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Funding Acknowledgements Type of funding sources: None. Introduction Electrical storm (ES) is a life-threatening clinical condition characterized by the recurrence of three or more episodes of ventricular tachycardia (VT) and/or ventricular fibrillation within 24 hours, leading to ICD therapy. Catheter ablation of VT in patients with ES is a high-risk procedure but has been shown to reduce VT recurrence and the number of appropriate ICD therapies in patients with structural heart disease. Purpose Our study aimed to compare the characteristics and outcomes of VT ablation in patients with or without ES. Methods Our single-center study included a cohort of 39 consecutive patients (31 men, mean age=60.9±18.4 years) who underwent VT ablation between January 2020 and January 2022, 21 of them (53.8%) due to ES and 18 patients (46.2%) had an elective procedure. Clinical and procedural characteristics, VT recurrence, and mortality rates were compared between the two groups. Results Patients with ES were older than patients without ES (67.8 vs 54.2 years, p=0.004), they were mainly presented with ischaemic cardiomyopathy (85.7% vs 27.8%, p Conclusion Patients presented with ES are a more vulnerable population with many comorbidities. Catheter ablation of VT in patients with ES is a more complex procedure with a higher complication rate and these patients have a higher risk of in-hospital mortality. Further studies are needed to determine the optimal timing of VT ablation in this patient population.

Funding Acknowledgements Type of funding sources: None. Background Subcutaneous ICD (S-ICD) is an established therapy for prevention of sudden cardiac death due to ventricular arrhythmias (VA). One major drawback of the S-ICD is the lack of antibradycardia pacing. Theroretically the S-ICD can be used in combination with endocardial or epicardial pacemaker (PM), or even cardiac resinchronization (CRT) devices, but recently there are only few case reports available on this topic. Purpose To evaluate the feasibility and safety of concomitant use of endocardial or epicardial PM or CRT devices and S-ICD in a single center patient cohort. Methods Fifty-seven patients underwent S-ICD implantation in our center between 2017 and 2022. Based on individualized decision making-process, six out of these patients underwent the S-ICD implantation without explantation of previuosly implanted transvenous devices, or after epicardial PM or CRT implantation (group 1). The procedural and follow-up data of these patients were compared with data of the other 51 patients (group 2). All patients underwent successful S-ICD screening before implantation. Patients with previously implanted devices were screened either in bipolar pacing mode and either during intrinsic rhythm, if present. S-ICD implantations were performed under general anaesthesia (33 %) or under deep sedation with ultrasound guided regional nerve blocks (66 %) using intermuscular generator placement and two incision technique. Defibrillation threshold test was performed successfully in all the 57 patients. Results All S-ICD implantations were performed successfully without any procedural complications. There were no significant difference between group 1 and group 2 in terms of age (52,3±20 yrs vs. 37,7±18,5 yrs, p=0,75), ejection fraction (49,2±25,6 % vs. 46,5±21 %, p=0,77), procedure duration (57±9,7 min. vs. 52,2±15,5 min., p=0,46), and the mean follow-up duration (20,5±23,6 months vs. 25±18,8 months, p=0,59). During follow-up, one patient in group 1 (17%), and 10 patients in group 2 (19,6 %) experienced adequate ICD therapies due to VA. There were no inadequate ICD therapy in group 1, but eight patients (15,6 %) in group 2 suffered from inadequate ICD shocks caused by T wave oversensing (3/8), atrial fibrillation (2/8) myopotential oversensing (2/8,) and S-ICD lead fracture (1/8). In group 1, no interferences occured between the implanted devices, and no missed S-ICD therapy were observed during induced or spontaeous VA due to pacing artefact oversensing by the S-ICD caused by undersensing of the VA by the pacemakers. Non of the patients in group 2 experienced symptomatic bradycardia required antibradycardia pacing during follow up. Conclusion Based on our observations, S-ICD implantation after previously implanted endocardial or epicardial pacemaker or CRT systems seems feasible and safe. After individualized decision-making, with careful screening and device programming the potential interference between the implanted devices can be prevented.

Background Cryoballoon ablation is a well-established anatomical approach for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Although widely adopted, regional variations in standards of care have not been well characterized. Purpose To evaluate regional variations in patient selection and procedural characteristics for PVI with cryoablation in the Cryo Global Registry (NCT02752737). Methods Patients with AF were enrolled from May 2016 to October 2021 at 128 sites in 37 countries. Patients were treated with cryoballoon ablation according to local clinical practice. Baseline subject and procedural characteristics were summarized for 8 regions (Central Asia and Russia, East Asia, Europe, Middle East, North America, South Africa, South America, and Southeast Asia). Procedure-related serious adverse events (SAEs) were evaluated in a subset of patients with ≥7 days of follow-up. Results A total of 3680 patients undergoing initial PVI for AF were included. Cryoballoon ablation was more commonly performed in patients with paroxysmal vs. persistent AF in all regions, and in males vs. females in all regions except Central Asia and Russia. Mean age ranged from 47±12 in the Middle East to 64±11 in East Asia. Regional variations were observed in the proportion of patients with common AF comorbidities undergoing cryoablation (Table 1). Median procedure time ranged from 61 (49–68) minutes in Central Asia and Russia to 95 (76–120) minutes in Southeast Asia. Median fluoroscopy time was ≤20 minutes in all regions. The use of 3D mapping was relatively uncommon except in North America (63.3%). Large variation was observed in the use of esophageal monitoring, whereas phrenic nerve monitoring was used in ≥97.7% of cases in all regions (Table 2). Same-day discharge was uncommon except in North and South America (37.8% and 26.5% of cases, respectively). Average freeze duration ranged from 153±41 seconds in Southeast Asia to 230±29 seconds in Central Asia and Russia. Mean number of applications per vein ranged from 1.2±0.4 in Central Asia and Russia to 2.1±1.0 in North America. Acute procedural success was ≥94.7% in all geographies and focal radiofrequency touch-up was required in ≤13.0% of cases. In 3126 subjects with ≥7 days of follow-up, 122 procedure-related SAEs were reported in 111 patients (3.6%), and 1 procedure-related death was reported during data collection. Conclusion(s) Despite regional variations in patient selection and procedural characteristics, PVI using cryoballoon ablation is performed with high acute success and short procedural times around the world. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Medtronic, Inc.

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): The registry was sponsored Medtronic, Inc., Minneapolis, MN. Background Atrial fibrillation (AF), the most common cardiac arrhythmia, burdening patients with a myriad of symptoms. Three recent randomized trials demonstrated that cryoballoon ablation (CBA) is superior to antiarrhythmic drugs (AADs) as a first-line treatment for the prevention of arrhythmia reoccurrence in patients with paroxysmal AF. However, the global outcome of CBA performed according to local standard of care as a first-line therapy for AF is not reported. Purpose To compare safety, efficacy, and quality of life outcomes in patients treated with CBA for first-line management of AF against patients treated with CBA following failed AAD therapy. Methods The Cryo AF Global Registry, an ongoing, prospective, multicenter registry, of AF patients undergoing index CBA performed according to local standards at 58 centers in 26 countries worldwide. In this analysis, subjects undergoing first-line cryoablation were compared to patients who were refractory to AAD therapy and/or taking AADs at baseline. Safety was assessed utilizing a composite of serious procedure-related complications. To evaluate efficacy, time-to-first atrial fibrillation, -flutter and/or -tachycardia (AF/AFL/AT) recurrence post a 90-day blanking period was compared between groups using Kaplan-Meier estimates. Quality of life was evaluated using the EQ-5D-3L questionnaire at baseline and at 12 months following CBA. Log-rank, two-sample t-test, and exact binomial tests were utilized to test difference between groups. Results Of 1,394 total patients, 433 (31.1%) were drug naïve prior to CBA. Patients in the AAD therapy cohort failed a mean of 1.2 ± 0.5 AADs before CBA. Freedom from AF/AFL/AT recurrence at 12 months was 87.8% in first-line patients compared to 81.6% in AAD-refractory patients (p Conclusion This real-world global evaluation supports CBA as a safe and efficacious first-line treatment that improves the quality of life for patients with symptomatic AF.

Background Infective endocarditis (IE) is a rare, but life-threatening complication of cardiac device implantation. Despite recent preventive strategies, and advances in antimicrobial and surgical treatment, morbidity and mortality rates are still high. Aims The objective of our study was to assess the epidemiological characteristics, temporal tends and mortality rate of cardiac device related IE (CDRIE) in our high-volume, tertiary referral center. Methods retrospective data collection was performed from January 1, 2006 to December 31, 2016. Thirty-day, 6-month and 1-year mortality was estimated, which were compared to left-sided native valve endocarditis (LSNIE). Patients administered between 2006 and 2010 and between 2011 and 2016 were compared to assess temporal trends. Results 465 cases of IE were administered, out of whom 54 patients had CDRIE (39 males [72%], mean age: 55.8 ±19 yrs; 4 VVI, 7 VDD, 7 VVI-ICD, 20 DDD, 5 DDD-ICD and 11 CRT devices; median time since first implantation: 1558 days [IQR: 470 days – 8.6 yrs]). The infection was caused by streptococci in 3 cases (5.5%), Staphylococci were the most prevalent infective agents (70%), S. aureus (SA) in 28 cases (52%, out of whom 10 were MRSA), coagulase negative Staphylococcus in 10 cases (18.5%), blood culture negative cases in 8 patients (15%), and in 5 cases other pathogens were responsible. 266 patients had LSNIE (201 males [75%], mean age: 54.4 ± 15.6 yrs). There was no difference between the two groups in age or in portion of males. Mortality rates were the same in CDRIE group compared to LSNIE group (30-day: 13% vs 13%, 6-month: 20% vs 25%, 1-year: 26% vs 29% and long-term: 44% vs 44%, ns resp.) Patients who died in the CDRIE group (n = 25) were older (64 yrs [IQR:59-71 yrs] vs 52 yrs [IQR: 27-69 yrs], p = 0.02), male sex was less common (52% vs 79%, p = 0.03), had lower ejection fraction (39.6 ±16.6% vs 54.6 ±14.5%, p Patients admitted before 2011 (n = 22) did not differ from patients admitted after 2011 (n = 32) in terms of age, male gender, concomitant valve infection, pocket infection, or embolic event. The 30-day (0% vs 6%) and the 1-year mortality (18% vs 31%) were the same before and after 2011, but the 6-month mortality was better before 2011 (4.5% vs 31%, p = 0.01). CRT device implantation was more prevalent over time (5% vs 31%, p = 0.01), and SA infection became more frequent (36% vs 63%, p = 0.05) Conclusions During the last decade patients with CDRIE had a same survival as patients with LSNIE, every fourth patient died one year after the diagnosis. Almost three-quarter of the infections were caused by Staphylococci, and the portion of S. aureus infection increased over time.