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Introduction: Percutaneous epicardial access (EpiAcc) is frequently required for endo-epicardial ablation of ventricular tachycardia (VT), especially in ischemic cardiomyopathy, where it has been demonstrated to increase success rate. For patients who have indications for chronic oral anticoagulation (OAC), this often poses a challenge due to potential risks of procedural complications. We sought to assess the safety and outcomes of epicardial VT ablation on uninterrupted OAC compared to off anticoagulation. Methods: In this multicenter study, we retrospectively analyzed patients with ischemic cardiomyopathy and VT who underwent endo-epicardial ablation with EpiAcc. The study group included patients who underwent ablation either under uninterrupted OAC or off anticoagulation. Procedural data, outcomes, and complication rates were analyzed for comparison of both groups. Results: Overall, we analyzed 135 patients who underwent VT ablation via EpiAcc; 55 under full-dose uninterrupted AC and 80 off AC. There was no difference in procedure-related complications between both groups (1.8% vs 2.5%, p=0.09). There was no major bleeding requiring transfusion in any group. There was no difference in risk of cardiac tamponade between both groups (0% vs 0%, p=1). The rate of groin hematoma was 1.8% vs 1.3%, p=0.087). No thromboembolic events were reported. Conclusion: Epicardial VT ablation on uninterrupted OAC is a safe alternative to off AC, with no additional risk of life-threatening complications, thus preventing the possibility of thromboembolic events in patients who have an indication for chronic AC. 1

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Introduction: Leadless pacemakers (LP) are a less invasive option compared to conventional transvenous pacemakers (TVP). They were introduced with the hope of eliminating complications associated with TVP and leads, which are more common among the elderly population. However, evidence supporting their use is uncertain. This study aims to compare the safety of the LP compared to TVP in patients 65 and older. Methods: We retrospectively analyzed consecutive patients, aged 65 and older, who were implanted a LP or TVP between August 2017 and November 2021, in 2 experienced Cardiovascular centers. The primary endpoint was a composite of any procedure-related complication (hematoma, venous thrombosis, infections, hemothorax, device dislodgement, pneumothorax). The secondary endpoint was the need for reinterventions. Results: A total of 313 patients were included; 219 received a TVP and 94 patients received a LP. Of the TVPs implanted, 68% used cephalic access, 21% axillary and 11% subclavian. The mean age was 78.9 + 7.76 for the TVP group and 82.6 +8.83 for the LP group. A total of 23 patients in the TVP group reached the primary end point vs 4 patients in the LP group, with a relative risk reduction of 60% of procedure related complications in LP compared to TVP (risk ratio [RR]:0.4; 95% CI (0.144-1.139); P= 0.043). In addition, 8 patients in the TVP group reached the secondary outcome vs none in the LP group (3.65% vs. 0%; p= <0.00001).. There were no statistically significant differences in individual outcomes between the TVP group and the LP group: incision-site hematomas (11 (5%) vs. 2 (2.1%); p=0.24), venous thrombosis (2 (2%) vs 1 (0.5 %); p=0.9), infections (1 (0.5%) vs 1 (1%) ; p=0.54), hemothorax (1 (0.5%) vs. 0 (0%); p=1), device dislodgement (8 (3.6%) vs 0 (0%); p=0.11), pneumothorax (none in either group). Conclusion: This study demonstrates that LP is a safer option than TVP among patients aged 65 and older. Additional studies are needed to further establish these findings. 1