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Background: Recurrence rates of atrial fibrillation (AF) remain high even after complete wide area circumferential pulmonary vein isolation (PVI). In recent years adjunct posterior wall isolation (PWI) has been performed in patients with more persistent forms of AF but the benefits remain unclear. Aim: The objective of this meta‐analysis was to evaluate the efficacy of adjunct posterior wall isolation in reducing recurrence rates of AF using cryoballoon ablation (CBA). Methods: We searched PubMed, Google Scholar, Clinicaltrials.gov and Cochrane CENTRAL. We included studies comparing PVI to PVI + PWI in patients with either persistent or paroxysmal AF (PAF) undergoing CBA. After data extraction and quality assessment of the studies, we assessed recurrence rates of atrial tachy‐arrhythmias (AF, atrial flutter, and atrial tachycardia) as well as total ablation time and procedural adverse events. Risk ratio (RR), mean difference (MD), and 95% confidence interval (CI) were calculated using Review Manager. Results: Concomitant PWI exhibited a substantial reduction in the risk of AF recurrence (RR: 0.51; 95% CI: 0.42–0.63, p <.00001), as well as all atrial arrhythmias (RR: 0.58; 95% CI: 0.49–0.68, p <.00001). On subgroup analysis, in patients with only PAF, adjunct PWI resulted in significant reduction in recurrence risk of AF (RR: 0.56; 95% CI: 0.41–0.76, p =.0002) as well. There was no significant difference in adverse events between both groups (RR: 0.90; 95% CI: 0.44–1.86; p =.78), whereas total ablation time was significantly increased in PVI + PWI group (MD: 21.75; 95% CI: 11.13–32.37, p <.0001). Conclusion: Adjunct PWI when compared to PVI alone decreases recurrence rates of atrial fibrillation after CBA of patients with persistent as well as paroxysmal atrial fibrillation. [ABSTRACT FROM AUTHOR]

Atrial Fibrillation (AF) is a major risk factor for stroke, which is the second leading cause of death worldwide. It remains uncertain whether insertable cardiac monitors (ICMs) enhance the ability to recognize AF over external cardiac monitoring in patients who have experienced a stroke. We conducted a systematic review and meta-analysis to determine whether ICM devices are more effective than external cardiac monitoring for the detection of AF in stroke patients. We included studies that reported an AF detection rate in stroke patients with a follow-up of at least 12 months. We analyzed the data of 1233 patients from 3 randomized control trials (RCTs). When compared to external cardiac monitoring, ICM devices (Medtronic Reveal LINQ and Reveal XT) showed a significantly higher detection rate of AF (RR = 5.04, 95% CI = 2.93–8.68; p < 0.05; ARR = 10.47%, NNT = 10). The ICM arm had significantly higher usage of oral anticoagulants (OAC) as compared to the control arm. (RR = 2.76, 95% CI = 1.89–4.02, p < 0.05). Additionally, ICM usage was associated with a higher incidence of mild to moderate adverse events (RR = 10.52, 95% CI =1.35–82.14; p = 0.02) and a higher number of severe adverse events as compared to the control arm (RR = 7.61, 95% CI = 1.36–42.51; p = 0.02). ICM devices are associated with better detection rates of AF and higher usage of OAC as compared to external cardiac monitoring in post-stroke patients. However, ICM insertion is associated with a higher incidence of mild/moderate and severe adverse effects. • ICM usage shows higher AF detection in comparison to external cardiac monitoring. • Both Medtronic Reveal LINQ and XT devices show higher AF detection compared to control. • ICM usage after stroke results in higher usage of OAC as compared to control. • No difference in reduction of recurrent stroke and mortality between ICM and control. • ICM reports higher implant-related adverse effects than external cardiac monitoring. [ABSTRACT FROM AUTHOR]

Background: Conduction system pacing (CSP) by His bundle pacing or left bundle branch area pacing (LBBAP) is incorporated into Heart Rhythm Society guidelines for the management of bradycardia and cardiac resynchronization therapy. Despite increasing adoption with both lumenless leads and stylet-driven leads, concerns regarding the feasibility and safety of the extraction of CSP leads remain., Objective: The aim of the study was to report on the safety, feasibility, and clinical outcomes of the extraction of CSP leads., Methods: Patients undergoing the extraction of CSP leads from 10 international centers were enrolled in this retrospective study. Data regarding indications, lead location, lead type, extraction tools, procedural success, complications, and reimplantation in the conduction system were collected., Results: Overall, 341 patients (age 69 ± 15 years; female 34%; cardiomyopathy 46%; lead dwell time 22 ± 26 months) underwent the extraction of 224 His bundle pacing and 117 LBBAP leads (lumenless leads 321; stylet-driven leads 20). Complete procedural success was achieved in 338 (99%), while clinical success was 100% with retained distal fragments in 3 patients (1%). Among patients with a lead dwell time of >6 months (6-193 months; n = 226), manual extraction was successful in 198 (87%), mechanical tools in 22 (10%), and laser in 6 (3%). Femoral tools were necessary in 3 patients. Minor complications occurred in 7 patients (2.1%). CSP reimplantation was successful in 233 of 244 patients attempted (95%)., Conclusion: The overall success rates of the extraction of CSP leads were very high (although the LBBAP lead dwell time was <3 years), with a low need for extraction tools and minimal complication. Reimplantation in the conduction system is feasible and safe., Competing Interests: Disclosures Dr Vijayaraman has received honoraria and research support from and is a consultant for Medtronic, serves on the advisory board of and is a consultant for Abbott, and has received honoraria from Biotronik and Boston Scientific. He owns a patent for His bundle pacing delivery tool. Dr Koneru has received honoraria from Medtronic and Biotronik and has received fellowship support from Boston Scientific, Biosense Webster, Medtronic, and Abbott Medical. Dr Sharma has received honoraria from Medtronic and is a consultant for Medtronic, Abbott, and Biotronik. Dr De Pooter has received speaker honoraria and consultancy fees from Medtronic, Biotronik, Abbott, and Boston Scientific. Dr Schaller has received honoraria from Medtronic, Cook Medical, and Phillips. Dr Cano has received honoraria from and is a consultant for Medtronic, Biotronik, and Boston Scientific. Dr Whinnett has received honoraria from Medtronic and Boston Scientific and is a consultant for Medtronic and Abbott. Dr Migliore is a consultant for and has received research support from Boston Scientific and Cook Medical. Dr Ponnusamy has received honoraria from Medtronic. Dr Zanon has received honoraria from Abbott, Biotronik, Boston Scientific, Medtronic, and MicroPort. Dr Heuverswyn has received honoraria from Abbott and Boston Scientific. Dr Ellenbogen is a consultant for Medtronic, Boston Scientific, Abbott, and Biotronik and has received honoraria from Medtronic, Boston Scientific, and Biotronik. Dr Herweg is a speaker and consultant for Abbott and is a speaker for and has received fellowship support from Medtronic. The rest of the authors report no conflicts of interest., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)