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In this study, Rhinochill was not found to be more efficient than Blanketrol for TH induction, although there was a non-significant trend in favour of Rhinochill that potentially warrants further investigation with a larger trial.

OBJECTIVES Atrial fibrillation is common and can cause significant morbidity and detriment to quality of life. Success rates for conventional catheter ablation are suboptimal in persistent atrial fibrillation, especially when longstanding. Convergent hybrid ablation combines endoscopic surgical epicardial and endocardial catheter ablation. It offers promise in treating persistent atrial fibrillation. We aimed to evaluate outcomes at our center following Convergent ablation. METHODS We conducted an observational study of patients undergoing ablation from 2012–2019 at a London cardiac center. 67 patients underwent Convergent Ablation entailing epicardial ablation, mostly via sub-xiphoid access, followed by endocardial left atrial catheter ablation. Baseline and follow-up data were obtained retrospectively from clinical records. Primary outcome was freedom from atrial fibrillation on/off anti-arrhythmic drugs after 12-months follow-up. Secondary outcomes included freedom from atrial fibrillation over entire follow-up, freedom from anti-arrhythmic drugs, freedom from atrial arrhythmias, symptom status, repeat ablation and complications. RESULTS At baseline, 80.6% had persistent atrial fibrillation >1 year (80.6%), 49.3% had body mass index >30kg/m2 at baseline and 19.4% had left ventricular ejection fraction of 40% or less. Median follow-up was 2.3 (1.4–3.7) years. Freedom from atrial fibrillation recurrence was 81.3% at 1 year and 61.5% over overall follow-up. 11 patients (16.4%) required redo atrial fibrillation ablation. Prolonged atrial fibrillation duration was associated with increased recurrence at 12 months and duration greater than 5 years with a shorter time to recurrence on Kaplan–Meier analysis, but this and other factors did not significantly impact on atrial fibrillation recurrence during the overall follow-up period. CONCLUSIONS Convergent ablation had good 1 year- and overall success rates for treating persistent atrial fibrillation. Our results in a diverse, real-world population support the potential of Convergent ablation in patients with challenging to treat persistent atrial fibrillation.

Background Cardiac resynchronization therapy‐defibrillator (CRT‐D) implantation via the cephalic vein is feasible and safe. Recent evidence has suggested a higher implantable cardioverter‐defibrillator (ICD) lead failure in multi‐lead defibrillator therapy via the cephalic route. We evaluated the relationship between CRT‐D implantation via the cephalic and ICD lead failure. Methods Data was collected from three CRT‐D implanting centers between October 2008 and September 2017. In total 633 patients were included. Patient and lead characteristics with ICD lead failure were recorded. Comparison of “cephalic” (ICD lead via cephalic) versus “non‐cephalic” (ICD lead via non‐cephalic route) cohorts was performed. Kaplan–Meier survival and a Cox‐regression analysis were applied to assess variables associated with lead failure. Results The cephalic and non‐cephalic cohorts were equally male (81.9% vs. 78%; p = .26), similar in age (69.7 ± 11.5 vs. 68.7 ± 11.9; p = .33) and body mass index (BMI) (27.7 ± 5.1 vs. 27.1 ± 5.7; p = .33). Most ICD leads were implanted via the cephalic vein (73.5%) and patients had a mean of 2.9 ± 0.28 leads implanted via this route. The rate of ICD lead failure was low and statistically similar between both groups (0.36%/year vs. 0.13%/year; p = .12). Female gender was more common in the lead failure cohort than non‐failure (55.6% vs. 17.9%, respectively; p = .004) as was hypertension (88.9% vs. 54.2%, respectively, p = .038). On multivariate Cox‐regression, female sex (p = .008; HR, 7.12 [1.7−30.2]), and BMI (p = .047; HR, 1.12 [1.001−1.24]) were significantly associated with ICD lead failure. Conclusion CRT‐D implantation via the cephalic route is not significantly associated with premature ICD lead failure. Female gender and BMI are predictors of lead failure.