Pulsed-field ablation (PFA) is an emerging technique for managing atrial fibrillation (AF). Still, its role in persistent AF (PeAF) with left atrial posterior wall isolation (LAPWI) remains to be defined. The ATHENA registry evaluated 249 PeAF patients across 9 Italian centers using the FARAPULSE PFA system, with 57.6% undergoing LAPWI. Electrical isolation of the posterior wall was achieved in all cases, with a first-pass success rate of 88.8%. The procedure demonstrated a favorable safety profile, with no major periprocedural complications and only a low rate of minor events (2.4%). Secondary endpoints further assessed long-term efficacy and safety, with 16.5% of patients experiencing arrhythmic recurrence beyond the blanking period at a median follow-up of 273 days, corresponding to an overall freedom from recurrence of 83.5%. Complication rates remained low throughout follow-up, with no late-occurring major adverse events reported. Redo procedures were required in 15.3% of LAPWI patients compared with lower rates in the PVI-only group, suggesting a potential benefit of adjunctive posterior wall ablation. These findings support PFA as a feasible, safe, and efficient approach for LAPWI in PeAF, even with fluoroscopy-only guidance.

Introduction: Despite recent advances in sickle cell disease (SCD) research and management, there remains very limited information available on critically ill SCD patients requiring intensive care units (ICUs).Methods: The National Inpatient Sample was queried using the International Classification of Diseases codes to identify critically ill patients with SCD requiring ICU admission. These patients were further stratified into those with and without adverse clinical events (ACEs). The study outcomes were the incidence of acute chest syndrome, cardiac arrest, hemodialysis, sepsis, shock, and transfusion.Results: Of 5941 patients admitted to the ICU, 2826 (47.6%) had ACE. Patients with ACE were likely to be older, male, white, rural, and have higher comorbidities. The prevalence of ICU admission increased by 126% (p < 0.01). The predictors of ACE included male sex, older age, coronary artery disease, heart failure, renal failure, and two or more comorbidities. Patients with ACE were more likely to have cardiac arrest, hemodialysis, sepsis, and shock (all p < 0.01).Conclusion: There has been an increase in the prevalence of critically ill SCD patients requiring ICU care, with subsequent morbidity and mortality. Further research is needed to understand the underlying factors that drive these observed trends and increase mortality rates.Trial Registration: The authors have confirmed clinical trial registration is not needed for this submission.