Background: Premature ventricular contractions (PVCs) are frequently observed with left ventricular (LV) systolic dysfunction, although the prevalence of these associated conditions in the general population remains unknown. Objective: We sought to understand the prevalence of frequent PVCs (defined PVCs>5%) and high burden PVCs (defined PVCs>10%) and LV systolic dysfunction in patients receiving ambulatory Holter monitors (HM). Methods: A prospective multicenter (8 US medical centers) cross-sectional study collected demographic and PVC burden data from consecutive patients undergoing 24-hour, 48-hour, and 14-day HM (July 2018-June 2020). Left ventricle ejection fraction (LVEF) data was collected if obtained within 6 months of HM. Four PVC burden groups were analyzed (<1%, 1-5%, 5.1-10% and >10% burden) and stratified by normal LVEF (≥50%) or presence LVEF<50%. Results: The prevalence of PVC burden of 5.1-10% and >10% was 4% and 5%, respectively in the population undergoing HM (n=6,529). Age was significantly different between PVC groups (p<0.001). In those with LVEF assessment (n=3,713), the prevalence of LVEF<50% and both LVEF<50% and PVC>5% was 16.4% and 4.2%, respectively. The prevalence of PVC>5% and PVC>10% in patients with LVEF<50% was 26% and 16%, respectively. PVC>5% were more prevalent in older, male, and Caucasians (p<0.001). Females had a lower prevalence of PVC>5% than males (6% vs. 11%; p<0.001), but not among those with LVEF<50% (24% vs. 26%, p=0.10). Conclusion: PVC>5% and PVC>10% and LVEF<50% are prevalent in patients undergoing HM. PVC>5% are associated with older age. Females have a lower prevalence of PVC>5% than males but similar combined PVC>5% and LVEF<50%.

Background: The right phrenic nerve is vulnerable to injury (rPNI) during cryoballoon ablation (CBA) isolation of the right pulmonary veins. The complication can be transient or persistent. The reported incidence of rPNI fluctuates from 4.73% to 24.7% depending on changes over time, CBA-generation, and selected protective methods. Methods: Through September 2019, a database search was performed on MEDLINE, EMBASE, and Cochrane Database. In the selected articles, the references were also extensively searched. The study provides a comprehensive meta-analysis of the overall prevalence of rPNI, assesses the transient to persistent PNI-ratio, the outcome of using compound motor action potentials (CMAP), and estimated average time to nerve recovery. Results: From 2008 to 2019, 10,341 records from 48 trials were included. Out of 783 eighty- PNI (7.7%), 589 (5.7%) were transient, and 194 (1.9%) were persistent. CMAP caused a significant reduction in the risk of persistent PNI from 2.3% to 1.1% (p = 0.05; odds ratio [OR] 2.13) in all CBA groups. The mean time to rPNI recovery extended beyond the hospital discharge was significantly shorter in CMAP group at three months on average versus non CMAP at six months (p = 0.012). CMAP (in contrast to non-CMAP procedures) detects PNI earlier from 4 to 16 sec (p < 0.05; I2 = 74.53%) and 3 to 9º (p < 0.05; I2 = 97.24%) earlier. Conclusions: rPNI extending beyond hospitalization is a relatively rare complication. CMAP use causes a significant decrease in the risk of prolonged injury and shortens the time to recovery

Background: It is common practice to observe patients during an overnight stay (ONS) following a catheter ablation procedure for the treatment of atrial fibrillation (AF). Objectives: To investigate the safety and economic impact of a same day discharge (SDD) protocol after cryoballoon ablation for treatment of AF in high-volume, geographically diverse US hospitals. Methods: We retrospectively reviewed 2,374 consecutive patients (1,119 SDD and 1,180 ONS) who underwent cryoballoon ablation for AF at three US centers. Baseline characteristics and longer-term safety were recorded during follow-up. The mean cost of an ONS was used to evaluate yearly cost savings as a function of the percentage of SDD cases/yearr. Results: There was no difference between SDD and ONS in the 30 day total complication rate [n=15 (1.26%) versus n=24 (2.03%); p=0.136 respectively]. The most common complication was hematoma in both the SDD (n=8; 0.67%) and ONS (n=11; 0.93%) cohorts. Sensitivity analysis demonstrated that when 50% of every 100 patients treated were discharged the same day, hospital cost savings ranged from $45,825 to $83,813 per year across US hospitals. Conclusions: SDD following cryoballoon ablation for AF appears to be safe and is associated with cost savings across different US hospitals.