43 [1.27, 1.60]), no difference in primary care provider visits (aIRR [95% CI] 1.0 [0.95, 1.05]), but lower rates of emergency department (ED) visits and hospitalizations (aIRR [95% CI] 0.80 [0.69, 0.92]) compared with controls. Among those with newly diagnosed AF, the reduction in ED visits and hospitalizations was even greater (aIRR [95% CI] 0.27 [0.17, 0.43]). AF screening in an asymptomatic, moderate-risk population with an ECG patch was associated with an increase in cardiology outpatient visits but also significantly lower rates of ED visits and hospitalizations over the 1 year following screening.AF screening in an asymptomatic, moderate-risk population with an ECG patch was associated with an increase in cardiology outpatient visits but also significantly lower rates of ED visits and hospitalizations over the 1 year following screening. We present a case series and short review of electroanatomical mapping (EAM)-guided pacing lead implantation. The cases illustrate different aspects of EAM use in special circumstances and summarizes our experience with EAM-guided His lead implantation in 32 consecutive patients. Advantages and caveats encountered when using EAM in device procedures are discussed. To illustrate usefulness of EAM-guided lead implantation and computed tomography (CT) image integration in a case series. Lead implantation was performed targeting different anatomically defined regions using EAM for mapping and lead navigation, as well as using the system for image integration for 2 cardiac resynchronization therapy implantations. For His bundle pacing lead implantation, a steep learning curve for successful His bundle lead placement seems obtainable (91%) for new implanters using EAM-guided implantation. Successful lead placements in other locations guided by anatomical or physiologically defined positions are demonstrated in individual cases. However, map shifts are frequently encountered and should be recognized and corrected. EAM-guided His bundle lead implantation seems to be a useful tool for arriving at high success rates for new His lead implanters with a steep learning curve, if appropriate precautions are undertaken. In selected cases EAM and CT scan image integration can be of benefit in lead implantation in other locations. Knowledge of specific problems in using EAM for device procedures should be recognized.EAM-guided His bundle lead implantation seems to be a useful tool for arriving at high success rates for new His lead implanters with a steep learning curve, if appropriate precautions are undertaken. In selected cases EAM and CT scan image integration can be of benefit in lead implantation in other locations. Knowledge of specific problems in using EAM for device procedures should be recognized. Placement of a left ventricular assist device (LVAD) has been described to compromise implantable cardioverter-defibrillator (ICD) defibrillation threshold (DFT). Elevated DFT will have negative consequences and increases the risk of ineffective ICD shocks, morbidity, and mortality. DFT testing is not routinely performed in clinical practice, despite this fact. We describe the clinical characteristics of 7 LVAD patients who presented with multiple ineffective ICD shocks, along with the management strategy in such patients. Seven patients (5 male, mean age 52.2 ± 9 years, 85.7% nonischemic cardiomyopathy) with an ICD in situ who progressed to NYHA class IV, ACC/AHA stage D chronic systolic congestive heart failure who underwent successful LVAD implantation presented to our institution in the setting of ventricular tachyarrhythmia and ineffective ICD shocks. Six patients underwent implantation of azygos and subclavian coils with subsequent DFT testing. The remaining patient was made comfort care. Five patients had successful DFT testing with azygos (n =4) and subclavian (n = 1) defibrillation coil implantation. One patient had unsuccessful DFT testing despite evaluation of multiple shock vectors. There were no major or minor vascular complications in any of the cases. There were no procedural-related deaths. This case series highlights the need for a systematic approach to management of ICDs and DFT testing in LVAD patients. The addition of new shock vectors with azygos and subclavian coil implantation may reduce DFT, shock burden, morbidity, and mortality.This case series highlights the need for a systematic approach to management of ICDs and DFT testing in LVAD patients. IWP-2 The addition of new shock vectors with azygos and subclavian coil implantation may reduce DFT, shock burden, morbidity, and mortality. The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an alternative to conventional transvenous ICD (TV-ICD) therapy to reduce lead complications. To evaluate outcomes in channelopathy vs patients with structural heart disease in the EFFORTLESS-SICD Registry and with a previously reported TV-ICD meta-analysis in channnelopathies. The EFFORTLESS registry includes 199 patients with channelopathies (Brugada syndrome 83, long QT syndrome 24, idiopathic ventricular fibrillation 78, others 14) and 786 patients with structural heart disease. Channelopathy patients were younger (39 ± 14 years vs 51± 17 years; < .001) with left ventricular ejection fraction 59% ± 9% vs 41% ± 18% ( < .001). The complication rate (follow-up 3.2 ± 1.5 years vs 3.0 ± 1.5 years) was similar 13.6% vs 11.2% ( = .42). Appropriate shocks rates were 9.5% vs 10.8% ( = .70), with shocks for monomorphic ventricular tachycardia being 2.0% vs 6.9% ( < .02) and for polymorphic ventricular tachycardia/ventriculuctural heart disease. Comparable IAS rates were achieved with the device programmed to higher rates for channelopathy patients. High-power short-duration (HPSD) ablation has been explored for pulmonary vein isolation. Early data suggest similar efficacy with shorter procedure times and perhaps greater safety. Data are lacking on the use of this ablation strategy for other arrhythmias. The purpose of this study was to evaluate the safety, efficacy, and clinical outcomes of HPSD ablation in patients with typical atrial flutter compared to those undergoing ablation with conventional settings. Consecutive patients undergoing cavotricuspid isthmus (CTI) ablation using standard power settings were compared to those performed after transitioning to HPSD ablation. Demographics, procedural details, and ablation outcomes were prospectively collected. The primary endpoint was duration of radiofrequency energy delivery. Secondary endpoints were radiation duration and analgesia requirements. A total of 114 consecutive subjects undergoing CTI ablation (57 standard power, 57 HPSD) were included. HPSD ablation and electroanatomic mapping/contact force (EAM/CF) use were associated with 66% (95% confidence interval [CI] 58%-73%) and 50% (95% CI 37%-60%) shorter ablation times compared to standard power and not using EAM/CF, respectively.