Background Sex-specific outcomes following AF ablation(CA) have reported conflicting findings. Objectives We report the impact of female sex on outcomes in patients with persistent AF from the CAPLA randomized trial. Methods 338 patients with PsAF were randomized to pulmonary vein isolation(PVI) or PVI with posterior wall isolation(PWI).The primary outcome was arrhythmia recurrence at 12 months.Clinical and electroanatomical characteristics,arrhythmia recurrence and quality of life were compared in women and men. Results Seventy-nine(23.4%) women(PVI 37;PVI+PWI 42) and 259(76.6%) men(PVI 131,PVI+PWI 128)underwent AF ablation.Women were older (median age 70.4(IQR 64.8-74.6) vs 64.0(IQR 56.7-69.7)years,p<0.001) and had more advanced left atrial electroanatomical remodeling.At 12 months, arrhythmia-free survival was lower among women(44.3% vs 56.8% in men,HR 1.44,95% CI 1.02-2.04, LogRank p=0.036).PWI did not improve3 arrhythmia-free survival at 12 months(HR 1.02,95% CI 0.74-1.40, LogRank p=0.711).Median AF burden was 0% in both groups(women:IQR 0.0-2.2% vs men:IQR 0.0-2.8%,p=0.804).Healthcare utilisation was comparable in women(36.7%) and men(30.1%,p=0.241),however women were more likely to undergo a repeat procedure(17.7% vs 6.9%,p=0.007).Women reported more severe baseline anxiety(average HADS anxiety score 7.5±4.9 vs 6.3±4.3 in men,p=0.035) and AF-related symptoms (baseline AFEQT 46.7±20.7 vs 55.9±23.0 in men,p=0.002),with comparable improvements in psychological symptoms(ΔHADS anxiety score: -3.8±4.6 vs -3.0±4.5, p=0.152(ΔHADS depression score: -2.9±5.0 vs -2.6±4.0,p=0.542) and greater improvement in AFEQT compared to men at 12 months(ΔAFEQT +45.9±23.1 vs +39.2±24.8,p=0.048). Conclusion Women undergoing CA for PsAF report more significant symptoms and poorer quality of life than men.Despite higher arrhythmia recurrence and repeat procedures among women,AF burden was comparably low, resulting in significant improvements in quality of life and psychological wellbeing following CA in both sexes.

Abstract Background The implantable cardioverter defibrillator (ICD) reduces mortality in patients at risk of sudden cardiac death. However, it is not known if the psychological status of ICD patients differs by geography. The aim of this analysis is to compare Quality of Life (QoL) and ICD shock-related anxiety between ICD patients in Asian with those in other countries. Methods The PainFree SST study was a prospective, multicenter, global study that enrolled 2770 patients including 225 from from Asia (181 from Japan, 25 from India, and 19 from Malaysia). The EuroQol 5-D (EQ-5D) measured QoL and the Florida Shock Anxiety Scale (FSAS) measured ICD shock-related anxiety. These questionnaires were administered bi-annually and monthly for 6 months after a shock. Change in QoL and shock anxiety was analyzed used linear mixed models for repeated measures. Results: Both the EQ-5D health score and FSAS score were higher in Asian patients compared to patients in the other countries post-implant (EQ-5D: 69.5 ± 18.3 points vs 66.5 ± 19.3 points, p<0.0001, FSAS: 19.7 ± 9.4 points vs 16.4 ± 7.7 points, p<0.0001), and stayed higher for the entire follow-up period (Figure 1). The EQ-5D health score was significantly reduced after a shock (Asian: -18.1 points, p<0.0001; other countries: -7.5 points, p<0.0001) with a greater reduction in Asian patients (p=0.0035) . Recovery in the month following a shock was greater in Asian patients (+19.8 vs +3.6 points, p<0.0001). The FSAS score was significantly increased after a shock (Asian: +6.4 points, p<0.0001; other countries: +4.8 points, p<0.0001) and the increase was similar between geographies (p=0.20). The recovery effect at 1 month was greater in Asian patients (-5.8 vs -1.7 points, p=0.0003) (Figure 2). Conclusions Asian patients were more anxious about a shock in spite of greater QoL, compared with those in other countries. After a shock, Asian patients had a greater decrease in QoL and a similar increase in anxiety but recovery was greater in both measures in the month following a shock.Figure 1Figure 2

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): 1. Canadian Institutes of Health Research (CIHR) 2. Additional financial support from St. Jude Medical and Biosense Webster Background Recurrent shocks for ventricular tachycardia (VT) are associated with an increased risk of heart failure and mortality and have a negative influence on quality of life. Catheter ablation has been shown to improve VT event-free survival in patients with antiarrhythmic drug (AAD)-refractory VT and prior myocardial infarction (MI); however, the effects of ablation on shock burden has yet to be investigated. Purpose Our primary objectives were to compare the shock-treated VT event burden and appropriate shock burden following randomization to treatment with either catheter ablation or escalated AAD therapy among VT patients with prior MI in the Ventricular tachycardia AblatioN versus escalated antiarrhythmic drug therapy in Ischemic Heart disease (VANISH) randomized trial. Methods Recurrent event analyses were performed using the intention-to-treat population of the VANISH trial. Shock-treated VT event burden was defined as the total number of VT events treated with ≥1 appropriate internal or external shocks. Appropriate shock burden was defined as the total number of appropriate internal and external shocks delivered, regardless of the number of VT events. All VT events and implantable cardioverter defibrillator (ICD) therapies were adjudicated by reviewers blinded to the treatment allocation. Three recurrent event models were used to compare the shock burden between treatment arms (Anderson-Gill (AG), Frailty, and Prentice, Williams, and Peterson Total Time (PWP-TT). Each model clustered by patient and accounted for competing risk of death with the Fine and Gray sub-distributions hazards model. Results Of the 259 patients enrolled in the VANISH trial [median age 69.8 (IQR 63.0-74.2) years, 7.0% women], 132 patients were randomized to ablation and 129 patients to escalated AAD therapy. Over a median follow-up of 23.4 (IQR 14.7-40.4) months, there were 138 shock-treated VT events [39.07 (95% CI 33.14-46.07) shock-treated VT events per 100 person-years] in the ablation arm and 218 shock-treated VT events [64.60 (95% CI 56.49–73.84) shock-treated VT events per 100 person-years] in the escalated AAD therapy arm (Figure 1). Ablation patients had a 40% lower shock-treated VT event burden (ie. number of shock-treated VT events) compared to patients randomized to escalated AAD therapy [Figure 1; AG HR 0.60 (95% 0.38-0.95)]. Further, there was also a statistically significant reduction in the appropriate shock burden (i.e. number of appropriate shocks) among ablation patients (169 appropriate shocks) compared to escalated AAD therapy patients (266 appropriate shocks) [Figure 1; AG HR 0.61 (95% CI 0.37-0.96)]. All results were consistent between the 3 recurrent event models. Conclusion Among patients with AAD-refractory VT and a prior MI, catheter ablation reduced shock-treated VT event burden and appropriate shock burden compared to escalated AAD therapy.

Abstract Funding Acknowledgements Medtronic OnBehalf PainFree SST Background Anti-tachycardia Pacing (ATP) is an established therapy that terminates VT without the need for painful ICD shocks. Here we use the data from PainFree SST clinical trial to evaluate the ATP success rate by device type, indication and MCL. Methods Spontaneous episodes that were detected by ICD or CRT-D devices in the VT, fast VT and VF zones were included in the analysis. Episodes successfully terminated by ATP were deemed as having ATP success. Using the GEE method, ATP success rate and its 95% CI were calculated for device types, indications and ventricular MCL. Results Of the 2770 enrolled patients (79% male, average age 65 years), 1699 (61%) were implanted with an ICD and 1071 (39%) with a CRT-D system; 1917 (69%) were reported as primary prevention and 847 (31%) were secondary prevention patients. For all MVT episodes, the ATP success rate was similar between ICD and CRT-D devices (82.3% vs 80.3%, p = 0.74). Patients with secondary prevention had a higher ATP success rate compared to those with primary prevention but the difference was not statistically significant (84.4% vs 76.8%, p = 0.16). Regardless of device type and indication, ATP success rate was significantly higher in the slower VTs (MCL ≥ 320 ms) compared to the faster VTs (MCL ≥ 240 to < 320 ms) (89.2% vs 73.7%, p < 0.0001). Conclusion We found that ATP had a greater than 80% rate of success for terminating ventricular tachycardias overall. Slower VTs was significantly associated with a higher ATP success rate regardless of device type and indication compared to faster VTs. For faster VTs with a MCL ≥ 240 to < 320 ms, the ATP success rate was still successful at terminating VT more than 70% of the time. Table 1. ATP Success Rates - No. of Enrolled Subjects (% of total) No. of Episodes Analyzed for ATP Success (No. of Subjects) GEE-estimated ATP Success Rate (95% CI) P-value* Overall 2770 (100%) 2277 (376) 81.5% (78.4%, 84.2%) - Device Type - - - 0.7440 ICD 1699 (61.3%) 1484 (229) 82.3% (78.3%, 85.6%) - CRT-D 1071 (38.7%) 793 (147) 80.3% (75.0%, 84.6%) - Indication - - - 0.1609 Primary Prevention 1917 (69.2%) 631 (160) 76.8% (71.2%, 81.6%) - Secondary Prevention 847 (30.6%) 1615 (212) 84.4% (80.7%, 87.6%) - Median Cycle Length - - - <0.0001 (>/=) 240 ms and < 320 ms - 861 (257) 73.7% (69.2%, 77.7%) - (>/=) 320 ms - 1416 (209) 89.2% (85.7%, 91.9%) - * Per a GEE main effect model for all episodes where device type, indication and median cycle length were considered.

Abstract Background Interventional cardiac electrophysiology (EP) is rapidly evolving; a nationwide registry was established and re-administered since 2011 to conduct a periodic review of resource allocation across Canada. Methods The registry collects annual data on EP lab infrastructure, imaging, tools, human resources, procedural volumes, and wait times. Leading physicians from each EP lab were contacted electronically. Results All Canadian EP centres were identified (n=30); 50% and 45% of active centres participated in the last 2 instalments of the registry. Since 2011, data has been consistently obtained from 11 university-affiliated centres. Table 1 reports trends in procedural volumes and operators. Figure 1 depicts the ablations done per operator. The mean wait time to see an electrophysiologist for an initial non-urgent consult is 23 weeks. The wait time between an EP consult and ablation date is 17.8 weeks for simple ablation, 15.9 weeks for VT ablation, and 30.1 weeks for AF ablation. On average centres have 2 (range: 1–4) rooms equipped for ablations; each centre uses the EP lab an average of 7 shifts per week. While diagnostic studies and radiofrequency ablations are performed in all centres, point-by-point cryoablation is available in 85% and cryoballoon in 77% of the centres; 38% of the respondents use circular ablation techniques. Trends in procedural volumes + operators 2015–2016 2013–2014 2011–2012 Procedures per operator 117±70 120±68 113±42 Procedures per centre 498±299 477±245 446±237 Ratio of staff to trainees 2.0:1 1.6:1 1.5:1 Full time physicians per centre 4.1 (0–7) 4.1 (1–7) 3.5 (0–7) Nurses trained specifically for EP 4.6 (0–10) 4.4 (0–10) n/a Ablation procedures volume: AV Reciprocal Tachycardia 12% 10% 11% AV Nodal Re-entry Tachycardia 18% 19% 23% Atrial Fibrillation/Atypical Flutter 33% 35% 30% Typical Flutter 20% 14% 19% Ventricular Tachycardia 8% 8% 10% Total annual ablations in all respondent centres 5478 5243 4908 Mean ± standard deviation. Staff (full-time + part-time prorated to 0.5). Annual ablation volumes per operator Conclusion This initiative provides contemporary data on invasive EP practices. The results show feasibility in data collection which will serve as a reference for decisions regarding resource planning.

Remote monitoring (RM) coupled with in-clinic follow-up is cost-effective and superior to solely in-clinic follow-up for both pacemakers (PMs) and implantable defibrillators (ICDs). Remote View technology permits specialised sites to program ICDs of patients off site. We sought to determine the feasibility of remote only follow-up, eliminating scheduled clinical visits and travel to specialised sites. This prospective before-after study included 5 Canadian centres. Patients receiving shared specialised and satellite site care who had PMs or ICDs capable of RM were eligible for enrolment. The primary outcome was feasibility of remote programming, as measured by compliance, safety, and efficacy of reducing specialised site in-clinic visits. Quality of life was evaluated at baseline and 12 months using 4 survey tools. 176 patients were enrolled (76 PM, 100 ICD). Compliance was 93% to RM transmissions; death, CV hospitalization, device-related hospitalization (safety) was 7.5%. There was a significant reduction in mean specialised site clinical visits (0.61±0.64 vs 0.17±0.38, p < 0.0001) for ICD patients and no significant change in visits to the satellite clinic (0.37±0.78 vs 0.56±0.50, p=0.09). There was a similar number of remote transmissions (110 vs 92 events). Four Remote View visits were performed. There was a significant reduction in mean in-clinic visits for PM patients (1.65±1.19 vs 0.26±0.44, p < 0.0001; total 91 vs 17 visits). The total number of RM visits for PM patients increased from 0 to 64. There were no adverse events related to Remote View. Quality of life improved in the domains of device-related distress (p=0.003) and health security (p=0.011). A RM-only program of follow-up is feasible. Preliminary results show acceptable levels of safety, significant reduction in health care utilization, and improved quality of life. RM-only follow-up should be further studied to determine whether superior effectiveness and reduced costs can be achieved with preserved safety.

Introduction: Safety of same-day pacemaker (PPM) implant and atrioventricular node ablation (AVNA) for management of atrial fibrillation is uncertain, particularly owing to concerns regarding acute complications post–pacemaker implant.

Objectives: To assess the impact of contact force (CF) and force time integral (FTI) on procedural efficacy and efficiency in cavotricuspid isthmus (CTI) ablation. A secondary objective was to assess CF and FTI achieved at different anatomical thirds.

Interventional cardiac electrophysiology (EP) is a rapidly evolving field; a nationwide registry was established and re-administered since 2011 to conduct a periodic review of resource allocation across Canada. A retrospective questionnaire was designed to collect data regarding EP laboratory infrastructure, imaging, human resources, procedural volumes, and wait times. Leading physicians from each EP lab were contacted electronically; participation was voluntary. Each survey collected data over two calendar years. All existing Canadian EP centres were identified (29 in 2011, 31 in 2018); 50% and 45% of active centres participated in the last two instalments of the registry. Since the registry's inception in 2011, data has been consistently obtained from 11 centres. All eleven centres are university-affiliated. The number of full time physicians ranges between one and seven, (mean of 4 per centre). Table 1 reports trends in procedural volumes and operators. The mean wait time to see an electrophysiologist for an initial non-urgent consult is 23 weeks. The wait time between an EP consult and ablation date is 17.8 weeks for a simple ablation, 15.9 weeks for a VT ablation, and 30.1 weeks for an AF ablation. On average centres have two (range: 1-4) rooms equipped for ablations; each centre uses facilities an average of seven daily shifts per week. While diagnostic studies and radiofrequency ablations are performed in all centres, point-by-point cryoablation is available in 85% and cryoballoon in 77% of the centres; 23% and 15% of the respondents use PVAC and NMARQ technology respectively. Two centres actively use remote magnetic navigation systems. CARTO and intracardiac echo are the most commonly utilized 3D mapping systems in 11 (85%) centres, followed by EnSite-NavX Velocity in nine (69%), EnSite-NavX Precision in 7 (54%), Mediguide in two (15%) centres, Rhythmia and LocaLisa are used in one centre each. Philips is the most widely used imaging system in 85% of centres, followed by Siemens in 54% centres. Non-3D tracing systems were operated by technicians in 23% of the centers in 2016, up from 50% in 2011. Industry representatives are increasingly operating 23% of the tracing systems up from 11% in 2011. This initiative provides contemporary information on invasive electrophysiology lab practices. The results show a feasibility in ongoing data collection which will serve as a reference for decisions regarding the needs of laboratories and research planning. This data provides basic benchmarks of national resources and may assist local resource planning.

BACKGROUND:The effect of implantable cardioverter-defibrillator (ICD) shock on device-measured activity and patient-reported outcomes is unknown. OBJECTIVE:The purpose of this study was to analyze the acute and long-term effects of ICD shock on objective behavioral data (ie, device-based physical activity) and subjective patient-reported outcomes (eg, quality of life and shock anxiety). METHODS:The PainFree Smart Shock Technology (SST) clinical trial included 2770 patients with a single- or dual-chamber ICD or cardiac resynchronization therapy - defibrillator device who were followed for 22 ± 9 months. Participants completed measures of quality of life (EuroQol-5D [EQ-5D] questionnaire) and shock anxiety (Florida Shock Anxiety Scale) at baseline, biannual visits, and monthly for 6 months after an ICD shock. Daily physical activity data were obtained from a built-in device accelerometer. RESULTS:The average daily activity was 185.3 ± 119.4 min/d. Activity was significantly reduced after an ICD shock (P < .0001) and recovered to a normal level after ∼90 days. An ICD shock was also associated with decreased quality of life (EQ5-D health score) and increased EQ-5D anxiety scores, but it did not affect mobility, self-care, activity, or pain. Similarly, shock anxiety (Florida Shock Anxiety Scale) increased in shocked patients and remained significantly elevated at 24 months, regardless of appropriate or inappropriate shock delivery. CONCLUSION:ICD shocks have a long-lasting adverse effect on both objective, device-measured physical activity and subjective patient-reported outcomes of quality of life and shock anxiety. Successful management of patients with an ICD requires attention to clinically relevant behavioral and psychological outcomes to expedite recovery and return to activities of daily living.

The RAFT trial demonstrated that cardiac resynchronization reduces both mortality and heart failure admissions in patients with functional class II or III heart failure and widened QRS. We studied the influence of CRT on ventricular arrhythmias (VA) in patients with primary vs secondary prophylaxis ICD indications. All ventricular arrhythmias among RAFT participants were accumulated from device downloads and were adjudicated by 2 blinded reviewers in a core lab; disagreement was settled by a 3rd reviewer or by committee when disagreement remained. In this prespecified analysis the occurrence of VAs was compared in CRT-D vs ICD patients. 1764 of 1798 enrolled patients had device data available for analysis and were included. Of these 1531 vs 233 were for primary vs secondary prophylaxis, and 884 were randomized to ICD; 880 to CRT-D. Patients experienced 11,278 VAs during 5953.6 patient years at risk. Among primary prophylaxis patients, there were no significant baseline differences; CRT-D increased time to first VA significantly in comparison to ICD (P=0.039). Hazard Ratio 0.86 (0.742-0.992) vs 1.15 (0.828-1.600) in the secondary prophylaxis patients. Among primary prophylaxis patients, CRT tended to reduce the number of patients experiencing VAs (344 (47.3%) vs 383 (51.6%), p=0.09), and overall days of VAs (1996 VA days CRT vs. ICD 2221; adjusted for person years at risk: 0.66 days of VA CRT vs ICD 0.76 p=0.14). In this, the largest series of adjudicated arrhythmias in a CRT trial, CRT significantly prolonged time to first ventricular arrhythmia among patients with primary prophylaxis indication, an effect not seen among patients who had already experienced VAs.

In previous trials of rate versus rhythm control of atrial fibrillation (AF), rhythm control was only partially successful in keeping patients out of AF and many patients in rate control were not in AF. Thus, the differential effect between the two strategies on keeping patients from AF was small. This may explain the inability to demonstrate a clinically meaningful difference between rate versus rhythm control. In the RAFT-AF trial, the plan is to include patients with high burden AF to ensure that patients randomized to rate control are largely in AF and patients randomized to rhythm control be kept out of AF with aggressive ablation procedures. The purpose of this report is to determine (1) patient characteristics entered RAFT-AF trial to this point, (2) the rhythm and the ability to control rate in patients randomized to rate control, and (3) the ability to maintain sinus rhythm in patients randomized to rhythm control. In the RAFT-AF trial, patients with high burden AF and heart failure are randomized to aggressive rate control or ablation based rhythm control. Patients are followed at regular intervals when ECGs were collected. A reviewer blinded to the patient’s treatment allocation reviewed ECGs for atrial rhythm. To date, 144 patients are enrolled. The age is 66.9±8.5years, 70.8% are male. Underlying heart disease is 37.2% ischemic, 62.8% non-ischemic; 65.1% have impaired LV function (EF≤45%, mean=29.5±8.0) and 34.9% had preserved LV function (>45%, mean=57.2±6.8). At the time of enrollment, 9.0% had high burden paroxysmal AF, 2.8% had type 1 persistent AF (AF lasting < 7 days but had cardioversion), 63.9% had type 2 persistent AF (AF lasting > 7 days but < 1 yr) and 24.3% had long-term persistent AF (AF > 1 yr). The LA parameters were 46.8± 5.5 mm in diameter and 51±20 ml in volume. Baseline 6 minute walk distance was 347.5±100.5 meters. In the RAFT-AF trial, patients assigned to the two strategies are appropriately treated to attain the intended rhythm outcome: rate controlled patients are mostly in AF, and rhythm controlled patients are mostly in sinus rhythm. Whether this will result in meaningful clinical outcomes will require trial completion with enrollment of 600 patients and a mean follow-up of more than 3 years.

BackgroundOverdrive pacing produces characteristic responses in varying arrhythmias. If antitachycardia pacing fails to terminate an arrhythmia, the response following pacing may provide evidence of the mechanism. The RAFT trial randomized 1798 patients with NYHA class II/III heart failure, LV EF 120ms to an ICD +/- cardiac resynchronization. The standard ICD discrimination programming was 3 zones (V 150-200bpm; VT2: 200-250bpm; VF>250 bpm). The primary discriminators used were WAVELET in single chamber devices and PR Logic for dual chamber devices.MethodsAll arrhythmia events were reviewed by an adjudication committee. The response to pacing was analyzed in 4281 events among 688 patients for which electrograms were available.ResultsConclusionThe response to antitachycardia pacing may be useful as an additional discriminator to current algorithms. BackgroundOverdrive pacing produces characteristic responses in varying arrhythmias. If antitachycardia pacing fails to terminate an arrhythmia, the response following pacing may provide evidence of the mechanism. The RAFT trial randomized 1798 patients with NYHA class II/III heart failure, LV EF 120ms to an ICD +/- cardiac resynchronization. The standard ICD discrimination programming was 3 zones (V 150-200bpm; VT2: 200-250bpm; VF>250 bpm). The primary discriminators used were WAVELET in single chamber devices and PR Logic for dual chamber devices. Overdrive pacing produces characteristic responses in varying arrhythmias. If antitachycardia pacing fails to terminate an arrhythmia, the response following pacing may provide evidence of the mechanism. The RAFT trial randomized 1798 patients with NYHA class II/III heart failure, LV EF 120ms to an ICD +/- cardiac resynchronization. The standard ICD discrimination programming was 3 zones (V 150-200bpm; VT2: 200-250bpm; VF>250 bpm). The primary discriminators used were WAVELET in single chamber devices and PR Logic for dual chamber devices. MethodsAll arrhythmia events were reviewed by an adjudication committee. The response to pacing was analyzed in 4281 events among 688 patients for which electrograms were available. All arrhythmia events were reviewed by an adjudication committee. The response to pacing was analyzed in 4281 events among 688 patients for which electrograms were available. Results ConclusionThe response to antitachycardia pacing may be useful as an additional discriminator to current algorithms. The response to antitachycardia pacing may be useful as an additional discriminator to current algorithms.

BackgroundAnti-tachycardia pacing (ATP) is a common initial treatment in the termination of ventricular arrhythmias in implantable cardioverter defibrillators (ICDs). We sought to assess the efficacy of burst and ramp ATP on ventricular arrhythmias at different tachycardia cycle lengths (TCL) in the RAFT trial.MethodsThe RAFT trial randomized patients with functional class II and III heart failure to ICDs ± cardiac resynchronization and had standardized programming; VT was treated with burst pacing (8 beats/ 88% TCL/ fixed rate), followed by ramp pacing (6 beats/88% TCL/10ms decrements) if burst pacing failed. All arrhythmia events were adjudicated.ResultsView Large Image Figure ViewerDownload (PPT)ConclusionIn the cohort of RAFT patients it appears that ATP therapy was most successful in treating VT between 150-200bpm. VT faster than 200bpm was more likely to accelerate after ATP therapy, however, they too were more likely to receive Ramp ATP. BackgroundAnti-tachycardia pacing (ATP) is a common initial treatment in the termination of ventricular arrhythmias in implantable cardioverter defibrillators (ICDs). We sought to assess the efficacy of burst and ramp ATP on ventricular arrhythmias at different tachycardia cycle lengths (TCL) in the RAFT trial. Anti-tachycardia pacing (ATP) is a common initial treatment in the termination of ventricular arrhythmias in implantable cardioverter defibrillators (ICDs). We sought to assess the efficacy of burst and ramp ATP on ventricular arrhythmias at different tachycardia cycle lengths (TCL) in the RAFT trial. MethodsThe RAFT trial randomized patients with functional class II and III heart failure to ICDs ± cardiac resynchronization and had standardized programming; VT was treated with burst pacing (8 beats/ 88% TCL/ fixed rate), followed by ramp pacing (6 beats/88% TCL/10ms decrements) if burst pacing failed. All arrhythmia events were adjudicated. The RAFT trial randomized patients with functional class II and III heart failure to ICDs ± cardiac resynchronization and had standardized programming; VT was treated with burst pacing (8 beats/ 88% TCL/ fixed rate), followed by ramp pacing (6 beats/88% TCL/10ms decrements) if burst pacing failed. All arrhythmia events were adjudicated. Results ConclusionIn the cohort of RAFT patients it appears that ATP therapy was most successful in treating VT between 150-200bpm. VT faster than 200bpm was more likely to accelerate after ATP therapy, however, they too were more likely to receive Ramp ATP. In the cohort of RAFT patients it appears that ATP therapy was most successful in treating VT between 150-200bpm. VT faster than 200bpm was more likely to accelerate after ATP therapy, however, they too were more likely to receive Ramp ATP.

Catheter ablation of atrial fibrillation (AF) is the preferred treatment in patients with drug resistant, symptomatic AF. As the ablation procedure has become more accessible for patients, there may be an evolution of the types of patients undergoing AF ablation. The purpose of this study was to evaluate how patient characteristics, procedural variables, and complications for AF ablation has evolved over time.