Background: Beta‐blockers (BB) or dihydropyridine calcium channel blockers (CCBs) are still the first choices in the treatment of idiopathic premature ventricular complexes (PVCs), with low‐modest efficacy. Antiarrhythmic drugs (AADs) of Ic class are moderate to highly efficient but the evidence on their benefits is still limited.Aim: To compare effectiveness and safety of flecainide, propafenone, and sotalol in the treatment of symptomatic idiopathic PVCs.Methods: Our single‐center retrospective study analyzed 104 consecutive patients with 130 medication episodes of frequent idiopathic PVCs treated with AADs flecainide, propafenone (Ic class) or sotalol (III class). The primary outcome was complete/near complete reduction of PVCs after medication episode (PVCs burden reduction >99%), and the secondary outcome was significant PVC burden reduction (≥80%).Results: The complete/near complete PVCs burden reduction occurred in 31% and was significant in 43% of treated patients. A reduction of PVC burden for >99% was achieved in 56% of patients on flecainide, in 11% of patients on propafenone (p = .002), and in 21% of patients receiving sotalol (p = .031). There was no difference between propafenone and sotalol (p = .174). A reduction of PVC burden for ≥80% was achieved in 64% of patients on flecainide, in 30% of patients on propafenone (p = .009), and 33% of patients on sotalol (p = .020). There was no difference between propafenone and sotalol (p = .661).Conclusions: The efficacy of AADs class Ic and III in the treatment of idiopathic PVCs was modest. Flecainide was the most effective AAD in the achievement of complete/near complete or significant PVC burden reduction, compared to propafenone and sotalol.

Background and Objectives: ACS presents an acute manifestation of coronary artery disease and its treatment is based on timely interventional diagnostics and PCI. It has been known that the treatment and the outcomes are not the same for all the patients with ACS during the working day, depending on the availability of the procedures and staff. The aim of the study was to explore the differences in clinical characteristics and outcomes in patients admitted for ACS during on- and off-hours. Materials and Methods: The retrospective study included 1873 consecutive ACS patients admitted to a tertiary, university hospital that underwent coronary angiography and intervention. On-hours were defined from Monday to Friday from 07:30 h to 14:30 h, while the rest was considered off-hours. Results: There were more males in the off-hours group (on-hours 475 (56%) vs. off-hours 635 (62%); p = 0.011), while previous MI was more frequent in the on-hours group (on 250 (30%) vs. off 148 (14%); p < 0.001). NSTEMI was more frequent during on-hours (on 164 (19%) vs. off 55 (5%); p < 0.001), while STEMI was more frequent during off-hours (on 585 (69%) vs. off 952 (93%); p < 0.001). Patients admitted during on-hours had more multivessel disease (MVD) (on 485 (57%) vs. off 489 (48%); p = 0.006), as well as multivessel PCI (on 187 (22%) vs. off 171 (16%); p = 0.002), while radial access was preferred in off-hours patients (on 692 (82%) vs. off 883 (86%); p = 0.004). Left main PCI was performed with similar frequency in both groups (on 37 (4%) vs. off 35 (3%); p = 0.203). Death occurred with similar frequency in both groups (on 17 (2.0%) vs. off 26 (2.54%); p = 0.404), while major adverse cardio-cerebral events (MACCEs) were more frequent in the on-hours group (on 105 (12.4%) vs. off 70 (6.8%); p = 0.039) probably due to the more frequent repeated PCI (on 49 (5.8%) vs. off 27 (2.6%); p = 0.035). Conclusions: Patients admitted for ACS during working hours in a tertiary hospital present with more complex CAD, have more demanding interventions, and experience more MACCEs during follow-up mostly due to myocardial infarctions and repeated procedures.

Acute pulmonary vein (PV) reconnection is frequently encountered in patients undergoing PV isolation (PVI) procedure for treatment of atrial fibrillation. In this study, we investigated whether the identification and ablation of residual potentials (RPs), after initial achievement of PVI, reduces acute PV reconnection rate. Following PVI in 160 patients, mapping along the ablation line was performed to identify RPs, defined as bipolar amplitude ≥ 0.2 mV or 0.1-0.19 mV combined with a negative component of the unipolar electrogram. Ipsilateral PV sets with RPs were randomized to either no further ablation (Group B) or to additional ablation of the identified RPs (Group C). The primary study endpoint was spontaneous or adenosine-mediated acute PV reconnection after 30-minute waiting period and was also evaluated in ipsilateral PV sets without RPs (Group A). After isolation of 287 PV pairs, 135 had no RPs (Group A) while the remaining PV pairs were randomized to either Group B (n=75) or Group C (n=77). Ablation of RPs resulted in reduction of spontaneous or adenosine mediated PV reconnection rate (16.9% in group C vs 48.0% in group B; p<0.001). Group A was associated with a significantly lower percentage of acute PV reconnection as compared to group B (5.9% vs 48.0%; p<0.001) and to group C (5.9% vs 16.9%; p=0.016). After PVI achievement, absence of RPs along the circumferential line is associated with low likelihood of acute PV reconnection rate. Ablation of RPs significantly reduces spontaneous or adenosine-mediated acute PV reconnection rate.

Background and Objectives: Idiopathic ventricular arrhythmias commonly occur in patients without structural heart disease and most often present as premature ventricular contractions (PVCs). Although generally considered benign, a high PVC burden may cause symptoms, reduce quality of life, and lead to reversible PVC-induced cardiomyopathy. This study aimed to evaluate long-term outcomes after radiofrequency catheter ablation of idiopathic outflow tract PVCs. Materials and Methods: This single-center retrospective study included 101 patients with idiopathic PVCs who underwent radiofrequency catheter ablation. PVC burden and clinical outcomes were assessed at baseline and during follow-up at 3 months, 12 months, and 5 years. Procedural success, predictors of success, and changes in antiarrhythmic drug therapy were analyzed. Results: During follow-up, a marked reduction in PVC burden was observed compared with baseline values. The median PVC burden decreased from 21.89% at baseline to 0.79% at 3 months, 0.23% at 12 months, and 0.09% at the 5-year follow-up after ablation. Acute procedural success was achieved in 88.1% of patients. Long-term success at 5 years was observed in 80.2% of patients. The use of antiarrhythmic drugs decreased during follow-up. Left ventricular ejection fraction remained stable, with no significant difference between baseline and 5-year values. Monomorphic PVC morphology and procedural success at 12 months were identified as independent predictors of long-term success. Conclusions: Radiofrequency catheter ablation provides effective and sustained reduction in PVC burden in patients with idiopathic outflow tract PVCs, with high acute success rates, durable long-term outcomes, and reduced reliance on antiarrhythmic drug therapy.

This study introduces the pulmonary vein isolation outcome degree (PVIOD) as a new semiquantitative measure for the efficacy of atrial fibrillation (AF) catheter ablation and reports the determination of predictors associated with PVIOD. The median follow-up periods of 117 patients after the first and last ablation were, respectively, 82 (IQR 15) and 72 (IQR 30) months. PVIOD 1 included 32.5% of patients, those with successful single pulmonary vein isolation (PVI); PVIOD 2 included 29.1% of subjects, those with success after multiple procedures; PVIOD 3 comprised 14.5% of patients, those with clinical success; and PVIOD 4 included 23.9% of cases, those with procedural and clinical failure. In the multivariate ordinal logistic regression analysis, PVIOD 1–4 were independently associated with longstanding persistent AF with paroxysmal AF as the referent category (odds ratio (OR), 3.5; 95% confidence interval (95% CI), 1.1–10.7 (p = 0.031)), left atrial (LA) diameter (OR, 1.2; 95% CI, 1.1–1.3 (p = 0.001)) and left ventricular ejection fraction (LVEF) (OR, 0.9; 95% CI, 0.86–1.0 (p = 0.038)). LA size > 41 mm, LVEF ≤ 50% and longstanding persistent AF are strong predictors of AF recurrence. PVIOD 1–4 offer the most exact long-term prognosis of PVI. The purpose of the present article is to expand the quantitative measure of procedural success in the medical and biological fields.

Background/Objectives: Atrial fibrillation (AF) is closely associated with adverse remodeling of the left atrium (LA). This study evaluated the impact of LA diameter on long-term outcomes following radiofrequency ablation (RFA) of the pulmonary veins and assessed LA and left ventricular (LV) remodeling over a seven-year follow-up period. Methods: A total of 117 patients with symptomatic, drug-refractory AF underwent RFA. Structural remodeling was evaluated using echocardiography. Long-term outcomes were categorized using the Pulmonary Vein Isolation Outcome Degree (PVIOD), a four-level classification reflecting procedural and clinical success. Results: After seven years, 32.5% of patients who achieved successful sinus rhythm maintenance after a single RFA (PVIOD 1) demonstrated significant reverse remodeling of LA and LV. LA diameter decreased from 39.3±0.6 mm to 36.5±0.6 mm (p< 0.001); LV end-diastolic diameter (LVEDD) from 53.1±0.6 mm to 50.9±0.7 mm (p=0.008); LV end-systolic diameter (LVESD) from 34.7±0.8 mm to 32.0±0.1 mm (p=0.005); and LV ejection fraction (LVEF) increased from 56.8±0.8% to 62.1±1.1% (p< 0.001). Among patients with long-term success after multiple procedures (PVIOD 2; 29.1%), LA diameter decreased significantly from 41.9±0.7 mm to 40.2±0.6 mm (p=0.044), without significant ventricular changes. Patients achieving clinical success (PVIOD 3; 14.5%) showed no significant structural changes. Those with procedural and clinical failure (PVIOD 4; 23.9%) exhibited progressive negative remodeling: LA diameter increased from 44.7±0.7 mm to 47.4±0.7 mm (p=0.006); LVEDD from 52.8±0.9 mm to 57.1±0.6 mm (p< 0.001); LVESD from 36.5±1.1 mm to 40.7±1.2 mm (p=0.006); and LVEF decreased from 50.7±1.7% to 43.8±1.8% (p=0.004). Conclusions: Early and successful single RFA performed in patients with normal LA diameter is associated with complete reverse remodeling and prevention of AF recurrence. As LA size increases, the likelihood of achieving durable procedural success decreases, emphasizing the importance of timely intervention before significant left atrial enlargement develops.