Introduction Implantable loop recorders (ILR) are recommended to detect atrial fibrillation (AF) in cases of cryptogenic stroke (CS). However, the utility of loop recorder for detection of other actionable arrhythmias in these patients is limited. Objective: To evaluate the utility of ILR to detect arrythmias other than AF in patients with cryptogenic stroke. Methods: We enrolled consecutive CS patients referred for an ILR. A retrospective chart review was conducted from 2018 to 2021. All patients were monitored for a minimum of one year. Results: The cohort included 260 consecutive patients with cryptogenic stroke with a mean age of 68. 2 +/- 13.27 years patients of this cohort had at least one actionable arrhythmic event. AF was found in 47 (18%) patients and 44 (17%) patients were found to have other arrhythmias. Out of these 44 patients, 23 patients (9%) were found to have supraventricular tachycardias (SVT), 4 patients (2%) had ventricular tachycardias, 9 patients (3%) had pauses, 8 patients (3%) had significant bradycardia events. Anticoagulation was initiated in all 47 patients with AF. A total of 15 patients (6%) underwent procedures which included 7 pacemakers, 1 implantable cardioverter-defibrillator, 1 SVT ablation, 6 electrophysiology studies because of ILR findings. Conclusion: ILRs can successfully identify AF in patients with cryptogenic stroke. However, there is a high incidence of other arrythmias that can be detected by implanting ILRs that would otherwise would not be identified or have delayed detection. The study demonstrates the advantage of long-term remote monitoring of patients with CS beyond AF detection.

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.

Background: Coronavirus disease (COVID-19) has overwhelmed healthcare systems worldwide often at the cost of patients with serious non-COVID-19 conditions. Outcomes and risks of contracting COVID-19 in patients hospitalized during the pandemic are unknown. Objective: To report our experience in safely performing electrophysiology procedures during the COVID-19 pandemic. Methods: We examined non-COVID-19 patients who underwent electrophysiology procedures during the peak of the pandemic between March 16, 2020 and May 11, 2020 at seven Northwell Health hospitals. We developed a priority algorithm to stratify inpatients and outpatients requiring electrophysiology procedures and instituted a protocol to minimize hospital length of stay (LOS). All patients underwent post discharge 30-day tele-health follow-up and chart review up to 150 days. Results: A total of 217 patients underwent electrophysiology procedures, of which 86 (39%) patients were outpatients. A total of 108 (49.8%) patients had a LOS less than 24 hours, including 74 device implantations and generator changes, 24 cardioversions, five ablations, and one electrophysiology study. There were eleven (5.1%) procedure or arrhythmia related re-admissions and two (0.9%) minor procedural complications. Overall average hospital LOS was 83.4±165.1 hours and a median of 24.0 hours. For outpatient procedures, average hospital LOS was 9.4±13.4 hours and a median of 4.3 hours. Overall follow-up time was 83.9 ±42 days and a median of 84 days. During follow-up, two (0.9%) patients tested positive for COVID-19 and recovered uneventfully. No deaths occurred. Conclusion: During the peak of the COVID-19 pandemic, patients safely underwent essential electrophysiological procedures without increased incidence of acquiring COVID-19.