Patients who received anticoagulation were more likely to require mechanical ventilation (29.8% vs. 8.1%). In-hospital mortality among patients requiring mechanical ventilation was 29.1% with a median survival of 21 days for those receiving anticoagulation vs. 62.7% with a median survival of nine days for patients not receiving anticoagulation.

Longer duration of anticoagulation treatment was associated with a reduced mortality risk (adjusted hazard ratio, 0.86 per day; 95% confidence interval 0.82 to 0.89; p<0.001). In addition, 24 patients (3%) who received anticoagulation had bleeding events, compared with 38 patients (1.9%) among those who did not receive anticoagulation. Bleeding events were more common among patients who were intubated (7.5%) vs. nonintubated patients (1.35%).

According to the researchers, anticoagulation may be associated with improved outcomes in COVID-19 patients, but the benefits should be weighed against the risk of bleeding. The findings provide clinical insights for hospitalized COVID-19 patients, but additional research is needed to determine whether systemic anticoagulation is associated with increased survival, the researchers conclude.

It must be noted that in an observational study like this, it is very difficult to gauge treatment effects in the presence of unmeasured confounders and inherent treatment biases that may exist, commented Kim A. Eagle, MD, MACC, ACC.org Editor-in-Chief.

"Nevertheless, studies to date suggest that COVID-19 is often associated with heightened coagulation and it stands to reason that anticoagulants have an important role to reduce clinically important procoagulant clinical events including deep vein thrombosis, pulmonary embolism and stroke."

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Paranjpe I, Fuster V, Lala A, et al. J Am Coll Cardiol 2020;May 6:[Epub ahead of print].

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Furthermore, the incidence of chronic PV reconnection was found to be lower with HP-SD ablation, and in a higher proportion of HP-SD applications, catheter motion was less than 1 mm during 50% or more of application duration, allowing energy delivery with greater stability.

The authors found that both ablation strategies were effective for cavotricuspid isthmus; however, high-power short-duration was less effective for mitral annular line, requiring ablation at lower powers for longer durations to avoid steam pops. In an accompanying editorial comment, Felix Bourier, MD, and Philipp Sommer, MD, note this study "presents data on the effect of high-power short-duration on midterm outcome, but also highlights the importance of catheter stability on lesion formation and the rate of chronic pulmonary vein isolations." They add, "More and more data seem to justify that different patients may need different treatment strategies – and this may not only be true in terms of where to deploy the lesions but also in how to deploy the lesions."

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Yavin HD, Leshem E, Shapira-Daniels A, et al. JACC Clin Electrophysiol 2020;May 5:Epub ahead of print].

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In reviewing strategies for primary and secondary prevention of AFib, they explain that primary prevention has focused mostly on reversing the modifiable risk factors and secondary prevention has focused on reducing the burden of AFib and preventing its progression to more persistent forms. They discuss the potential of upstream targets and agents, and using genetics to target AFib therapy.

Following the initial assessment of patients with AFib, the authors state treatment strategies need to be developed with two major goals: 1) preventing thromboembolism, and 2) symptom control with either a rhythm control or rate control strategy. Along with a review of oral anticoagulation therapy and management of bleeding, they look at the use of left atrial appendage closure as well as rate and rhythm control strategies, including ablation.

While a "unifying hypothesis" that explains all causes of AFib has not emerged, the authors state AFib appears to be a "final common pathway" resulting from the influence of varied genetic, environmental, cellular stress and lifestyle factors. "Difficulties in predicting the consequences of AFib and its therapies and the limitations of current therapies make it imperative to study and improve preventive and therapeutic strategies," the authors conclude. "A hope is that basic and translational research will lead to more effective and safe therapeutic options, including pharmacological and nonpharmacological ablative approaches."

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Chung MK, Refaat M, Shen W-K, et al. J Am Coll Cardiol 2020;75:1689-1713.

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Furthermore, the authors found that HBP was more successful in patients with Sapien valves compared with those with CoreValves (69% vs. 44%), and that LBBAP was associated with higher success rates and lower pacing thresholds compared with HBP.

The authors also found pacing thresholds remained stable and LVEF remained unchanged during a mean follow-up of 12 months.

In an accompanying editorial comment, Jordana Kron, MD, FACC, and Santosh K. Padala, MD, FACC, write that "one of the most elegant findings of this work is the validation of the anatomic relationship between the prosthetic aortic valve location and the bundle of His, which can be used to guide physiologic pacing implanters." They add, "While further studies assessing long-term clinical outcomes with LBBAP are required, this study is a valuable contribution to the literature and provides an impetus for long-term physiologic pacing studies in the post TAVR population."

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Vijayaraman P, Cano Ó, Koruth JS, et al. JACC Clin Electrophysiol 2020;May 5:Epub ahead of print].

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The study enrolled 381 participants at 27 sites across the U.S. and Canada. All patients had symptomatic persistent AFib, as well as documented nonresponse or intolerance to one or more antiarrhythmic drug. After ablation with the STSF catheter, patients were followed up at one, three, six, nine, 12 and 15 months.

Electrocardiograms were obtained at baseline and discharge and at six, nine, 12 and 15 months, while 24-hour Holter monitoring was performed at baseline and at six, 12 and 15 months. In addition, transtelephonic monitoring transmissions were performed monthly or when symptoms occurred during the nine-month follow-up period.

Of the 381 participants, 348 had the STSF catheter inserted and underwent radiofrequency (RF) ablation, comprising the safety population. Of these patients, 13 (3.8%) experienced a primary adverse event. The effectiveness population consisted of 333 patients. Of these, 330 (99.1%) achieved acute procedure success. After 15 months, the primary effectiveness success rate was 61.7% and the clinical success rate, defined as freedom from symptomatic AFib, was 80.4%.

According to the researchers, the findings demonstrate safety and effectiveness of persistent AFib ablation with CF-sensing catheters. Individualized ablation approaches based on a patient's clinical presentation could help optimize outcomes, they conclude. The researchers note that future research is needed to determine the decrease in atrial arrhythmia following catheter ablation treatment for persistent AFib.

In an accompanying editorial comment, Edward P. Gerstenfeld, MD, MS, FACC, and Joshua D. Moss, MD, FACC, write that the findings will likely result approval of the STSF catheter from the U.S. Food and Drug Administration but the "more interesting question is whether use of modern irrigated CF-sensing catheters has improved our overall results treating" persistent AFib. They add that treatment for persistent AFib has been "possibly further enhanced with the availability" of CF-sensing catheters.

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Mansour M, Calkins H, Osorio J, et al. JACC Clin Electrophysiol 2020;May 8:[Epub ahead of print].

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