Background It is common practice to observe patients during an overnight stay (ONS) following a catheter ablation procedure for the treatment of atrial fibrillation (AF). Objectives To investigate the safety and economic impact of a same‐day discharge (SDD) protocol after cryoballoon ablation for treatment of AF in high‐volume, geographically diverse US hospitals. Methods We retrospectively reviewed 2374 consecutive patients (1119 SDD and 1180 ONS) who underwent cryoballoon ablation for AF at three US centers. Baseline characteristics, acute procedure‐related complications, and longer‐term evaluations of safety were recorded during routine clinical follow‐up. The mean cost of an ONS was used in a one‐way sensitivity analysis to evaluate yearly cost savings as a function of the percentage of SDD cases per year. Results The SDD and ONS cohorts were predominately male (69% vs. 67%; p = .3), but SDD patients were younger (64 ± 11 vs. 66 ± 10; p < .0001) with lower body mass index (30 ± 6 vs. 31 ± 61; p < .0001) and CHA2DS2‐VASc scores (1.4 ± 1.0 vs. 2.2 ± 1.4; p < .0002). There was no difference between SDD and ONS in the 30‐day total complication rate (n = 15 [1.26%] versus n = 24 [2.03%]; p = .136, respectively). The most common complication was hematoma in both the SDD (n = 8; 0.67%) and ONS (n = 11; 0.93%) cohorts. Sensitivity analysis demonstrated that when 50% of every 100 patients treated were discharged the same day, hospital cost savings ranged from $45 825 to $83 813 per year across US hospitals. Conclusions SDD following cryoballoon ablation for AF appears to be safe and is associated with cost savings across different US hospitals.

Park HJ, Link MS, Noujaim SF, Galper JB. Increased inducibility of ventricular tachycardia and decreased heart rate variability in a mouse model for type 1 diabetes: effect of pravastatin. Am J Physiol Heart Circ Physiol 305: H1807-H1816, 2013. First published October 25, 2013; doi:10.1152/ajpheart.00979.2012.-Although a reduction in the high-frequency (HF) component of heart rate variability (HRV) is a major complication of diabetes and a risk factor for sudden death, its relationship to ventricular tachycardia (VT) is unknown. We developed a mouse model for the study of VT and its relationship to changes in HRV in the Akita type 1 diabetic mouse. Programmed ventricular stimulation of anesthetized mice demonstrated that Akita mice were more inducible for VT compared with wild-type mice: 78.6% versus 28.6% (P ϭ 0.007). Optical mapping of perfused hearts demonstrated multifocal breakthroughs that occasionally gave rise to short-lived rotors consistent with focal initiation and maintenance of VT. Treatment of Akita mice with pravastatin, which had been previously shown clinically to decrease ventricular ectopy and to increase HRV, decreased the inducibility of VT: 36.8% compared with 75.0% with placebo treatment (P ϭ 0.022). The HF fraction of HRV was reduced in Akita mice (48.6 Ϯ 5.2% vs. 70.9 Ϯ 4.8% in wild-type mice, P ϭ 0.005) and was increased compared with placebo treatment in pravastatin-treated mice. Pretreatment of Akita mice with the muscarinic agonist carbamylcholine or the ␤-adrenergic receptor blocker propranolol decreased the inducibility of VT (P ϭ 0.001). In conclusion, the increased inducibility of focally initiated VT and reduced HF fraction in Akita mice were partially reversed by both pravastatin treatment and pharmacologic reversal of parasympathetic dysfunction. In this new animal model for the study of the pathogenesis of VT in type 1 diabetes, pravastatin may play a role in the prevention of VT by attenuating parasympathetic dysfunction. type 1 diabetes; ventricular tachycardia; statins; secondary effects of diabetes ALTHOUGH DIABETES MELLITUS is associated with an increase in cardiovascular mortality and sudden death (11), its relationship to ventricular tachycardia (VT) is not known. Risk factors for sudden death include clinical manifestations of parasympathetic dysfunction, such as a decreased high-frequency (HF), predominantly parasympathetic, component of heart rate (HR) variability (HRV) and increased dispersion of QT intervals (25,27). Furthermore, analysis of HRV in a group of patients with a history of nonsustained VT demonstrated a reduction in parasympathetic activity in conjunction with an increase in sympathetic activity before the onset of nonsustained VT, further supporting the relationship between decreased parasympathetic tone and the development of arrhythmia (21). Patients with diabetes for 10 yr have an impaired response of the heart to parasympathetic stimulation characterized by a reduction in the HF component of HRV. The increase in the incidence of sudden death in d...

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