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Aims We sought to compare the effectiveness and safety of high-power short-duration (HPSD) radiofrequency ablation (RFA) with conventional RFA in patients with atrial fibrillation (AF). Methods and results MEDLINE, Cochrane, and ClinicalTrials.gov databases were searched until 15 May 2020 for relevant studies comparing HPSD vs. conventional RFA in patients undergoing initial catheter ablation for AF. A total of 15 studies involving 3718 adult patients were included in our meta-analysis (2357 in HPSD RFA and 1361 in conventional RFA). Freedom from atrial arrhythmia was higher in HPSD RFA when compared with conventional RFA [odds ratio (OR) 1.44, 95% confidence interval (CI) 1.10–1.90; P = 0.009]. Acute PV reconnection was lower (OR 0.56, P = 0.005) and first-pass isolation was higher (OR 3.58, P < 0.001) with HPSD RFA. There was no difference in total complications between the two groups (P = 0.19). Total procedure duration [mean difference (MD) −37.35 min, P < 0.001], fluoroscopy duration (MD −5.23 min, P = 0.001), and RF ablation time (MD −16.26 min, P < 0.001) were all significantly lower in HPSD RFA. High-power short-duration RFA also demonstrated higher freedom from atrial arrhythmia in the subgroup analysis of patients with paroxysmal AF (OR 1.80, 95% CI 1.29–2.50; P < 0.001), studies with ≥50 W protocol in the HPSD RFA group (OR 1.53, 95% CI 1.08–2.18; P = 0.02] and studies with contact force sensing catheter use (OR 1.65, 95% CI 1.21–2.25; P = 0.002). Conclusion High-power short-duration RFA was associated with better procedural effectiveness when compared with conventional RFA with comparable safety and shorter procedural duration.

This is the first report of an incidence of postoperative seizures of 0.6% in pediatric cranial vault reconstructive surgery. There was no significant difference in postoperative seizures or seizure-like events in those patients who received the tranexamic acid or aminocaproic acid vs those that did not. This report provides evidence of the safety profile of antifibrinolytic in children having noncardiac major surgery. Caution should prevail however in using antifibrinolytic in high-risk patients. Antifibrinolytic dosage regimes should be based on pharmacokinetic data avoiding high doses.

Background: Conventional permanent His Bundle pacing (PHBP) can be challenging and associated with high fluoroscopy exposure. The aim of this study was to assess the feasibility and safety of performing low fluoroscopy PHBP using 3-dimensional electroanatomic mapping and comparing outcomes with conventional fluoroscopy guided PHBP implants. Methods: PHBP was performed at 2 centers using electroanatomic mapping-guided low fluoroscopy implantation in 10 patients using a novel protocol (group 1) and conventional fluoroscopy guided implantation in 20 patients (group 2). The primary end point was feasibility of achieving PHBP with low/zero fluoroscopy and safety end points included total radiation exposure (fluoroscopy time and dose area product), procedure-related complications associated with lead implantation or need for lead revisions. Results: PHBP was successful in 9 of 10 patients (90%) in group 1 and 100% successful in the group 2 patients. The mean His lead fluoroscopy time was significantly lower in group 1 (0.2±0.2 minutes) compared with 8±7 minutes in group 2 ( P =0.002) as was the total fluoroscopy time (0.8±0.3 versus 13±8 minutes, P =0.003) and the dose area product (96±83 versus 1531±923 microGy/m 2 , P =0.003). The HB capture threshold was lower in group 1 (0.7±0.4 at 1 ms) compared with patients in group 2 (1.15±0.7 at 1 ms) P =0.04. There were no procedure-related complications or lead dislodgements in either group. There was an increase in HB capture threshold in 1 patient (5%) in group 2 at 1-month follow-up. Conclusions: Electroanatomic mapping-guided PHBP is feasible can be performed safely and results in a significant reduction in fluoroscopy duration and exposure.