Background: Catheter ablation is an effective treatment for symptomatic supraventricular tachycardia (SVT). Most studies target the general adult population; data on the elderly are less robust. We studied the clinical and procedural characteristics and outcomes in elderly patients undergoing SVT ablation. Methods: All patients undergoing atrioventricular nodal re‐entry tachycardia (AVNRT), atrioventricular re‐entry tachycardia (AVRT), and/or atrial tachycardia (AT) ablation between May 2011 and May 2022 at a tertiary center were included. Cases with concurrent ablation of atrial flutter, atrial fibrillation, and ventricular arrhythmias were excluded. Clinical and procedural characteristics and outcomes were compared between patients aged ≥ 70 years and those aged < 70 years. Results: There were 1758 cases of SVT ablation; 1608 patients were < 70 years old, and 150 patients were ≥ 70 years old. Elderly patients were more likely to have underlying structural heart disease and/or ischemic heart disease, more likely to have AVNRT and less likely to have AVRT ( p < 0.001). Consequently, elderly patients were more likely to undergo right‐sided ablation ( p < 0.001). The use of stereotaxis, intracardiac echocardiography, and electroanatomical mapping did not differ significantly. Procedure time, radiofrequency application time and fluoroscopy time were shorter in elderly patients ( p < 0.05). Importantly, immediate complication and success rates did not differ significantly. Conclusion: In our study, the acute success rates are high, and complication rates are low across both cohorts despite differences in clinical and procedural characteristics. SVT ablation should be considered for symptomatic patients regardless of age. Further data including patient comorbidities and longer‐term outcomes may help patient selection.

Background and Objectives: The role of biventricular pacing (BVP) is less well-established in patients with heart failure with reduced ejection fraction (HFrEF) without left bundle branch block (LBBB). Conduction system pacing (CSP) has gained significant traction and may provide a safe and more physiological alternative to BVP in these patients. A few small studies studying this question have reported conflicting results. This meta-analysis aims to compare procedural and clinical outcomes between CSP and BVP in this group. Materials and Methods: An online literature search was systematically conducted to retrieve studies comparing CSP and BVP in HFrEF patients with non-LBBB. Four studies with 461 patients were included. Results: Implant-derived paced QRS duration was significantly shorter (mean difference [MD] −19.7 ms, 95% confidence interval [CI] −36.2 to −3.3, p = 0.0355) with CSP. Echocardiographic response with significantly greater improvement in left ventricular ejection fraction (MD 5.6%, 95% CI 3.1 to 8.0, p = 0.0106) was also observed with CSP. There were no statistically significant differences in clinical outcomes such as all-cause mortality (relative risk [RR] 0.53, 95% CI 0.18 to 1.60, p = 0.133) and heart failure hospitalization (RR 0.54, 95% CI 0.19 to 1.56, p = 0.129). Conclusions: This meta-analysis suggests that CSP may have better electrical synchrony and echocardiographic response compared to BVP in HFrEF patients with non-LBBB. Further randomized studies with longer follow-up may be required to elucidate potential benefits in clinical outcomes.

Background: Cardiac blood cysts are exceedingly rare cardiac tumours usually found on cardiac valves in infants. We report and discuss a rare unique case wherein a giant atrial septal cardiac blood cyst was found in an adult. Case summary: A 59-year-old Chinese lady with history of hypertension, hyperlipidemia and transient ischaemic attack presented with atypical chest pain. Her ECG suggested right ventricular strain. Echocardiography revealed a large right atrial intracardiac mass attached to the interatrial septum which prolapsed into the right ventricle during each cardiac cycle with associated dilatation of the right atrium and right ventricle. Computed tomography scans showed no evidence of malignancy or metastasis. Considering our patient’s profile and the characteristics of the mass, it was opined to likely be a cardiac myxoma. After consultation with our cardiothoracic surgeons, she underwent surgical resection of the intracardiac mass. Histology revealed that the intracardiac mass was a cardiac blood cyst. Discussion: First described by Elsasser in 1844, cardiac blood cysts are extremely rare benign cardiac tumours very rarely seen in adults. Though benign, they have been associated with outflow tract obstruction, valvular regurgitation and embolization. Symptomatic patients do well with surgical resection, while long-term outcomes in asymptomatic patients followed up with serial echocardiograms are mixed. Due to its rarity, existing literature is limited to case reports and small case series, with a lack of guidelines on management till recently. Our case report serves to highlight this unique presentation of an exceedingly rare intracardiac tumour.

Background: Current-generation zotarolimus-eluting stents (ZES) have been shown to be an effective choice for percutaneous coronary intervention. However, data comparing real-world clinical outcomes between ZES and other stent platforms (non-ZES) are limited. We aim to compare real-world clinical outcomes of patients receiving ZES versus non-ZES during percutaneous coronary intervention based on our centre’s registry. Methods: This was a non-randomised, non-blinded, all-comers observational registry comparing clinical outcomes in patients treated with ZES versus non-ZES (control). The primary endpoint of our study was defined as major adverse cardiac events, which was a composite of cardiac mortality, target vessel failure and MI at 1 year. Results: Within the study period, 526 patients fulfilled inclusion criteria (ZES: 218, controls: 308). Characteristics and procedural data of both groups were similar. Our study showed no significant differences in major adverse cardiac events between the ZES and control groups (3.2% versus 3.9%; HR 0.82; 95% CI [0.32–2.09]; p=0.68). Comparing clinical outcomes of ZES and control groups, there were similar rates of all-cause mortality (1.4% versus 2.3%; HR 0.60; 95% CI [0.16–2.33]; p=0.46) and MI (0.5% versus 1.0%; HR 0.47; 95% CI [0.049–4.49]; p=0.51). There were low rates of stent-related complications and no differences in target vessel revascularisation (1.4% versus 0.7%; HR 2.12; 95% CI [0.36–12.7]; p=0.41) and target vessel failure (1.4% versus 0.7%; HR 2.12; 95% CI [0.36–12.7]; p=0.41) between the ZES and control groups. Conclusion: Our study showed no significant differences in clinical outcomes between patients receiving ZES and those receiving non-ZES.