Aims Although cryoballoon pulmonary vein isolation is a well-established treatment for paroxysmal atrial fibrillation (AF), it’s role in persistent AF is unclear. We examined procedural success and long-term outcomes of cryoablation in persistent and longstanding persistent AF. Methods and results International multicentre registry from three UK and eight European centres. Consecutive patients undergoing cryoablation for persistent AF included. Procedural data, complications, and follow-up were prospectively recorded. Patients were followed-up at 3, 6, and 12 months with an electrocardiogram with open access to arrhythmia nurses thereafter. Ambulatory monitoring was dictated by symptoms. Success was defined as freedom from AF or atrial tachycardia lasting >30 s off antiarrhythmic drugs (AADs). Six hundred and nine consecutive cryoablation procedures. Mean procedure and fluoroscopy times were 95 ± 65 and 13 ± 10 min. Single procedure success rates were 368/602 (61%) off AADs over a median of 2.4 (1.0–4.0) years. Arrhythmia-free survival off AADs was 64% and 57% for persistent and longstanding persistent AF at 24 months of follow-up (P = 0.02). Rate of repeat ablations was 20% in persistent and 32% in longstanding persistent AF (P = 0.006). Cox regression analyses showed a significant association between duration of AF and left atrial diameter and arrhythmia recurrence [hazard ratio (HR) 1.05, P-value 0.01 and HR 1.02, P-value 0.004]. Conclusion Cryoablation for persistent AF is safe, fast and has good outcomes at long-term follow-up. Cryoablation is reasonable as a first line option for these patients. Short procedure times may help increase capacity of cardiac units to meet the rising demand for AF ablation. Randomised control trials are needed to compare outcomes with different techniques.

Background Exercise-induced premature ventricular complexes (EI-PVCs) are common during exercise stress tests. Their optimal management and prognostic significance remain uncertain. Aim To perform meta-analysis of observational studies on the prognostic significance of EI-PVCs. Methods A search was conducted on Medline and Embase. Inclusion criteria were observational studies comparing the prognosis of patients with and without EI-PVCs whilst exclusion criteria were studies without confounder adjustment and studies with zero endpoints. Composite endpoints included all-cause mortality, cardiac mortality and cardiovascular events. Relative risk of endpoints were analysed with random effects model. Meta-regression and sensitivity analysis were performed. Results Ten studies were included. In asymptomatic patients who had no clinical evidence of heart disease, EI-PVCs were associated with a pooled risk ratio of 1.82 (95% CI 1.44 to 2.30) of developing adverse cardiovascular events over 16 years. The corresponding pooled RR for patients with symptomatic heart disease was 1.36 (95% CI 1.18 to 1.57) over 5.4 years. Sensitivity analysis: only EI-PVCs on the recovery phase of an exercise test, not during exercise, had adverse prognostic significance.

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Background: Catheter ablation for supraventricular tachycardia (SVT) in adults with congenital heart disease (ACHD) is an important therapeutic option. Cavotricuspid isthmus (CTI) dependent intra-atrial re-entrant tachycardia (IART) is common. However, induction of sustained tachycardia at the time of ablation is not always possible. We hypothesised that performing an empiric CTI line in case of noninducibility leads to good outcomes.Objectives: Long-term outcomes of empiric versus entrained CTI ablation in CHD patients were examined.Methods: Retrospective, single-centre, case-control study over seven years.Arrhythmia free survival post empiric versus entrained CTI ablation were compared.Results: 87 CTI ablations were performed in 85 ACHD patients between 2010 and 2017. The mean age of the cohort was 43 years and 48% were men. Underlying etiology included ASD (31%), VSD (11.4%), AVSD (9.1%), AVR (4.8%), Fallot's tetralogy (18.4%), Ebstein's anomaly (2.3%), Fontan surgery (9.2%) and Mustard/Senning repair (13.8%). CTI dependent IART was entrained in 59 patients whereas it was non-inducible in 28. The latter had an empiric CTI-line ablation. 57% of procedures were performed without a general anaesthetic. There were no procedural complications. There was no significant difference in the mean procedure and fluoroscopy times between the groups (Empiric vs Entrained CTI; 169.1 vs 183.3 and 28.1 vs 19.9 min). After a mean follow-up of 21 months, arrhythmia-free survival was 64.3% versus 72.8% (p-value 0.44) in the empiric and entrained CTI groups. Conclusion:Long-term outcomes after empiric and entrained CTI line ablation for IART ACHD patients are comparable. This is a safe and effective therapeutic option.In the case of non-inducibility of IART, an empiric CTI line ablation should be performed in this cohort.

After primary PCI, complete revascularization in STEMI multivessel disease is associated with lower MACE rates than medical therapy. However, ischemia-testing-guided rather than angiography-guided revascularization was associated with the lowest MACE. This study provides preliminary data and hypotheses for future randomized controlled studies.