Because of demographic aging, the prevalence of arterial hypertension (HTN) and cardiac arrhythmias, namely atrial fibrillation (AF), is progressively increasing. Not only are these clinical entities strongly connected, but, acting with a synergistic effect, their association may cause a worse clinical outcome in patients already at risk of ischemic and/or haemorrhagic stroke and, consequently, disability and death. Despite the well-known association between HTN and AF, several pathogenetic mechanisms underlying the higher risk of AF in hypertensive patients are still incompletely known. Although several trials reported the overall clinical benefit of renin–angiotensin–aldosterone inhibitors in reducing incident AF in HTN, the role of this class of drugs is greatly reduced when AF diagnosis is already established, thus hinting at the urgent need for primary prevention measures to reduce AF occurrence in these patients. Through a thorough review of the available literature in the field, we investigated the basic mechanisms through which HTN is believed to promote AF, summarising the evidence supporting a pathophysiology-driven approach to prevent this arrhythmia in hypertensive patients, including those suffering from primary aldosteronism, a non-negligible and under-recognised cause of secondary HTN. Finally, in the hazy scenario of AF screening in hypertensive patients, we reviewed which patients should be screened, by which modality, and who should be offered oral anticoagulation for stroke prevention.

Over the last few years, COVID-19 has attracted medical attention both in terms of healthcare system reorganization and research. Among the different cardiovascular complications of the SARS-CoV-2 infection, cardiac arrhythmias represent an important clinical manifestation requiring proper therapy both in the acute and post-acute phase. The multiparametric in-hospital monitoring of COVID-19 patients frequently detects new-onset or recurrent cardiac arrhythmias. As many patients are monitored remotely from cardiology departments, this setting calls for proper arrhythmia interpretation and management, especially in critically ill patients in the intensive care unit. From this perspective, the possible pathophysiologic mechanisms and the main clinical manifestations of brady- and tachyarrhythmias in COVID-19 patients are briefly presented. The progressively increasing body of evidence on pathophysiology helps to identify the reversible causes of arrhythmias, better clarify the setting in which they occur, and establish their impact on prognosis, which are of paramount importance to orient decision making. Despite the accumulating knowledge on this disease, some dilemmas in the management of these patients may remain, such as the need to implant in the acute or post-acute phase a permanent pacemaker or cardioverter/defibrillation in patients presenting with brady- or tachyarrhythmias and lifelong oral anticoagulation in new-onset atrial fibrillation detected during SARS-CoV-2 infection.

Purpose Telemedicine has been successfully employed in a wide range of specialties. We hereby present the results of a pivotal study we ran in our centre just before the COVID19 pandemic. Methods This was a prospective study including all adult cystic fibrosis patients who underwent lung transplant (LuTx) from September 2017 to August 2019. Patients were randomized into two groups; patients assigned to the first arm (intervention) received a home medical assistant (HMA) system device, to which a pulse oximeter and a spirometer with reusable turbine were integrated; they were asked to perform a spirometry and register their SpO2 at rest and on effort on a twice-weekly basis. All the data were digitally transmitted to our centre, where physiotherapists and physicians were able to analyse them real-time. Both the groups received traditional hospital-based follow-up. Results 32 patients were enrolled, 16 in each group. No statistically significant difference was found between the two groups (see Table 1).With reference to the telemonitoring group:- Adherence to telemonitoring significantly decreased during the 12months period of follow up (see figure 1).- Hospital reported data were consistent with the last being registered with the HMA device.- Of note, two patients were requested to anticipate their hospital routine visit because of a FEV1 decrease being reported on their HMA device, in order to rule out possible acute lung allograft dysfunction.- 13 out of 16 patients reported a high degree of satisfaction with the telemonitoring experience. Conclusion The COVID19 pandemic highlighted the necessity to investigate alternative practices to treat chronically ill individuals. In our study, telemonitoring proved to be a valuable tool to improve quality health care to LuTx recipients, especially for those who live far from the transplant centre. We are now implementing this approach scheduling online video consultations. Further research should be focused on standardizing quality of telemedicine services.

Background: Pulmonary hypertension (PH) is a haemodynamic condition, secondary to different causes. Thalassaemia may lead to PH of different origin and needs a comprehensive analysis to be correctly characterized and possibly treated. Case summary: We present a case study of a patient with a non-transfusion-dependent thalassaemia and a previous diagnosis of group 5 PH. A complete diagnostic assessment led to a specific diagnosis of chronic thromboembolic PH. Thus, we were able to start a specific therapy with riociguat that provided an improvement in terms of haemodynamic, imaging, and functional status. Discussion: A correct characterization and treatment of PH are essential in order to change the patient’s prognosis. Chronic thromboembolic PH is a treatable cause of PH in thalassemic patients and should be investigated.

Background: Among arrhythmias observed in SARS‐CoV‐2 infection, bradyarrhythmia poses the dilemma of urgent pacing. In this population, data on patients' characteristics and clinical outcomes are lacking. Methods: A systematic literature search was conducted for bradyarrhythmia associated with COVID‐19 from inception to December 2024 following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Extension for Scoping Reviews guidelines; quality assessment was performed using the Joanna Briggs Institute critical appraisal tool. From each report, the type of bradyarrhythmia, relevant clinical variables, and outcomes were extracted. Comparison between groups with different bradyarrhythmias was performed for the variables available in all cases. Cluster analyses were performed using both the k‐means and hierarchical methods. Results: Overall, 103 case series/case reports were identified reporting data on 151 patients: 76 with sinus node dysfunction and 75 with atrioventricular block (AVB). Median age was 54.5 years; 10.6% were pediatric patients. Despite few comorbidities, 24.5% required mechanical ventilation and 11.3% died. Sinus node dysfunction was more frequently associated with antiviral therapy, while patients with permanent AVB were significantly older (58 versus 48.5 years; P =0.011) and showed a significant trend toward a higher mortality rate (23.1% versus 5.6%; P =0.048) than those with transient AVB. Cluster analyses showed a higher inflammatory profile in younger patients associated with left ventricular dysfunction and AVB. Conclusions: COVID‐19 can be associated with sinus node dysfunction or AVB even in a young patient population exhibiting a high inflammatory profile. The need for mechanical ventilation and the mortality rate was not negligible. Sinus node dysfunction was associated with the use of antiviral therapy, and permanent AVB was associated with a higher mortality rate.