The scleral pocket technique has dramatically changed wound closure after phacoemulsification with implantation of a posterior chamber lens. The use of single-stitch technique and wound closure by fibrin adhesive is now possible. We conducted a comparative study of 385 consecutive patients; 167 received only fibrin glue for wound closure and 218 had the single-stitch procedure. No complications were observed in either group. Surgically induced astigmatism was smaller in the fibrin group (vector analysis: 0.80 diopters [D]) than in the single-stitch group (vector analysis: 0.99 D). Minimal, statistically insignificant different against-the-rule astigmatism developed: single-stitch group: -0.07 D (Cravy), -0.09 D (Naeser); fibrin adhesive group: -0.13 D (Cravy), -0.17 D (Naeser). These results suggest that postoperative against-the-rule astigmatism can be prevented with fibrin glue.

No abstract

No abstract

Background Conventional fluoroscopy guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs). However, with the complex nature of most procedures, patients and staff bare an increased radiation exposure. Near-zero or zero-fluoroscopy CA is an alternative method which could substantially reduce or even eliminate the radiation dose. Our aim was to analyse procedural outcomes with fluoroscopy minimising approach for treatment of VAs in patients with structurally normal hearts (SNH) and structural heart disease (SHD). Methods Fifty-two (age 53.4 ± 17.8 years, 38 male, 14 female) consecutive patients who underwent CA of VAs in our institution between May 2018 and December 2019 were included. Procedures were performed primarily with the aid of the three-dimensional electro-anatomical mapping system and intra-cardiac echocardiography. Fluoroscopy was considered only in left ventricular (LV) summit mapping for coronary angiography and when epicardial approach was planned. Acute and long-term procedural outcomes were analysed. Results Sixty CA procedures were performed. Twenty-five patients had SHD-related VAs (Group 1) and 27 patients had SNH (Group 2). While Group 1 had significantly higher total procedural time (256.9 ± 71.7 vs 123.6 ± 42.2 min; p < 0.001) compared to Group 2, overall procedural success rate [77.4% (24/31) vs 89.7% (26/29); p = 0.20)] and recurrence rate after the first procedure [8/25, (32%) vs 8/27, (29.6%); p = 0.85] were similar in both groups. Fluoroscopy was used in 3 procedures in Group 1 where epicardial approach was needed and in 4 procedures in Group 2 where LV summit VAs were ablated. Overall procedure-related major complication rate was 5%. Conclusions Fluoroscopy minimising approach for CA of VAs is feasible and safe in patients with SHD and SNH. Fluoroscopy could not be completely abolished in VAs with epicardial and LV summit substrate location.

No abstract

No abstract

No abstract

Funding Acknowledgements Type of funding sources: None. Background In patients with persistent atrial fibrillation (PeAF) and heart failure with reduced ejection fraction (HFrEF) current guidelines recommend treatment of AF with catheter ablation (CA) (1). Recurrence of either AF or atrial flutter, often requiring additional procedures, are not uncommon, thus optimal long-term treatment of these patients is still unknown. Recently conduction system pacing (CSP), with more physiological ventricular activation, has made the ‘’pace and ablate’’ strategy an attractive alternative for the treatment of PeAF refractory to medical therapy (2). Purpose Long term data comparing CA with conduction system pacing and AV node ablation (CSP/AVNa) for treatment of patients with PeAF and HFrEF is lacking. Hence, we sought to compare clinical outcomes of both treatment modalities. Methods In a retrospective study consecutive patients under 75 years of age, with PeAF and left ventricular ejection fraction (LVEF) less than 50%, treated with CSP/AVNa from 2018 to 2021 in UMC Ljubljana were included. A control patient treated with CA for PeAF matched in age, sex and LVEF was assigned for each included CPS/AVNa patient. Both groups were compared for procedure-related characteristics, echocardiographic parameters, hospitalisations for heart failure and all-cause mortality. Results Among 771 patients referred for interventional treatment of AF, 23 patients treated with CSP/AVNa were included and compared with 23 CA matched controls. The general characteristics of both groups are summarised in Table 1. The mean follow-up was 20 ± 10 and 21 ± 8 months for CPS/AVNa and CA group, respectively (p=0.76). In CPS/AVNa group 83% received his bundle pacing and 17% left bundle branch area pacing. A selective CSP was achieved in 43% of CSP/AVNa patients. In addition to pulmonary vein isolation, additional ablation lines were performed in 35% of patients in the CA group. Significant improvement in LVEF was observed in both groups, 12% ± 11% (p&lt;0.001) in CSP/AVNa and 21% ± 12% (p&lt;0.001) in CA group. Hospitalisations for HF were rare during the follow-up, with 9% in CSP/AVNa and 4% in the CA ablation group (p=0.561). All-cause mortality was 9% in CSP/AVNa and 0% in CA group (p=0.153). However, major comorbidities were more common in the CSP/AVNa group than in the CA group, 3.4 ± 1.6 and 2.3 ± 1.5, respectively (p=0.017). Procedure-related characteristics are summarised in Table 1. In each group, 2 minor procedure-related adverse events were observed: 2 acute rises in pacing threshold post-AVNa in CSP/AVNa group and puncture site hematoma and transient pericardial effusion in CA group. Conclusion In patients with PeAF and HFrEF, CSP/AVNa treatment strategy seems to derive similar clinical outcomes compared to CA approach. Larger prospective randomised data are needed to further confirm these initial findings and determine optimal long-term treatment strategy for this group of patients.