COVID-19 outbreak had a major impact on the organization of care in Italy, and a survey to evaluate provision of for arrhythmia during COVID-19 outbreak (March-April 2020) was launched. A total of 104 physicians from 84 Italian arrhythmia centres took part in the survey. The vast majority of participating centres (95.2%) reported a significant reduction in the number of elective pacemaker implantations during the outbreak period compared to the corresponding two months of year 2019 (50.0% of centres reported a reduction of > 50%). Similarly, 92.9% of participating centres reported a significant reduction in the number of implantable cardioverter-defibrillator (ICD) implantations for primary prevention, and 72.6% a significant reduction of ICD implantations for secondary prevention (> 50% in 65.5 and 44.0% of the centres, respectively). The majority of participating centres (77.4%) reported a significant reduction in the number of elective ablations (> 50% in 65.5% of the centres). Also the interventional procedures performed in an emergency setting, as well as acute management of atrial fibrillation had a marked reduction, thus leading to the conclusion that the impact of COVID-19 was disrupting the entire organization of health care, with a massive impact on the activities and procedures related to arrhythmia management in Italy.

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We report the case of a 57-year-old

We report the case of a 68-year-old woman in whom the use of duloxetine, a potent serotonin and norepinephrine reuptake inhibitor, was associated with "tako-tsubo" cardiomyopathy (TTC). Although several pathophysiological mechanisms for TTC have been proposed, available evidence suggests that an excess of catecholamines may play a major role. Our patient had a history of myocardial infarction with normal coronary arteries, probably the first manifestation of TTC. We speculate that duloxetine may have precipitated TTC by increasing plasma catecholamine concentration in a predisposed patient.

This study demonstrates that in patients with uncomplicated myocardial infarction, captopril significantly improves the chronotropic response to baroreceptor stimulation.