Background: Catheter ablation is an effective treatment for atrial fibrillation (AF), primarily performed in patients who fail antiarrhythmic drugs. Whether early catheter ablation, as first-line therapy, is associated with improved clinical outcomes remains unclear. Methods: Electronic databases (PubMed, Scopus, Embase) were searched until March 28th, 2021. Randomized controlled trials (RCTs) compared catheter ablation vs antiarrhythmic drug therapy as first-line therapy were included. The primary outcome of interest was the first documented recurrence of any atrial tachyarrhythmia (symptomatic or asymptomatic; AF, atrial flutter, and atrial tachycardia). Secondary outcomes included symptomatic atrial tachyarrhythmia (AF, atrial flutter, and atrial tachycardia) and serious adverse events. Unadjusted risk ratios (RR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance considered if the confidence interval (CI) excludes one and p < 0.05. Results: A total of six RCTs with 1212 patients (Ablation n = 609; Antiarrhythmic n = 603) were included. Follow- up period ranged from 1–2 years. Patients who underwent ablation were less likely to experience any recurrent atrial tachyarrhythmia when compared to patients receiving antiarrhythmic drugs (RR 0.63; 95% CI 0.55–0.73; p < 0.00001). Symptomatic atrial tachyarrhythmia was also lower in the ablation arm (RR 0.53; 95% CI 0.32–0.87; p = 0.01). No statistically significant differences were noted for overall any type of adverse events (RR 0.93; 95% CI 0.68–1.27; p = 0.64) and cardiovascular adverse events (RR 0.90; 95% CI 0.56–1.44; p = 0.65) respectively. Conclusions: Catheter ablation, as first-line therapy, was associated with a significantly lower rate of tachyarrhythmia recurrence compared to conventional antiarrhythmic drugs, with a similar adverse effect risk profile. These findings support a catheter ablation strategy as first-line therapy among patients with symptomatic paroxysmal atrial fibrillation.

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Funding Acknowledgements Type of funding sources: None. Background-Transcatheter aortic valve replacement (TAVR) is associated with periprocedural bleeding , mainly driven by vascular complications leading to blood cell transfusion. Additionally, anemia is highly prevalent in this population. The decision regarding the necessity for blood transfusion in patients undergoing TAVR is challenging. Methods-Electronic databases (Medline, Embase, Scopus, Cochrane) were searched from inception to December 16th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p &lt; 0.05.The primary outcomes of interest were all-cause mortality, myocardial infarction(MI), Stroke(CVA), and acute kidney injury(AKI). Results- A total of six studies with 6701 participants (Transfusions = 1505, Non-Transfusions = 5196) were included in our analysis. Average follow-up duration was 30 days. Mean age was 82.4 and 81.5 in the Transfusions and Non-transfusions group respectively. RBC transfusion was associated with higher 30-day mortality (OR-4.08; 95%CI 2.29-7.27; p &lt; 0.00001; I2 = 77) as well as increased risk of acute kidney injury (AKI) (OR 2.97;95%CI 2.07-4.26; p &lt; 0.00001; I2 = 77) and stroke (OR 2.44; 95%CI 1.78- 3.34; p &lt; 0.00001,I2 = 0) However, there was no significant difference in the incidence of MI (OR 1.15;95%CI 0.50-2.64; p = 0.74,I2 = 0) Conclusion- RBC transfusion is a correlate and an independent predictor of all-cause mortality, acute kidney injury and stroke in this patient population and should be used with caution Abstract Figure.

Funding Acknowledgements Type of funding sources: None. Background- Recent studies have demonstrated the favorable cardiovascular outcomes of coronary artery bypass graft surgery (CABG) among patients with diabetes mellitus (DM). However, little is known regarding the impact of T2DM in patients undergoing CABG. We aimed to compare the long-term mortality following CABG in patients with and without T2DM. Methods-Electronic databases ( PubMed, Embase, Scopus, Cochrane) were searched from inception to December 15th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p &lt; 0.05.The primary outcome was all-cause mortality. Results-Sixteen studies with a total of 183,200 participants (DM = 51,474, Non-DM = 131,726) were included in our analysis. Average follow up was 3 years. Mean age was 56.7 and 54.8 in the DM and Non-DM groups respectively. A statistically significantly higher rate of mortality was observed in patients with T2DM (OR 1.54; 95%CI 1.40-1.69; p &lt; 0.00001, I2 = 36)as opposed to patients without T2DM. Conclusion- Although CABG is the better revascularization strategy as opposed to PCI, Type 2 DM is an independent predictor for long-term mortality after CABG surgery. Abstract Figure.