-UP protocol is the implementation of a multidimensional model underlying the clinical treatment of patients with cardiovascular disease through the integration of medical and psychological clinical variables. PLAY-UP is a cohort study that will last for 24 months. 200 participants will be recruited and divided into three groups: early disease, midterm disease and long disease. All patients will undergo a clinical evaluation based on the detection of biological, medical and psychological indicators and variables. The evaluation battery will comprise three types of measurements: medical, psychological and pharmacological treatments. Clinical and psychological measurements will be processed in an integrated manner through the combination of all variables examined, elaborating the Allostatic Load Index from a longitudinal time perspective. The Allostatic Load Index will be calculated by measuring the z-score. Ethics and dissemination Ethical Committee Approval was obtained from CEtRA Abruzzo Region (IT) (ID 0461499/23). The results of the present project will be published in peer-reviewed journals, disseminated electronically and in print, and presented as abstracts and/or personal communications during national and international conferences.

Background: Convergent epicardial and endocardial catheter ablation had been used for the treatment of persistent atrial fibrillation (PeAF). Aims: The aims of this retrospective study are to describe the pattern of arrhythmias and substrate findings in patients previously submitted to convergent ablation and showing arrhythmic recurrences (AF/AT/AFL lasting at least 30 seconds) and documented with ILR during follow up. Methods: From a cohort of 119 patient who underwent convergent ablation, we selected the 55 with arrhythmic recurrences and showing AT/AF/AFL stored in ILR memories to submit them to remap procedure. Results: We excluded 1 patient who was submitted to ablate and pace without remapping and 1 patient whose data has been lost. Among 53 patients, 69.7% experienced AF (33.9% PAF and 35.8% PeAF), 5.6% typical AFL and 30.2% AT/atypical AFL. As for the substrates found, at detailed high-density mapping we had: 66.9% with veins reconnection (regardless the gaps localization), 37.7% with low-voltage area/abnormal signals on the posterior wall, 11.3% deserving CTI ablation for typical AFL and 28.3% with different LA substrates (septal, anterior, LAA, mitral annulus and 9.4% with gaps at superior surgical line). Notably, overlaps of arrhythmic patterns and substrate were also found in the same patients. Conclusion: In our study a total of 79.1% patients had substrates related to previous convergent ablation due to gaps at pulmonary veins or superior line. The rest had an arrhythmic substrate in areas not previously ablated like posterior wall or CTI. These findings suggest that a large amount of patients submitted to convergent ablation (up to 80%) may have an arrhythmic substrate and thus potentially recurrences due to previous epi-endocardial ablation.