Risultati per: LBP (Low Back Pain): Cosa dicono le linee guida del mal di schiena

Circulation, Volume 146, Issue Suppl_1, Page A15393-A15393, November 8, 2022. Introduction:In 2015, the American Heart Association revised the Jones Criteria, the gold standard for diagnosis of acute rheumatic fever (ARF). This revision included changes to increase the sensitivity for ARF in high-risk settings. The objective of this study was to determine if there were children who were found to be ARF-negative by strict application of these criteria in a high risk setting but found to have rheumatic heart disease (RHD) on follow-up evaluation.Methods:Between 2017 and 2020, we conducted an epidemiological study to determine the incidence of ARF in Uganda. Children and adolescents, 3-17 years, presenting with clinical concern for ARF (fever and joint pain, suspicion of carditis, or suspicion of chorea) were enrolled and evaluated using the Jones Criteria. Children ultimately found to have a laboratory-confirmed alternate diagnosis and those who did not meet ARF criteria but had an unknown final diagnosis, were asked to participate in a longitudinal echocardiographic follow-up study to monitor for development of RHD. Presence of RHD was considered a false negative test and used to calculate the false negative error of not receiving a diagnosis of ARF.Results:There were 351 children determined to have an alternate diagnosis during the study period; 180 with a laboratory confirmed final diagnosis (127 malaria, 20 non-rheumatic cardiac disease, 15 influenza, 18 other) and 171 with an unknown final diagnosis. Of these, 220 (62.7%) had at least one follow-up visit (median 366 days, range 10-1054). One child (1/220,

Circulation, Volume 146, Issue Suppl_1, Page A15560-A15560, November 8, 2022. Aging and low aerobic capacity are associated with an increased risk of cardiovascular events and mortality. We reported that a polygenic rat model selectively bred for low aerobic capacity (LCR) showed aortic stiffness and dysfunction with age compared to rats bred for a high aerobic capacity (HCR). We observed increased aortic mitochondrial ROS and extracellular mtDNA DAMPs levels, activation of AIM2 inflammasome and its downstream effectors and increased collagen content in old LCR rat aortas. However, the molecular mechanisms linking low aerobic capacity to inflammation in aging have not been elucidated. In order to decipher the changes in genetic networks in low aerobic capacity and aging-associated aortic stiffness, a global transcriptome analysis was performed by RNA-Seq and gene ontology analysis of aortas from young (4 month) and old (27 month) LCR and HCR rats. Down-regulated pathways in old LCR aortas include mitochondrial biogenesis and mitophagy and up-regulated pathways include pro-inflammatory pathways, apoptosis/necroptosis/ferroptosis pathways, in contrast to HCR aortas which have higher levels of pathways regulating longevity, oxidative phosphorylation, and mitophagy and autophagy. In line with that, old LCR rats displayed a 54% reduction in mitophagy (colocalization of mitochondrial marker protein TOM20 with lysosomal marker protein LAMP1) in aortic media and a 76% reduction in cultured VSMCs in comparison to older HCR rats. Mitophagy levels did not differ significantly between young LCR and HCR rats. The autophagic vacuole formation rate was a 12-fold lower in old LCR than in old HCR aortic VSMCs, suggesting that impaired mitophagy may be responsible for accumulation of mtDNA-derived damage associated molecular patterns (mtDNA DAMPs). Treatment with various inducers of mitophagy (rapamycin, deferiprone, and MitoTEMPO) significantly increased mitophagy and decreased mtDNA DAMPs levels in old LCR VSMCs. This was also associated with a reduction in inflammasome activation, mitochondrial dysfunction, and ROS levels. We conclude that impaired mitophagy causes accumulation of DAMPs and inflammasome activation, inducing aortic stiffness and dysfunction in old age LCR rats.

Circulation, Volume 146, Issue Suppl_1, Page A14354-A14354, November 8, 2022. Background:Patients with heart failure (HF) are known to be stratified the risk of mortality by serum chloride level. However, since large-scaled studies to date have not included the elderly patients, it is still unclear whether serum chloride level well predicts the prognosis of the elderly patients with HF, whose clinical profiles are different from young adult patients. We aimed to test the hypothesis that hypochloremia gave different prognostic impacts in non-elderly and elderly patients with HF.Methods:This observational study included 1,326 elderly patients ( >65 year-old) without regular hemodialysis who were hospitalized for worsening of HF and discharged alive. They were divided into two subgroups depending on serum chloride levels at admission (Low-chloride group (98 mEq/L, n=1518)), referred to prior reports. Propensity scores were developed and patients in Normal-chloride group were matched with those in Low-chloride group in a 1:1 ratio. The endpoint of this study was death from any cause.Results:Among 1,326 unmatched patients, Low-chloride group included significantly more male patients, and those with higher BUN, CRP, bilirubin levels, dose of furosemide and atrial fibrillation, and prescriptions of oral anticoagulant, and lower BMI, blood pressure, hemoglobin, prescription of mineral corticoid receptor antagonist, thiazide and statins. Following propensity score matching by diverse baseline parameters, 106 pairs in both groups were included in the matched population. During 413 days of median observational period, 62 patients (28.8%) died. Kaplan-Meier analysis showed that patients in the Low-chloride group had a significantly higher mortality rate (p=0.011,Figure).Conclusion:In this observational study, baseline hypochloremia was associated with an increased mortality in elderly patients hospitalized with heart failure.

Circulation, Volume 146, Issue Suppl_1, Page A10484-A10484, November 8, 2022. Introduction:Carotid plaque is recommended for cardiac risk stratification for intermediate risk patients but has not been integrated into cardiology community clinics to help refine testing and reduce risk for major adverse cardiovascular events (MACE). The purpose was to determine the clinical usefulness of carotid plaque score (PS) to guide management of low-intermediate risk patients.Methods:Patients 40-75 years who received a carotid ultrasound were followed up to 10 years for MACE (cardiovascular death, myocardial infarction, stroke). Low-intermediate risk participants (n = 9,114) with no known cardiovascular disease were included. Administrative data holdings housed at IC/ES were used for event follow-up. Kaplan-Meier curves and Cox proportional hazard ratios determined relative risk. Combining plaque score (Rotterdam method, plaque presence within carotid segments, PS 0 to 6) with stress echo (SE) was assessed in a subset of participants (n = 624).Results:The optimum threshold for PS = 2 for 1-year MACE (AUC = 0.738). The population rate of MACE over 10 years was 4%. In participants referred for SE, PS of

Circulation, Volume 146, Issue Suppl_1, Page A14235-A14235, November 8, 2022. Lower plasma tissue plasminogen activator (tPA), a key fibrinolytic enzyme, is associated with higher atherogenic cholesterol levels in humans, but the mechanism is unknown. Hepatocyte (HC) is the factory producing atherogenic apoB lipoproteins, also a major source of basal plasma tPA. Our hypothesis is that tPA limits apoB-VLDL production in HCs.Silencing tPA in HCs using AAV8-H1-sh-tPA inLdlr-/-mice leads to increased plasma cholesterol, triglyceride, apoB, and exacerbated atherosclerosis compared with scramble-silenced controls. Fractionation of plasma lipoproteins by FPLC or ultracentrifugation shows increased cholesterol and apoB in VLDL and LDL fractions. Inhibiting VLDL hydrolysis by P407 leads to a faster plasma triglyceride-rising rate in HC-tPA-silenced wild type mice, suggesting higher hepatic VLDL production. In a pulse-chase assay, tPA-silenced human primary HC has higher apoB-associated radioactivity in cell medium and lysate, suggesting increased apoB production.Adequate apoB lipidation is required for its secretion. By electronic microscopy, the distribution of VLDL shifts to a larger diameter in plasma VLDL isolated from HC-tPA-silencedLdlr-/-mice, suggesting higher lipid contents in VLDL. The endoplasmic reticulum (ER)-associated apoB is higher in tPA-silenced vs. control HCs, more prominent in the less denser density fractions. As density and lipidation are inversely related, these findings are consistent with the hypothesis that tPA limits apoB lipidation in ER. MTP is an ER chaperone incorporating neutral lipids onto apoB in HC. The tPA-silenced human primary HC has higher neutral lipid transfer activity than controls, despite similar MTP protein levels. Moreover, higher apoB is in the anti-MTP-precipitations from tPA-silenced vs. control HCs, suggesting that silencing tPA increases apoB-MTP interaction. Proximity ligation and immunoprecipitation assays show tPA interacts with apoB in HC. Solid-phase binding assay and native gel reveal purified human tPA binds to LDL, but not to MTP. tPA competes with MTP in binding to LDL. Moreover, tPA inhibits MTP-mediated neutral lipid transfer. These findings suggested tPA binds to apoB and inhibits MTP-dependent apoB lipidation and VLDL secretion.

Circulation, Volume 146, Issue Suppl_1, Page A9814-A9814, November 8, 2022. Background:Low voltage ECG (LowV-ECG) pattern is defined as a peak-to-peak QRS amplitude of less than 5mm in the limb leads and/or less than 10mm in the pericardial leads. It can occur in many cardiac conditions associated with congestive heart failure (CHF), such as ischemic cardiomyopathy (ICM), cardiac amyloidosis (CA), hemochromatosis (HC), and hypothyroidism (HT). The clinical significance of LowV-ECG abnormalities in CHF patients has not been well investigated.Methods:Clinical, echocardiographic, and ECG data was collected in 460 consecutive CHF patients with non-V-paced rhythms enrolled over 2 years in the Get With the Guidelines Heart Failure (GWG-HF) registry at a single academic tertiary center. ECGs were reviewed for the presence of low QRS voltage and additional ECG features classically reported in ICM, CA, HC, and HT.Results:LowV-ECG was noted in 8.5% patients (39/460) of the study cohort, and was more common in females, 11.6% (25/216) vs. 5.7% (14/244) in males, p=0.025. LowV-ECG patients had increased BMI (34.9+/-12.8 vs. 31.1+/-9 kg/m2, p=0.016) and more commonly had a history of DM (12.2% vs.5.5%, p=0.01). There were no significant differences in age, GFR, or presence of CAD, hypertension or Afib. Prevalence of HFrEF, HFmrEF, and HFpEF in patients with LowV-ECG was 6.8, 10, and 9.8%, respectively, p=0.506. With regards to the ECG features typically associated with cardiac amyloidosis, poor R-wave progression was more common in LowV-ECG patients, 41% (16/39) vs.13.5% (57/421) in the rest of the cohort, p

Circulation, Volume 146, Issue Suppl_1, Page A14149-A14149, November 8, 2022. Introduction:High power radiofrequency ablation (RFA), a novel technique, is recently being employed for pulmonary vein isolation (PVI) for atrial fibrillation (AF). This study aimed to report our center’s procedural data and preliminary results of a high power RFA technique for AF without fluoroscopic guidance.Methods:Symptomatic AF patients were consecutively enrolled in this prospective observational study and underwent PVI. Ablation index (AI) was marginally used for at least 400 on the posterior wall and 500 on the anterior wall or 15 seconds total at 50 Watt ablation power, whichever came first. Contact-force catheter and esophageal temperature was used during the procedure. Post-ablation esophageal endoscopy was utilized. PVI was performed using CARTO and the ST SF D/F curve ablation catheter in a temperature-controlled mode.Results:PVI was achieved in all (n = 36, mean age: 68±11.3 years, female: 29%, CHADsVASc: 2.8±1.5, LA volume index:60.4±17.2 mL/m2). 29(80%) patients had paroxysmal AF. For left wide antral circumferential ablation (WACA); total duration was 7.4±11.3 min, total ablation sites were 49.9±11.2, average contact force was 9.97±2.2 g and average AI was 363.9±20.5. For right WACA total duration was 6.4±2 min, total ablation sites were 45.6±15.3, average contact force was 13.0±3.5 g and average AI was 403.6±32.9. WACA technique was employed for paroxysmal AF, additional ablation lines were targeted for persistent AF. For the entire flouro-less, 50W study population, average AI was 382.2±26.6, total ablation duration was 18.1±4.7 min, total ablation sessions were 118.4±33.4 and average temperature was 38.7±1.4 degree Celsius. During in-hospital follow-up no major complications such as death, stroke, tamponade, or atrio-esophageal fistula occurred.Conclusions:50 watts fluoro-less AF RFA is a safe and efficient procedure.

Circulation, Volume 146, Issue Suppl_1, Page A12348-A12348, November 8, 2022. HypothesisThe morphology of low-density non-calcified coronary plaque is associated with acute coronary syndrome (ACS) and culprit lesion precursorsMethods:This was a post-hoc analysis of the multicenter ICONIC study. A subset of 94 patients suspected of coronary artery disease (CAD) underwent coronary CT angiography imaging (CCTA) with subsequent follow-up for the occurrence of the first ACS event were selected. At the time of ACS, the culprit lesion was adjudicated by invasive coronary angiography cardiologists blinded to the CCTA.Quantitative CT was performed by a validated software as a service (Cleerly Labs, Cleerly, Inc., Denver, CO). A level-III reader used multiplanar reformation (MPR) images from this analysis to qualitatively assess individual collections of low-density non-calcified (LDNC) plaques (-189 to 30 HU).The degree of embedded LDNC plaque (DELP) was the amount a LDNC plaque was surrounded by non-calcified plaque. DELP was categorized as 90, 180, 270, and 360. LDNC plaque shape was categorized as crescent, round, lobular, or bean-shaped. DELP and shape were qualitatively assessed using the cross-sectional MPR image with the greatest LDNC plaque area. LDNC plaques with >270 DELP and round or bean-shaped were considered high-risk plaque (HRP) morphology.Results:ACS occurred in 64 patients. 247 LDNC plaques were analyzed. Patients without and with ACS had, on average 0.40±0.86 and 1.02±1.21 (p-value = 0.014) LDNC plaques with HRP morphology. The proportional hazard ratio associating the presence of one or more HRP morphology plaques with ACS was 2.03 (1.19, 3.48; p-value = 0.009), after controlling for diameter stenosis, age, sex, and family history of CAD. The odds ratio of the association of HRP morphology with culprit lesion precursors was 10.93 (3.77, 31.71; p-value

Circulation, Volume 146, Issue Suppl_1, Page A11036-A11036, November 8, 2022. Introduction:Aortic Valve Calcification (AVC) measured by computed tomography (C-CT) and Dobutamine stress echocardiography (DSE) are both important when determining AS severity in low flow low gradient (LFLG) AS. It is generally accepted that AS is moderate if aortic mean gradient is

Circulation, Volume 146, Issue Suppl_1, Page A13682-A13682, November 8, 2022. Introduction:Cardiac lipomas are rare primary cardiac tumors. Depending on the location, they can present with vague symptoms such as chest pain, palpitations, dizziness, or arrhythmias.Case Presentation:A 58 y.o. female with a PMH of HLD and HTN presents for evaluation of chest pain and palpitations. An initial CvCTA was negative for significant CAD. A TTE showed a 1.6cm x 1.42 cm echolucent mobile mass attached to the lateral wall of the LV (Figure 1.A). Initially, there was a reasonable concern for an LV thrombus. However, it was unusual since the TTE revealed a normal EF and overall wall motion. Due to suspicions of a non-thrombus LV mass, a cardiac MRI was performed which showed a highly mobile mass attached to the mid anterior/anterolateral wall and a chordae within the LV cavity (Figure 1.B, Figure 1.C). The lesion was T2-hyperintense with loss of signal during fat suppression, highly suspicious for a lipoma. Given the mass mobility and strong patient preference, an elective robotic surgical resection was performed with a surgical biopsy confirming a lipoma (Figure 1.D).Discussion:Cardiac lipomas are often silent; however, symptoms can range from benign palpitations to life-threatening arrhythmias and outlet obstruction. TTE is typically the first-line imaging choice, followed by either cardiac CT or MRI imaging used for further diagnostic evaluation. Treatment options include conservative observation or prophylactic resection for asymptomatic patients, and therapeutic resection for symptomatic patients.Conclusion:Cardiac lipomas should be considered in the differential for any cardiac mass. TTE is the first-line imaging choice followed by a cardiac CT or MRI. Treatment remains a discussion between the patient and physician, varying from conservative management of symptoms to definitive treatment with surgical resection.

Circulation, Volume 146, Issue Suppl_1, Page A15587-A15587, November 8, 2022. Introduction:Spontaneous coronary artery dissection (SCAD) and Takotsubo cardiomyopathy (TCM) are uncommon non-atherosclerotic causes of acute myocardial infarction (MI). These patients have fewer cardiovascular risk factors than those who have atherosclerotic MI. Clinical presentation in both subsets of MI is identical due to which diagnosis requires echocardiography and coronary angiography. The incidence of TCM and SCAD in the same patient is scarce and only documented in a few case reports and a case series.Case presentation:We present the case of a 50-year-old female with a past medical history of hypertension, hypothyroidism, and median arcuate ligament syndrome. She presented to the emergency department with intermittent chest pain radiating to her upper back, both arms, and her left jaw and it was associated with nausea. On examination, she was tachycardic, tachypneic, and anxious. She had normal heart sounds with no chest tenderness. Her EKG demonstrated ST-elevations in leads II, III, aVF, V4, V5, and V6. Laboratory results showed elevated high sensitivity troponin of 11,949 (pg/ml) and 30,256 (pg/ml) four hours later. The patient underwent emergent coronary angiography, which revealed diffuse tubular stenosis suggestive of type 2 SCAD in the second obtuse marginal artery but otherwise normal coronary anatomy with minimal stenosis. Left ventriculogram showed antero-apical, apical, and infero-apical hypokinesis and basal hyperkinesis, suggestive of Takotsubo cardiomyopathy. Transthoracic echocardiogram (TTE) completed 48 hours later demonstrated improved contractility with lateral wall hypokinesis. The patient was managed conservatively with medical management, and she was discharged on aspirin, plavix, carvedilol, isosorbide mononitrate, and losartan.Conclusions:SCAD and TCM are uncommon diagnoses that can rarely co-exist. TTE can help diagnose TCM in patients with chest pain and elevated cardiac biomarkers. Non-occlusive coronary vasculature is a diagnostic criterion per the proposed Mayo Clinic criteria. This case highlights the importance of coronary angiography in patients with TCM for assessment of potential co-existent coronary vascular pathology; SCAD in our case.

Circulation, Volume 146, Issue Suppl_1, Page A11054-A11054, November 8, 2022. Introduction:Dual antiplatelet therapy (DAPT) and dual pathway inhibition (DPI) are potential long-term antithrombotic strategies for patients with coronary artery disease (CAD). However, patients already on DAPT are most likely to remain on the same treatment regimen rather than switching. To date, there is no data on the feasibility of switching from DAPT to DPI and the pharmacodynamic (PD) effects of such approach.Methods:SWAP-AC was a prospective, randomized, PD study conducted in 90 patients with CAD on DAPT with aspirin (81mg/qd) plus a P2Y12inhibitor [clopidogrel (75 mg/qd; n=30), ticagrelor (90mg/bid; n=30), or prasugrel (10mg/qd; n=30)]. Patients in each cohort were randomized to maintain DAPT or switch to DPI (aspirin 81mg/qd plus rivaroxaban 2.5mg/bid). PD assessments included VerifyNow P2Y12reaction units (PRU), light transmittance aggregometry (LTA) using 20 μM ADP, tissue factor (TF), and a combination of collagen + 5 μM ADP + TF (CATF, a marker of platelet-mediated global thrombogenicity), and a thrombin generation (TG) assay. Assays were performed at baseline (on DAPT) and 30 days post-randomization [trough (before maintenance dose) and peak (2 hours after maintenance dose) levels].Results:Switching from DAPT to DPI occurred without side effects. TG was reduced with DPI. In each cohort, DAPT was associated with lower PRU levels than DPI (Figure); LTA following ADP stimuli showed consistent results (data not shown). LTA following CATF stimuli (primary endpoint) showed no differences between DPI and DAPT in the ticagrelor and prasugrel, but not clopidogrel, cohorts (Figure). There were no differences in any of the cohorts with LTA using TF.Conclusions:SWAP-AC is the first study supporting the feasibility of switching to DPI patients with CAD on different maintenance DAPT regimens. Such approach was associated with increased P2Y12reactivity but reduced thrombin generation with a limited impact on platelet-mediated global thrombogenicity.

Circulation, Volume 146, Issue Suppl_1, Page A9867-A9867, November 8, 2022. Introduction:Pain is present in 37%-68.9% of hospitalized patients with heart failure (HF), but little is known about how pain at discharge influences transition from hospital to home or 12-month mortality. The aims were to examine if pain at discharge predicts 1) return to home status and 2) 12-month mortality among hospitalized patients with HF.Methods:In this prospective study, data were obtained from a dataset of 1,475 patients with HF hospitalized at 3 tertiary-care hospitals from 2009-2017. Pain at discharge (yes/no) was obtained from medical records using ICD-9 or ICD-10 codes. Return to home status (yes/no) and all-cause 12-month mortality were obtained from medical records. Descriptive statistics, independent samples t-tests, and χ2were used to describe the sample. Logistic regression was computed to address the aims.Results:The sample was 59.5% women and 40.5% men. The mean age was 68.6 (SD 13.6) years. Race was 53.6% Black and 46.4% White. Of 1,475 patients, 239 (16.2%) had pain documented at discharge. Patients with pain documented at discharge were younger compared to patients without pain (p

Circulation, Volume 146, Issue Suppl_1, Page A13079-A13079, November 8, 2022. Introduction:Glycosylated apolipoprotein J (ApoJ-Glyc) has been suggested to be a marker for the early detection of myocardial ischemia. Ischemia induces an intracellular accumulation of non-glycosylated ApoJ that mirrors a reduction in ApoJ-Glyc serum concentration in acute ischemic syndromes.Objective:The EDICA clinical trial – multi-centre, international, diagnostic study (NCT04119882)- was carried out to assess the performance of ApoJ-Glyc as a biomarker for the early detection of myocardial ischemia in patients attending the A&E department with chest pain suggestive of acute coronary syndrome (ACS).Methods:EDICA assessed 404 patients. Blood samples were obtained on admission, for assessment of high sensitivity-troponin (hs-Tn) and ApoJ-Glyc. ApoJ-Glyc serum levels were analyzed with a novel ELISA, targeting a specific glycosylated variant of ApoJ (ApoJ-GlycA6).Results:Based on clinical diagnostic tests, 291 patients were given a final diagnosis of “non-ischemic” event and 113 patients were considered to have had an ischemic event (33 STEMI, 48 NSTEMI, 27 Unstable Angina and 5 “unclassifiable” ACS). ApoJ-GlycA6 levels were significantly lower on admission in ischemic patients, compared with non-ischemic patients (66 [46-90]vs.73 [56-95] μg/ml, respectively; P=0.04). Ischemic patients who underwent PCI and had a pre-PCI TIMI 0-2 flow showed significantly lower ApoJ-GlycA6 levels at admission compared with non-ischemic patients (64 [37-81]vs.73 [56-95] μg/ml; P=0.01). Of interest, 51% of ischemic patients, had “inconclusive” or negative hs-Tn at admission. Among these, ApoJ-GlycA6 identified the ischemic event in 48% (

Circulation, Volume 146, Issue Suppl_1, Page A15317-A15317, November 8, 2022. Case Presentation:A 42-year-old male with a past medical history of recurrent myopericarditis treated with a combination of NSAIDs, colchicine, and steroids presented for left-sided chest pain. The pain first recurred when he attempted a prednisone taper and he was started on Anakinra. Upon presentation, physical examination and laboratory findings were within normal limits. Echocardiography and electrocardiogram were within normal limits. Cardiac magnetic resonance imaging (CMR) showed transmural enhancement of the basal-mid inferolateral segments and patchy mid-myocardial enhancement in the basal-mid anterolateral segments. Nuclear medicine PET showed FDG uptake in the basal anteroseptal, anterolateral, inferolateral, inferior, and apical segments suggestive of active inflammation. Initially, the diagnosis was thought to be recurrent myopericarditis of unknown etiology. Subsequent right heart catheterization with endomyocardial biopsy (EMB) showed mononuclear infiltrates in the interstitium associated with myocyte infiltration and focal moderate interstitial fibrosis. Due to his clinical, imaging, and pathologic findings, he was diagnosed with lymphocytic myocarditis. His anti-inflammatory therapy regimen was reinstated, and he was started on Mycophenolate Mofetil. On follow-up, the patient had significant symptomatic improvement.Discussion:Lymphocytic myocarditis is a pattern of myocardial inflammation that is typically associated with autoimmune and idiopathic causes. Myocarditis frequently manifests with signs and symptoms of heart failure, including chest pain, dyspnea, and arrhythmias. Diagnosis of myocarditis is often supported by CMR and FDG-PET findings, however, EMB is the gold standard for the diagnosis of myocarditis. Treatment is generally supportive, though immunomodulatory therapies have gained increased popularity due to benefits in treating symptoms and preventing complications of heart failure.

Circulation, Volume 146, Issue Suppl_1, Page A12285-A12285, November 8, 2022. Background:Recent studies increase concern for embolic events during radiofrequency ablation (RFA) for ventricular arrhythmias (VA).Objective:To assess peri-procedural symptomatic embolic events and anticoagulation regimens in patients undergoing endocardial RFA for VA.Methods:All patients undergoing endocardial RFA for VA from October 2018 to September 2021 were prospectively assessed for complications in hospital before discharge and at 30 days by clinic visit or phone call. Anticoagulation regimens were at the discretion of the treating physician.Results:There were 663 procedures in 616 patients (age 62+4 yrs, 73% structural heart disease, 48% sustained VT). Prior to the procedure 464 patients (70%) were taking an antithrombotic agent, either a direct acting anticoagulant agent (DOAC), warfarin, aspirin (ASA), other antiplatelet agent, or combinations (table 1); and the same type of agent was continued after ablation in 462. Of the 199 patients not receiving antithrombotic agents pre-ablation, 82.4% received 325 mg of ASA daily after the procedure, 3.0% received lower dose ASA, and 16 were started on DOAC or warfarin. There were 59 complications (8.9%) in 53 procedures. There were 2 strokes (0.3%); there were no transient ischemic attacks or other embolic events. There were 25 (3.8%) bleeding complications including 14 due to vascular access (2.1%) and 11 pericardial effusions (1.6%). Bleeding complications were more frequent in patients on the combination of antiplatelet and DOAC pre- or post-procedure.Conclusions:In this large single center series most patients undergoing VA ablation were receiving antithrombotic therapy pre-procedure that was continued post procedure. Full dose ASA was the most common post-procedure regimen for those not on pre-procedure anticoagulation. Stroke and emboli appear very rare. Combined antiplatelet and DOAC therapy is associated with increased bleeding risk.