Ventricular tachycardia is a major cause of sudden death. Several pharmacological and device-based therapies in recent years have delayed the progression of heart failure and have improved survival. A new study reveals a significant increase in age-adjusted mortality from ventricular tachycardia over the past 13 years, with higher mortality in men, black Americans and patients from the Southern United States. These findings reinforce the previous observations made on the influence of age, gender, ethnicity and geography on cardiovascular outcomes. The use of ICD 10 codes to ascertain cause of death limits differentiation between ventricular tachycardia as the true underlying mechanism leading to death and the presence of ventricular tachycardia in patients dying from other causes. While the insights gained from the report on contemporary ventricular tachycardia related mortality in the general population with cardiovascular disease is hypothesis generating, further studies are needed to delineate ventricular tachycardia as a proximate cause of death from an association.

Left anterior descending (LAD) coronary arterial injury is an underappreciated and rare consequence of ablation in the right ventricular outflow tract (RVOT). The authors present five cases of acute or subacute LAD injury after RVOT ablation. Most patients had fairly extensive ablation and two had coincident cardiac perforation. The patients reported also had a strikingly similar ECG morphology of their spontaneous ventricular arrhythmias. The authors’ report serves an important cautionary tale regarding ablation of intramural septal VAs.

Background Patients with atrial fibrillation are increasingly prescribed a direct oral anticoagulant (DOAC) over warfarin and seek to avoid anticoagulation even without a history of major bleeding. This study explores the outcomes of patients implanted with a Watchman device in relation to anticoagulation choice (warfarin versus DOAC) in the post-procedure period and a history of bleeding. Methods Patients implanted with a Watchman device at a single center were retrospectively analyzed. Characteristics including anticoagulation in the first 45 days and history of major bleed were assessed and efficacy (thromboembolism) and safety (bleeding) outcomes compared by Kaplan-Meier analysis. Results 209 patients were implanted (57% male, age 74.6  7.8 years) and followed for 23.5 ± 7.1 months. In the first half of patients, 98% were prescribed warfarin, which dropped to 51% in the second half (p<0.0001). A history of major bleed was present in 80.8% of the first half of patients and decreased to 60% in the second half (p=0.001). There were 16 safety and 4 efficacy events. There was no difference in safety outcomes according to history of major bleeding or anticoagulant choice in the first 45 days. There was no difference in efficacy outcomes over the duration of follow up according to anticoagulation choice in the first 45 days. Conclusions Patients implanted with a Watchman device were increasingly over time prescribed a DOAC and implanted without a history of major bleeding. Bleeding and thromboembolic events were infrequent and related neither to choice of anticoagulant nor to prior major bleeding.