key: cord-0076202-sua0ic5i authors: Anselmino, Matteo; De Ferrari, Gaetano Maria title: Editorial: Highlights in Cardiac Rhythmology: 2021 date: 2022-03-11 journal: Front Cardiovasc Med DOI: 10.3389/fcvm.2022.866883 sha: d26dd42ee5b1902ec04689826ba8754415938d76 doc_id: 76202 cord_uid: sua0ic5i nan The World Health Organization declared the outbreak of severe acute respiratory syndrome coronavirus 2 (COVID-19) a pandemic state on 11 March 2020, and, ever since, healthcare professionals have promptly invested all efforts into fighting against COVID-19 with the goal of saving the lives of patients, friends, and family members. Every day, physicians fight against diseases, from those limiting quality of life to those threatening survival. Taking the Hippocratic Oath, they respect scientific obligations, profess warmth and empathy, and take full responsibility for their patients' bettering. Nevertheless, physicians are not used to facing a long-lasting health crisis. Reactions to the unexpected scenario have been palpable. A small group of people are being squeezed by a gigantic enemy and simply remain petrified. A few, guided by feelings of inferiority towards the unprecedented situation, have shifted their energies toward personal or domestic matters, limiting professional duties. The majority, however, have "only" felt disoriented. There is a need for corporate guidance and a sense of the strength of a community moving together towards a common goal, favoring collaborations and team or network formation; these are crucial elements of great 2021's scientific production in all fields, Cardiac Rhythmology included (Figure 1) . Out of the most creative and original topics, few emerge. Conduction system pacing (CSP), including left bundle branch pacing, is emerging as a promising pacing modality to prevent electrical and mechanical delay through direct capture of the . The challenges related to the restricted number of tools initially confined CSP to small single-center experiences. As new tools are becoming available, the use of CSP is now spreading rapidly, even being used for distal conduction disturbances and, eventually, dealing with cardiac resynchronization. The clinical benefits of CSP are no longer in doubt, and apical pacing, particularly in patients with expected high pacing burden and initial structural heart disease, will soon be banded to avoid pacing-induced cardiomyopathy. The same year a temporary, fully implantable pacemaker undergoing complete dissolution and clearance by natural biological processes was designed (1), the technology for continuous ECG monitoring and heart rhythm analysis by all kinds of wearable or miniaturized devices was validated (3, 4) ]. Early rhythm control, compared to usual care, has proved to decrease the risk of adverse cardiovascular outcomes (5) suggesting transcatheter ablation even as a first-line therapy option (Saglietto et al.) . Also, ventricular tachycardia management is experiencing a paradigm shift. Novel imaging protocols permit thorough tissue characterization and standardization of the origin depiction of arrhythmias. Insights into the candidate selection, safety, and This issue includes a selection of the accomplishments of the Cardiac Rhythmology section from 2021; there is no time to rest-the wind blows strong in several directions. We do not yet know the future of parasternal access for substernal, less invasive, shock and pacing lead implantation, sympathetic nerve activity (measured at the skin or auditory canal levels), and alternative oxygen delivery and its impact on cardiac arrhythmias; however, we foresee good reasons to keep in touch also during 2022! Fully implantable and bioresorbable cardiac pacemakers without leads or batteries Continuous Heart Rate Monitoring for Automatic Detection of Life-Threatening Arrhythmias With Novel Bio-Sensing Technology Cryoballoon Ablation of Atrial Fibrillation Without Demonstration of Pulmonary Vein Occlusion-The Simplify Cryo Study Left Atrial Spontaneous Echo Contrast and Ischemic Stroke in Patients Undergoing Percutaneous Left Atrial Appendage Closure Early rhythm-control therapy in patients with atrial fibrillation MA conceived the editorial. MA and GD revised the text. Both authors contributed to the article and approved the submitted version.Conflict of Interest: MA has received educational grants from Abbott, is consultant for Biosense Webster and proctor for Medtronic.The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.Publisher's Note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.Copyright © 2022 Anselmino and De Ferrari. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). 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