BACKGROUNDA polypill that includes key medications associated with improved outcomes (aspirin, angiotensin-converting-enzyme [ACE] inhibitor, and statin) has been proposed as a simple approach to the secondary prevention of cardiovascular death and complications after myocardial infarction. METHODSIn this phase 3, randomized, controlled clinical trial, we assigned patients with myocardial infarction within the previous 6 months to a polypill-based strategy or usual care. The polypill treatment consisted of aspirin (100 mg), ramipril (2.5, 5, or 10 mg), and atorvastatin (20 or 40 mg). The primary composite outcome was cardiovascular death, nonfatal type 1 myocardial infarction, nonfatal ischemic stroke, or urgent revascularization. The key secondary end point was a composite of cardiovascular death, nonfatal type 1 myocardial infarction, or nonfatal ischemic stroke. RESULTSA total of 2499 patients underwent randomization and were followed for a median of 36 months. A primary-outcome event occurred in 118 of 1237 patients (9.5%) in the polypill group and in 156 of 1229 (12.7%) in the usual-care group (hazard ratio, 0.76; 95% confidence interval [CI], 0.60 to 0.96; P = 0.02). A key secondaryoutcome event occurred in 101 patients (8.2%) in the polypill group and in 144 (11.7%) in the usual-care group (hazard ratio, 0.70; 95% CI, 0.54 to 0.90; P = 0.005). The results were consistent across prespecified subgroups. Medication adherence as reported by the patients was higher in the polypill group than in the usual-care group. Adverse events were similar between groups. CONCLUSIONSTreatment with a polypill containing aspirin, ramipril, and atorvastatin within 6 months after myocardial infarction resulted in a significantly lower risk of major adverse cardiovascular events than usual care. (Funded by the European Union Horizon 2020; SECURE ClinicalTrials.gov number, NCT02596126; EudraCT number, 2015 -002868 -17.

The CB-A is very effective in producing PVI and affords freedom from AF at 12 months follow-up in 83% of patients affected by drug-resistant PAF following a 3-month BP. The most frequent complication observed was PNP which occurred in 19% of patients. All PNP reverted during follow-up.

Background Radiofrequency ablation (RFA) of ventricular tachycardia (VT) can fail due to inaccessibility to the VT substrate. Trans-arterial coronary ethanol ablation (TCEA) can be effective, but entails arterial instrumentation risk. We hypothesized that retrograde coronary venous ethanol ablation (RCVEA) can be an alternative bail-out approach to failed VT RFA. Methods and Results Out of 334 consecutive patients undergoing VT/PVC ablation, seven patients underwent RCVEA. Six of seven patients had failed RFA attempts (including epicardial in 3). Coronary venogram-guided venous mapping was performed using a 4F quadripolar catheter or an alligator-clip-connected angioplasty wire. Targeted veins included those with early pre-systolic potentials and pace-maps matching VT/PVC. An angioplasty balloon (1.5-2 × 6 mm) was used to deliver 1-4 cc of 98% ethanol into a septal branch of the anterior interventricular vein (AIV) in 5 patients with LV summit VT, a septal branch of the middle cardiac vein, and a postero-lateral coronary vein (n=1 each). The clinical VT was successfully ablated acutely in all patients. There were no complications of RCVEA, but one patient developed pericardial and pleural effusion attributed to pericardial instrumentation. On follow-up of 590 ±722 days, VT recurred in 4/7 patients, three of whom were successfully re-ablated with RFA. Conclusions RCVEA is safe and feasible as a bail-out approach to failed VT RFA, particularly those originating from the LV summit.

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