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Introduction: The QDOT MICROTM Ablation Catheter is a next‐generation ablation catheter that allows for high‐power ablation up to 90 watts. Methods: We aimed to assess AE associated with the QDOT MICROTM catheter using the MAUDE database. A MAUDE database search was conducted on May 25, 2024, to capture all AEs (since FDA approval) associated with this ablation catheter. Results: A total of 302 AEs from November 23, 2022, to April 30, 2024, were reported including 148 (49%) catheter‐related issues and 154 (51%) clinical complications. Among the catheter‐related issues, physical catheter damage (74.3%, n = 110) was most common, followed by communication or display issue (10.8%, n = 16), irrigation issue (9.5%, n = 14), signal issue or artifact (3.4%, n = 5), and inaccurate temperature measurement (2.0%, n = 3). Regarding clinical complications, the most common AE was pericardial effusion (43.5%, n = 67), followed by char formation (11.7%, n = 18), catheter thrombosis (7.1%, n = 11), stroke (7.1%, n = 11), pericarditis (7.1%, n = 11), esophageal complications (6.5%, n = 10), phrenic nerve palsy (3.9%, n = 6), cardiac arrest (3.9%, n = 6), significant AV block (3.9%, n = 6), pulmonary vein stenosis (3.2%, n = 5), coronary artery spasm (1.3%, n = 2), and pulmonary embolism (0.6%, n = 1). There were 11 deaths (five related to esophageal complications, five related to cardiac arrest, and one related to pericardial effusion with cardiac tamponade). Conclusion: As high‐power ablation strategy with novel ablation catheters is becoming more widely utilized, operators must be aware of potential catheter‐related issues and clinical complications that may arise. More data are needed to further evaluate risks of these complications to improve the catheter's safety and efficacy. [ABSTRACT FROM AUTHOR]

New ablation catheters have continuously developed to improve the safety and efficacy of ablation procedures. The TactiFlex Ablation Catheter Sensor Enabled (Abbott, Minneapolis, MN) is a novel open‐irrigation radiofrequency ablation catheter that has contact force‐sensing technology and flexible tip, allowing real‐time contact force assessment with directionality. This case report reported a loss of contact force vector and directionality with the TactiFlex SE ablation catheter during de novo atrial fibrillation (AF) ablation. [ABSTRACT FROM AUTHOR]

Background: Dual occlusive closure mechanism (disc and lobe type), Amulet device (Abbott; a second‐generation device that has replaced Amplatzer Cardiac Plug) was approved by the Food and Drug Administration (FDA) in August 2021 for percutaneous left atrial appendage occlusion (LAAO). However, real‐world safety data on the delivery system (Amplatzer Cardiac Plug and Amplatzer Amulet device) are lacking. Objective: We sought to assess the type of adverse events associated with the Amplatzer LAAO delivery system using the FDA Manufacturer and User Facility Device Experience (MAUDE) database. Methods: A MAUDE database search was conducted on March 31, 2023, for reports received between February 2013 and March 2023 to capture all adverse events. Results: A total of 59 adverse events were reported, of which 58 were sheath‐related events, and one was a wire‐related event. The most commonly encountered issue was air embolism (19%, 11 events), followed by sheath thrombosis (13.8%, eight events, two of which were also associated with device thrombosis), kinked sheath (10.3%, six events), and sheath deformation (8.6%, five events). Patient‐related adverse events included pericardial effusion requiring pericardiocentesis (22.4%, 13 events), vascular complications (20.7%, 12 events), and device dislodgement (5.2%, three events). Conclusion: LAAO‐related adverse events are increasingly being reported using the Amplatzer LAAO delivery sheath. It is anticipated that improvements in device technology, the advent of steerable sheaths, and operator experience will minimize these complications. [ABSTRACT FROM AUTHOR]

Background: Monomorphic ventricular tachycardia (VT) is rare in patients with hypertrophic cardiomyopathy (HCM), management of which is challenging. Limited data exists on the utility of catheter ablation for the treatment of VT in this population. Objectives: We aimed to assess clinical outcomes of catheter ablation for VT in HCM patients. Methods: A systematic search, without language restriction, using PubMed, EMBASE, SCOPUS, Google Scholar, and ClinicalTrials.gov was performed. The meta‐analysis was performed using a meta‐package for R version 4.0/RStudio version 1.2 and Freeman Tukey double arcsine method to establish the variance of raw proportions. Outcomes measured included (1) acute procedure success (defined as noninducible for clinical VT), (2) freedom from VT at follow‐up, (3) mortality. Results: This systematic review of six studies (three from the United States and three from Japan) incorporated a total of 68 drug‐refractory HCM patients who underwent VT radiofrequency catheter ablation (mean age 57.6 ± 13.3 years, mean LVEF 45.8 ± 15.4%, 85% men, maximum septal wall thickness 17.4 ± 4.6 mm, and 32.3% with an apical aneurysm). Acute procedural success was achieved in 84.5% patients (95% confidence interval [CI]: 70.6%–95.2%) with 27.9% patients had recurrent VT requiring multiple ablations (median 1, IQR 1–3). During the follow‐up period (18.3 ± 11.7 months), the pooled incidence of freedom from recurrent VT after index procedure was 70.2% (95% CI: 51.9%–86.2%), while after the last ablation was 82.8% (95% CI: 57%–99.2%). There were two deaths during follow‐up, one from heart failure and one from SCD 0.8% (95% CI: 0%–5.8%). Conclusion: The results of our pooled analysis demonstrated that catheter ablation for VT in HCM patients was associated with high acute procedural success, and reduced VT recurrence—findings comparable to previously published reports in other disease substrates. [ABSTRACT FROM AUTHOR]

Background: Swallowing‐associated arrhythmias are rare and most commonly present as atrial tachycardias. Methods: We present a case of a 45‐year‐old female who experienced frequent episodes of palpitations and dyspnea occurring immediately after swallowing solid food. She was noted to have atrial tachycardia with deglutition that was recorded on the 12‐lead electrocardiogram. She underwent fluoroscopic esophagram that demonstrated atrial tachycardia as the barium passed through the distal esophagus and gastroesophageal junction. Conclusion: Swallowing induced arrhythmias occur rarely and can be confirmed by EKG obtained during deglutition. Gastroesophageal evaluation is required to rule out primary esophageal disorders. Treatment of such arrhythmias is required if symptoms are intractable and can include pharmacotherapy and radiofrequency ablation. [ABSTRACT FROM AUTHOR]

Intracardiac echocardiography (ICE) has become an essential tool and is an integral part of percutaneous interventional and electrophysiology (EP) procedures. Intracardiac echocardiography offers real‐time, high‐quality, near‐field evaluation of cardiac anatomy. Standard ICE imaging includes placing the catheter in the right atrium (RA), right ventricle (RV), or left atrium (LA, via the transeptal approach). Coronary sinus echocardiography (CSE) is another alternative, where the ICE catheter is positioned in the coronary sinus (CS). This approach offers better catheter stability and allows operators to visualize cardiac structure with particularly excellent views of the LA, LAA, left ventricle (LV), and mitral annulus. Additionally, CSE is an attractive alternative in cases with unfavorable interatrial septum or fossa ovalis anatomical features that could lead to difficulty advancing ICE catheter in left atrium. In this article focusing on CSE, we provide illustration‐based guidance to help operators identify critical cardiac structures from CSE. [ABSTRACT FROM AUTHOR]

The article discusses analysis to assess the safety and efficacy of LAAO in AF patients with BD. Topics include promising data regarding the use of percutaneous LAAO devices; two landmark trials (PROTECT AF1 and PREVAIL trials2), which resulted in the approval of percutaneousLAAO excluded patients with a prior history of BD.

Background: Thromboembolic (TE) events are among the most common and devastating adverse events in patients with continuous‐flow left ventricular assist device (cf‐LVAD). Given the high burden of AF among cf‐LVAD patients, we sought to evaluate the effect of concomitant surgical LAAO in patients receiving cf‐LVAD. Methods: A systematic search using electronic databases was performed using the keywords: "left atrial appendage occlusion" and "left ventricular assist device." Statistical analysis was performed using metapackage for R version 4.0 and Rstudio version 1.2. Mantel–Haenszel risk ratio (RR) random‐effects model was used to summarize data between two groups. The primary outcomes included: (a) stroke; (b) LVAD pump thrombosis; (c) all‐cause mortality Results: Three studies with a total of 305 patients (LAAO = 68 and No‐LAAO = 237) were included in the analysis. HeartMate II (39%) and Heartware (27.5%) were the two most common cf‐LVADs utilized, while only 5% received HeartMate III. At a mean follow up of 1.47 years, LAAO group had a lower risk of stroke (8.8% vs. 15.2%, RR 0.64; 95% CI 0.28–1.49), LVAD pump thrombosis (1.5% vs. 3.8%, RR 0.28; 95% CI 0.05–1.55) and all‐cause mortality (5.9% vs. 20.2%, RR 0.69; 95% CI 0.19–2.52) when compared with no‐LAAO group, but the difference did not reach statistical significance. Conclusion: Concomitant surgical LAAO at the time of cf‐LVAD implantation demonstrated a trend toward positive outcomes and was not associated with adverse outcomes during the follow‐up period, though the results were not statistically significant [ABSTRACT FROM AUTHOR]

Background: Gene expression profiling (GEP) and donor‐derived, cell‐free DNA (dd‐cfDNA) measurement are alternative methods to endomyocardial biopsy (EMB) to monitor for rejection following heart transplantation. We aim to describe our use of GEP and dd‐cfDNA in heart transplant recipients > 1‐year post‐transplantation. Methods: This is a single‐center, retrospective study in post‐transplant recipients. For patients who were > 1‐year post‐transplantation and deemed to be at elevated clinical risk for rejection, we collected both GEP and dd‐cfDNA every 3 months. Baseline characteristics including GEP, dd‐cfDNA levels, rejection episodes, and number of biopsies were obtained. Results: Since July 2019, there were 18 patients being followed with GEP and dd‐cfDNA who were > 1‐year post‐transplantation. Nine EMBs had been performed in seven patients due to as follows; three due to elevated GEP ({greater than or equal to} 34), one due to elevated dd‐cfDNA ({greater than or equal to}.20%), two due to elevations of both GEP and dd‐cfDNA, two due to clinical rejection and one to follow up a post rejection episode. One of the two biopsies due to elevations of both GEP and dd‐cfDNA showed acute cellular rejection grade 2R. None of the biopsies due to either an elevation in the GEP or dd‐cfDNA revealed any significant rejection. Conclusion: In this study, the use of both GEP and dd‐cfDNA led to an increased number of EMB in patients > 1‐year post‐transplantation. Further studies are needed to validate these findings and evaluate long‐term consequences of these diagnostic tests in this population [ABSTRACT FROM AUTHOR]

Background: Due to an increasing need for cardiac implantable electronic device (CIED) placement, the cost of healthcare has been rising including the cost of hospital stay after the procedure. We conducted this systematic review and meta‐analysis to assess the safety and feasibility of same‐day discharge (SDD) after cardiac device implantations. Methods: We searched MEDLINE, and Embase databases from inception to March 2021 to identify studies that compared clinical outcomes between SDD group and hospital overnight stay (HO) group after cardiac device implantations. Outcomes included complications after the procedure, mortality, and re‐hospitalization. Data from each study were combined using the random‐effects model to calculate pooled odds ratio (OR) with 95% confidence interval (CI). Results: Eight studies (one randomized control trial, three prospective cohort and four retrospective cohort studies) with a total of 61,602 patients (4153 in SDD group and 57,449 in HO group) were included. SDD was not associated with more procedure‐related complications. The rates of wound problems (0.94% vs 1.84%, pooled OR = 0.86, 95%CI: 0.2‐3.68, p =.834), pneumothorax (1.15% vs 0.73%, pooled OR = 1.36, 95%CI: 0.26‐7.12, p =.718), hematoma (0.59% vs 2.32%, pooled OR = 0.35, 95%CI:0.01‐9.85, p =.534), lead/device dislodgement (4% vs 2.48%, pooled OR = 1.71, 95%CI: 0.64‐4.54, p =.281), readmission rate (17.6% vs 17.5%, pooled OR = 0.95, 95%CI: 0.74‐1.21, p =.667), and mortality rate (1.66% vs 1.44%, pooled OR = 0.77, 95%CI: 0.58‐1.01, p =.059) were similar between in SDD and HO groups respectively. Conclusions: Our meta‐analysis suggested that SDD after cardiac device implantations might be a safe and feasible alternative to HO without differences in procedure‐related complications, readmission rates, or mortality rates. [ABSTRACT FROM AUTHOR]

Background: Multiple strategies have advocation for power titration and catheter movement during atrial fibrillation (AF) ablation. Comparative favoring evidence regarding the efficacy, logistics, and safety of a higher‐power, shorter duration (HPSD) ablation strategy compared to a lower‐power, longer duration (LPLD) ablation strategy is insubstantial. We performed a meta‐analysis to compare arrhythmia‐free survival, procedure times, and complication rates between the two strategies. Methods: We searched MEDLINE, EMBASE, and Cochrane Library from inception to September 2020. We included studies comparing patients who underwent HPSD and LPLD strategies for AF ablation and reporting either of the following outcomes: Freedom from atrial tachyarrhythmia (AT) including AF and atrial flutter, procedure time, or periprocedural complications. We combined data using the random‐effects model to calculate the odds ratio (OR) and weight mean difference (WMD) with a 95% confidence interval (CI). Results: Ten studies from 2006 to 2020 involving 2274 patients were included (1393 patients underwent HPSD strategy and 881 patients underwent LPLD strategy). HPSD strategy was not associated with increased freedom from AT at 12‐month follow‐up (OR = 1.54, 95% CI: 0.99 to 2.40, p =.054). In the subgroup analysis of the randomized controlled trial, the HPSD strategy was associated with increased freedom from AT compared to the LPLD strategy (OR = 3.12, 95% CI: 1.18 to 8.20, p =.02). There was a significant reduction in the HPSD group for the total procedure (WMD = 49.60, 95% CI: 29.76 to 69.44) and ablation (WMD = 17.92, 95% CI: 13.63 to 22.22) times, but not for fluoroscopy time (WMD = 1.15, 95% CI: −0.67 to 2.97). HPSD was not associated with a reduction in esophageal ulcer/atrioesophageal fistula (OR = 0.35, 95% CI: 0.12 to 1.06) or pericardial effusion/cardiac tamponade rates (OR = 1.16, 95% CI: 0.35 to 3.81). Conclusions: When compared to the LPLD strategy, the HPSD strategy does not improve recurrent AT nor reduce periprocedural complication risks. However, subgroup analysis of the randomized controlled trial showed that HPSD significantly reduces AT recurrence. An HPSD strategy can significantly reduce total procedure and ablation times. [ABSTRACT FROM AUTHOR]

Background: Contrast-induced nephropathy (CIN) frequently occurs following coronary angiography (CAG) and is associated with worse outcomes, including both short and long-term mortality. Previous studies reported an association between procedural hyperglycemia (PH) and CIN, with or without diabetes mellitus (DM). We performed a systematic review and meta-analysis to explore the association of PH and CIN in patients undergoing CAG.Methods: We searched the databases of MEDLINE and EMBASE from inception to January 2020. Included studies investigated CIN incidence in patients undergoing CAG. Data from each study were combined using the random-effects model.Results: A total of eight studies were included in this meta-analysis. We found that PH was associated with an increased risk of CIN following CAG (pooled OR = 1.71, 95%CI:1.35-2.16, where PH was defined as ≥140 mg/dl; and pooled OR = 2.07, 95%CI:1.80-2.37, where PH was defined as ≥200 mg/dl). In subgroup analysis of non-diabetic patients and STEMI patients undergoing primary percutaneous coronary intervention, we found that PH was associated with an increased risk of CIN in both subgroups, where PH was defined as ≥140 mg/dl and ≥200mg/dl (p-value < 0.05).Conclusions: Our meta-analysis demonstrated that PH significantly increases the risk of CIN following CAG, in both diabetic and non-diabetic populations. Further studies are needed to evaluate whether strict blood glucose control can reduce the incidence of CIN in this population. [ABSTRACT FROM AUTHOR]

Introduction: Brugada syndrome (BrS) is associated with ventricular arrhythmia leading to sudden cardiac death. Risk stratification is challenging, as major arrhythmic events (MAEs) are rare. We assessed the utility of drug challenge testing in BrS by a systematic review and meta‐analysis. Methods and Results: We comprehensively searched the databases of MEDLINE and EMBASE from inception to May 2019. Included studies compared the incidence of MAE between spontaneous and drug challenge–induced Type 1. Mixed‐effects Poisson regression was used to calculate the incidence rate ratio (IRR). Eighteen studies from 2006 to 2018 were included (4099 patients, mean follow‐up: 4.5 years). Pooled annual incidences of MAE in spontaneous, drug challenge induced (regardless of symptoms), asymptomatic drug challenge induced, and symptomatic drug challenge–induced Type 1 were 23.8 (95% confidence interval [CI]: 19.8–27.8), 6.5 (95% CI: 3.9–9.1), 2.1 (95% CI: −0.3 to 4.4), and 19.6 (95% CI: 9.9–29.3) per 1000 person‐years, respectively. The incidence of MAE between symptomatic drug challenge induced and asymptomatic spontaneous Type 1 was not statistically different (IRR = 1.0; 95% CI: 0.6–1.7). Conclusions: The incidence of MAE in drug challenge–induced Type 1 in asymptomatic patients is low. The incidence of MAE between symptomatic drug challenge induced and asymptomatic spontaneous Type 1 was similar. [ABSTRACT FROM AUTHOR]

Objective: The presence of both sympathetic activation-mediated triggers and parasympathetic activation-mediated substrates are required to initiate and maintain some forms of atrial fibrillation (AF). AF predominantly precipitated by parasympathetic stimulation is known as vagally-mediated AF (VM-AF). The role of novel drugs and molecular targeted gene therapy that modulate the autonomic nervous system are therapeutic options in this unique population with VM-AF. Here, we review the role of the sympatho-vagal balance in the genesis of AF and consider drug therapy for VM-AF. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, literature search was conducted using the keywords "vagal", "vagal nerve", "vagus", "vagus nerve", and "atrial fibrillation". Retrieved citations were first screened independently by 2 reviewers for inclusion and exclusion criteria. Results: A total of 14 studies and 3 practice guidelines from 1986-2017 were included. Only two clinical investigations evaluated the effectiveness of disopyramide and sotalol in human subjects with VM-AF. The potential role of antiarrhythmic drugs has been studied in animal models. Conclusion: Growing evidence suggests that the autonomic nervous system is integral in the development of VM-AF. Novel medications and genetic targets are undergoing investigation with promising results. [ABSTRACT FROM AUTHOR]

We reported a case of cryptogenic organizing pneumonia (COP) presenting with an unusual diffuse micronodular pattern (DMP) mimicking miliary lung infiltration. The patient is a 66-year-old man with a past medical history of diabetes mellitus type 2 and hyperlipidemia who presented with progressive dyspnea associated with significant weight loss and night sweats for 2 weeks. Upon admission, the patient's clinical condition rapidly progressed to respiratory failure requiring mechanical ventilation. Initial Chest X-ray (CXR) showed diffuse reticulonodular infiltration mimicking miliary pattern. Chest computed tomography (CT) showed diffuse centrilobular micronodular infiltrations with features of a tree-in-bud pattern consistent with the CXR findings. He was then started on empiric antibiotics for community-acquired pneumonia and underwent a diagnostic bronchoscopy with alveolar lavage and transbronchial biopsies, which yielded negative cultures and unrevealing pathology. Tissue from CT-guided lung biopsy performed later on was also inconclusive. Due to the lack of clinical improvement, he eventually underwent surgical lung biopsy. The pathology result showed organizing pneumonia (OP) pattern with heavy lymphoplasmacytic infiltrates and numerous multinucleated giant cells. His final culture results, microbiological data and serology workup for autoimmune disease were all unremarkable. The patient was diagnosed with COP and was started on systemic corticosteroids. He displayed dramatic clinical improvement and was successfully liberated from the ventilator. Subsequent chest imaging showed resolution of the reticulonodular infiltrations. Early diagnosis for OP and ability to distinguish OP from infectious pneumonitides are critical as the majority of patients with OP respond promptly to corticosteroids. Common findings of radiographic pattern for OP are patchy air space consolidation or ground-glass opacity, yet DMP is another rare radiographic pattern that must be recognized, especially in COP. In summary, this case illustrates a rare radiographic presentation of COP. With early recognition and prompt diagnosis, proper treatment can significantly prevent morbidity and reduce mortality. [ABSTRACT FROM AUTHOR]

Objective: Recent studies have shown that atrial fibrillation (AF) is more prevalent in patients with retinal vessel occlusion and may be associated with both central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO). However, there is no systematic review and meta-analysis to confirm this finding. Methods: We searched the databases of MEDLINE and EMBASE from inception to January 2019. Included studies were published cohort, case-control or cross-sectional studies, and randomized control trials reporting the prevalence of AF in patients with CRAO or CRVO. Data from each study were combined using the random-effects model. Results: Eleven studies were included in our meta-analysis, involving a total population of 12,305 subjects with retinal vessel occlusion. The prevalence of AF ranged from 4.1% to 21.4% (pooled prevalence = 11.5%, 95% CI: 7.0–16.1, I2 = 96.3%). Five studies reported a control group of patients without retinal vessel occlusion. We found that AF is significantly associated with retinal vessel occlusion (pooled OR = 2.24, 95% CI:2.07–2.43, I2 = 0.0%). Conclusion: Our study showed that AF is significantly associated with retinal vessel occlusion. Further studies are needed to fully elucidate the exact mechanism linking AF with CRAO and CRVO. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients who present to the emergency department (ED) for suspected pulmonary embolism (PE) are often on active oral anticoagulation (AC). However, the diagnostic yield of computed tomography pulmonary angiography (CTPA) in screening for PE in patients who present on AC has not been well characterized. We aim to investigate the diagnostic yield of CTPA in diagnosing PE depending on AC status. METHODS: We reviewed and analyzed the electronic medical records of patients who underwent CTPA for PE at a university hospital ED from June 1, 2019, to March 25, 2022. Primary outcome was the incidence of PE on CTPA depending on baseline AC status and indication for AC. RESULTS: Of 2,846 patients, 242 were on AC for a history of venous thromboembolism (VTE), 210 were on AC for other indications, and 2,394 were not on AC. The incidence of PE on CTPA was significantly lower in patients on AC for other indications (5.7%) when compared to patients on AC for prior VTE (24.3%) and patients not on AC at presentation (9.8%) (P<0.001). In multivariable analysis among the whole cohort, AC was associated with a positive CTPA (odds ratio [OR] 0.26, 95% confidence interval [CI]: 0.15–0.45, P<0.001). CONCLUSION: The incidence of PE among patients undergoing CTPA in the ED is lower in patients previously on AC for indications other than VTE when compared to those not on AC or those on AC for history of VTE. AC status and indication for AC may affect pre-test probability of a positive CTPA, and AC status therefore warrants consideration as part of future diagnostic algorithms among patients with suspected PE. [ABSTRACT FROM AUTHOR]

Introduction: Recent studies suggest that implantable cardioverter defibrillators (ICDs) are associated with increased risk of cardiac implantable electronic device (CIED) infections when compared with permanent pacemakers (PPMs). However, there were controversies among studies. In this study we performed a systematic review and meta‐analysis to explore the risk of device infection in ICD versus PPM. Methods: We searched the databases of MEDLINE and EMBASE from inception to January 2019. Data from each study were combined using the random‐effects, generic inverse variance method of Der Simonian and Laird to calculate odds ratios (OR) and 95% confidence intervals (CI). Results: Twenty‐seven studies involving 202 323 CIEDs (36 782 ICDs and 165 541 PPMs) were included. Infections occurred from 9 days to 6 years postoperatively. When compared with PPM, ICD had a significantly higher risk of device infection in overall analysis (OR = 1.62, 95% CI: 1.29‐2.04). The risk was seen in subgroups such as single chamber or dual chamber device (OR = 1.57, 95% CI: 1.18‐2.09), de novo implantation (OR = 1.62, 95% CI: 1.29‐2.69), revision implantation (OR = 1.63, 95% CI: 1.24‐2.13), and cardiac resynchronization therapy (CRT) (OR = 1.75, 95% CI: 1.18‐2.60). CRT‐defibrillator increased risk of infection over CRT‐pacemaker in revision implantation (OR = 1.81, 95% CI: 1.20‐2.74) but not in de novo implantation (OR = 1.07, 95% CI: 0.23‐4.88). The increased risk of infection among defibrillator was higher in CRT compared to non‐CRT but not significant (P = 0.654). Conclusions: Our meta‐analysis demonstrates a statistically significant increased risk of device infection in CIED patients who received ICD when compared to PPM. [ABSTRACT FROM AUTHOR]

Background. Simultaneous bilateral primary spontaneous pneumothorax (SBPSP) is an extremely rare and potentially fatal condition. Patients usually have no relevant medical conditions. Some cases, however, may have certain risk factors such as smoking, being young, and male gender. We reported a case of a healthy young male who presented with BPSP. Case Presentation. A 21-year-old man with a past medical history of well-controlled intermittent asthma presented with acute worsening shortness of breath overnight. Chest X-ray performed showed bilateral large pneumothorax with significantly compressed mediastinum. Chest tubes were placed bilaterally with immediate clinical improvement. However, the chest tubes continued to have an air leak without full lungs expansion. Computed tomography scan without contrast of the chest revealed subpleural blebs in both upper lobes. The patient underwent bilateral video-assisted thoracoscopic surgery (VATS) with apical bleb resection, bilateral pleurectomy, and bilateral doxycycline pleurodesis. Biopsy of the apical blebs and parietal pleura of both lungs were negative for any atypical cells suspicious for malignancy or Langerhans cell histiocytosis. The patient had been doing well six months following surgery with no recurrence of pneumothorax. Conclusion. SBPSP is a rare and urgent condition that requires prompt intervention. In a young patient without any underlying disease, surgical intervention, such as VATS, is relatively safe and can be considered early. [ABSTRACT FROM AUTHOR]

We present a case of a 28-year-old woman withinterrupted inferior vena cava (IVC) with azygous vein continuation who underwent ablation of premature ventricular contraction (PVC) in the right ventricle (RV) with access to the right atrium (RA) via the azygous vein and superior vena cava (SVC). [ABSTRACT FROM AUTHOR]

Background: High‐power short‐duration (HPSD) atrial fibrillation (AF) ablation with a power of 40–50 W was proved to be safe and effective. Very high‐power short‐duration (vHPSD) AF ablation is a novel method using >50 W to obtain more durable AF ablation. This study aimed to evaluate the efficacy and safety of vHPSD ablation compared with HPSD ablation and conventional power ablation. Methods: A literature search for studies that reported AF ablation outcomes, including short‐term freedom from atrial arrhythmia, first‐pass isolation (FPI) rate, procedure time, and major complications, was conducted utilizing MEDLINE, EMBASE, and Cochrane databases. All relevant studies were included in this analysis. A random‐effects model of network meta‐analysis and surface under cumulative ranking curve (SUCRA) were used to rank the treatment for all outcomes. Results: A total of 29 studies with 9721 patients were included in the analysis. According to the SUCRA analysis, HPSD ablation had the highest probability of maintaining sinus rhythm. Point estimation showed an odds ratio of 1.5 (95% confidence interval [CI]: 1.2–1.9) between HPSD ablation and conventional power ablation and an odds ratio of 1.3 (95% CI: 0.78–2.2) between vHPSD ablation and conventional power ablation. While the odds ratio of FPI between HPSD ablation and conventional power ablation was 3.6 (95% CI: 1.5–8.9), the odds ratio between vHPSD ablation and conventional power ablation was 2.2 (95% CI: 0.61–8.6). The procedure times of vHPSD and HPSD ablations were comparable and, therefore, shorter than that of conventional power ablation. Major complications were low in all techniques. Conclusion: vHPSD ablation did not yield higher efficacy than HPSD ablation and conventional power ablation. With the safety concern, vHPSD ablation outcomes were comparable with those of other techniques. [ABSTRACT FROM AUTHOR]

Introduction: Atrial high‐rate episodes (AHRE) have been linked to increased thromboembolic risk and all‐cause mortality in patients with cardiac implantable electronic devices (CIEDs). Various predictors of AHRE development have been identified, emphasizing the need for close monitoring and the potential transition to clinical atrial fibrillation (AF). However, the predictive value of P wave characteristics on AHRE development remains conflicting. This meta‐analysis aims to summarize existing data to investigate this association. Method: We examined studies from MEDLINE and EMBASE databases up to May 2024 to investigate the association of baseline P‐wave duration (PWD), P‐wave dispersion (PWDIS), and interatrial block (IAB) with the risk of developing AHRE. We extracted the mean and standard deviations of PWD and PWDIS to calculate the pooled mean difference (MD). Risk ratios (RR) and 95% confidence intervals (CIs) were used to assess the association between IAB and AHRE risk, using the generic inverse variance method for combination. Results: The meta‐analysis included nine studies. Patients with AHRE had longer PWD and PWDIS compared to those without AHRE, with a pooled MD for PWD of 9.17 ms (95% CI: 4.74–13.60; I2 = 47%, p < 0.001) and a pooled MD for PWDIS of 20.56 ms (95% CI: 11.57–29.56; I2 = 57%, p < 0.001). Additionally, patients with IAB had a higher risk of developing AHRE, with a pooled RR of 3.33 (95% CI: 2.53–4.38; I2 = 0%, p < 0.001), compared to those without IAB. Conclusions: Our meta‐analysis found that patients with AHRE had higher PWD and PWDIS than those without AHRE. Additionally, IAB was associated with a higher risk of developing AHRE. These findings emphasize the importance of close monitoring and risk stratification, particularly for patients with P wave abnormalities. [ABSTRACT FROM AUTHOR]

Background: Recent studies have demonstrated an obesity paradox, where obese patients with cardiovascular disease have a better outcome compared to those with normal weight. However, the effect of obesity and body mass index (BMI) on the outcome of patients with cardiac resynchronization therapy (CRT) devices remains unclear. The current study aims to investigate this relationship using all available published data. Methods: We systematically reviewed studies from Medline and EMBASE databases from inception to January 2024. Eligible studies must investigate the association between BMI status and all‐cause mortality in individuals with CRT devices. Relative risk (RR) or hazard ratio (HR) and 95% CIs were retrieved from each study and combined using the generic inverse variance method. Results: A total of 12 cohort studies were included in the meta‐analysis. Pooled analysis showed that overweight and obesity patients had lower all‐cause mortality compared to those with normal body weight with the pooled risk ratios (RR) for overweight of 0.77 (95% CI 0.69–0.87, I2 47%) and for obesity of 0.81 (95% CI 0.67–0.97, I2 59%). Conversely, the underweight exhibited higher all‐cause mortality than the group with normal weight, with a pooled RR of 1.37 (95% CI 1.14–1.64, I2 0%). Additionally, higher BMI as continuous data was associated with decreased all‐cause mortality, with a pooled HR of 0.94 (95% CI 0.89–0.98, I2 72%). Conclusions: The pooled analyses observed an obesity paradox in patients with CRT, where overweight and obesity were associated with reduced all‐cause mortality, while underweight individuals exhibited higher all‐cause mortality. Further research is necessary to investigate the underlying mechanisms and their implications for clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia with a high stroke and mortality rate. The video‐assisted thoracoscopic radiofrequency pulmonary vein ablation is a treatment option for patients who fail catheter ablation. Randomized data comparing surgical versus catheter ablation are limited. We performed a meta‐analysis of randomized control trials to explore the outcome efficacy between surgical and catheter radiofrequency pulmonary vein ablation in patients with AF. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to December 2020. Included studies were published randomized control trials that compared video‐assisted thoracoscopic and catheter radiofrequency pulmonary vein ablation. Data from each study were combined using the fixed‐effects, generic inverse variance method of DerSimonian, and Laird to calculate odds ratios and 95% confidence intervals. Results: Six studies from November 2013 to 2020 were included in this meta‐analysis involving 511 AF patients (79% paroxysmal) with 263 catheter ablation (mean age 56 ± 3 years) and 248 surgical ablations (mean age 52 ± 4 years). Catheter ablation was associated with increased atrial arrhythmias recurrence when compared to surgical ablation (pooled relative risk = 1.85, 95% confidence interval: 1.44−2.39, p <.001, I2 = 0.0%) but associated with less total major adverse events (pooled relative risk = 0.29, 95% confidence interval: 0.16−0.53, p <.001, I2 = 0.0%). In subgroup analysis, catheter ablation was associated with increased AF recurrence in refractory paroxysmal AF when compared to surgical ablation (pooled relative risk = 2.47, 95% confidence interval: 1.31−4.65, p =.005, I2 = 0.0%) but not in persistent AF (relative risk = 1.09, 95% confidence interval: 0.60−2.0, p =.773). Conclusion: Catheter ablation was associated with higher atrial arrhythmia recurrence when compared with surgical ablation. However, our study suggests that the benefit of surgical ablation in patients with persistent AF is unclear. More studies and alternative ablation strategies investigation in persistent AF are warranted. [ABSTRACT FROM AUTHOR]