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Background: Recognition of the causes of early mortality after atrial fibrillation (AF) catheter ablation is essential for the improvement of patient safety. This study sought to determine the causes of early mortality (≤90 days) after AF ablation. Methods: We performed a retrospective analysis of AF ablation from January 1, 2013, to December 1, 2021 at the Mayo Clinic (Rochester, Phoenix, and Jacksonville). Causes of death were identified through a comprehensive chart review of the electronic health record from within the Mayo Clinic system and outside records when available. Results: A total of 6723 patients were included in the study. The 90-day all-cause mortality rate was 0.22% (n=15). Among all 90-day deaths, majority of the deaths (73.3%) did not have a direct relationship with the procedure. Sudden death was the most common cause of early death (20%), followed by peri-procedural stroke (13%), respiratory failure (13%), atrioesophageal fistula (13%), infection (7%), heart failure (7%), and traumatic brain injury (7%). The 90-day mortality rate directly due to AF ablation procedural complications was 0.06% (n=4). Conclusions: AF ablation procedure has a 90-day mortality of 0.22%, and the most common cause of early mortality was sudden death. The majority (73.3%) of early mortality was not directly associated with a procedural complication, and the mortality rate due to complications associated with the AF ablation procedure was low at 0.06%. Further studies are required to investigate causes and risk factors associated with sudden death in this patient population.

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.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.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, ICatheter 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.

Background Radiofrequency catheter ablation for cardiac arrhythmias has traditionally been guided by fluoroscopy. Fluoroscopy exposes the patient, operator, and staff to ionizing radiation which has no safe dose void of stochastic and deterministic biologic risks. Zero fluoroscopy (ZF) approaches for catheter ablation have been advocated to eliminate these risks. We conducted a meta-analysis comparing acute procedure success, recurrence-free survival, complications, and procedure times between the approaches. Methods We conducted a literature search from inception through December 2020 in the databases of EMBASE and MEDLINE. We included randomized controlled trials and cohorts that compared the outcomes of interest in ZF and conventional/low fluoroscopy (CF/LF) approaches. The outcomes sought were acute procedure success, recurrence-free survival, complications, and procedure times. Effect estimates were combined, using the random-effects, generic inverse variance method of DerSimonian and Laird. Results Sixteen studies from 2013 to 2020, including 6,052 patients (2,219 ZF, 3,833 CF/LF) were included. There were no significant differences in acute procedure success rate (odds ratio [OR] 1.10, 95% CI 0.75-1.59), recurrence-free survival (OR 1.08, 95% CI 0.78-1.49), periprocedural complication rate (OR 0.72, 95% CI 0.45-1.16), or total procedure time (weighted mean difference 2.32 minutes, 95% CI -2.85-7.50) between ZF and CF/LF approaches, respectively. Overall, only 1.26% of patients crossed over from ZF to CF/LF arm. Conclusions Peri- and post-procedural outcomes with a ZF approach compared favorably with traditional fluoroscopic guidance without increasing procedural times. As comfort with ZF grows, coupled with evolving mapping technologies, this method has potential to become the standard approach for catheter ablation. This article is protected by copyright. All rights reserved.

The impact of chronic kidney disease (CKD) or end-stage renal disease (ESRD) on patients receiving transvenous lead extraction (TLE) is not well-established. We performed a systematic review and meta-analysis to explore the association between CKD and all-cause mortality in TLE.We searched the databases of PubMed and EMBASE from inception to April 2022. Included studies were published TLE studies that compared the risk of mortality in CKD patients compared to control patients. Data from each study were combined using the random-effects model.Eight studies (5,013 patients) were included. Compared with controls, CKD patients had a significantly higher risk of overall all-cause mortality (hazard ratio [HR] = 2.14, 95% confidence interval [CI]: 1.65-2.77, IOur meta-analysis demonstrates a significantly increased risk of overall all-cause mortality in patients with CKD who underwent TLE compared to controls.

Background Although direct oral anticoagulants (DOACs) have been shown to be effective at reducing the risk of stroke in patients with atrial fibrillation/flutter (AF), they are sometimes underdosed off-label to mitigate their associated higher bleeding risk. We sought to evaluate frequency and clinical outcomes of inappropriate underdosing of DOACS in patients with AF. Methods We conducted a study of subjects with AF who had a clinical indication for stroke prophylaxis (with a congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65 to 47 years, sex category [CHA2DS2-VASc] of 2 or greater) and were prescribed 1 of the 4 clinically approved DOACs (apixaban, rivaroxaban, dabigatran, or edoxaban). We compared all-cause mortality, composite of stroke and systemic embolism, composite of myocardial infarction (MI), acute coronary syndromes (ACS), and coronary revascularization, and major bleeding between patients appropriately dosed and inappropriately underdosed. Results A total of 8125 patients met inclusion criteria, with a mean follow up of 2.2 ± 2 years. Of those, 1724 patients (21.2%) were inappropriately dosed. After adjusting for baseline variables, there was no difference in all-cause mortality, risk of stroke or systemic embolism, International Society on Thrombosis and Haemostasis (ISTH) major bleeding, or composite of myocardial infarction, acute coronary syndromes, or coronary revascularization between patients appropriately dosed and inappropriately underdosed. In subgroup analysis, only apixaban demonstrated an increased incidence all-cause mortality (hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.03-1.49) with inappropriate underdosing. There was no difference in the remaining clinical outcomes noted on subgroup analysis. Conclusion Underdosing of DOACs did not minimize risk of bleeding, systemic embolization or all-cause mortality in patients with AF. Inappropriate underdosing with apixaban in particular was associated with increased all-cause mortality.

We report 3 cases (mean age 48.3 ± 11.6 years) of idiopathic ventricular fibrillation (IVF), in which a triggering premature ventricular complex leading to IVF could not be identified. All patients underwent posterior fascicle transection with empirical linear ablation of the mid-Purkinje potentials identified along the left ventricular interventricular inferior septum, and no ventricular fibrillation recurrence was documented in any of the patients. (Level of Difficulty: Advanced.), Graphical abstract

Background Fever, alcohol, and sodium channel blockers can unmask Brugada pattern and may also induce arrhythmias in Brugada syndrome. We report a case of unmasked Type-1 Brugada pattern presenting with ventricular fibrillation that was induced by a tetrahydrocannabinol vaping. Case summary A 48-year-old male with a past medical history of hypertension treated with hydrochlorothiazide and back pain controlled with tetrahydrocannabinol vaping presented with sudden cardiac arrest from ventricular fibrillation, which was terminated with defibrillation. Electrocardiogram after resuscitation showed a new Type-1 Brugada pattern compared to a previous normal baseline electrocardiogram. Echocardiography and coronary angiogram were unremarkable. Complete blood count and chemistries were unremarkable except for mild hypokalaemia (K = 3.3 mmol/L). After correction of the hypokalaemia, the Type-1 Brugada pattern persisted. Urine drug screen was positive for tetrahydrocannabinol (60 ng/mL). Genetic testing was negative for inherited arrhythmic disease and cardiomyopathy gene panels. Discussion The patient’s type-1 Brugada pattern and ventricular fibrillation were likely induced by vaping tetrahydrocannabinol. He underwent secondary prevention with an implantable cardioverter-defibrillator. He abstains from cannabis and Type-1 Brugada pattern is normalized. There was no arrhythmic event at his 18-month follow-up appointment with abstinence from tetrahydrocannabinol.

Background Brugada syndrome (BrS) is an inherited arrhythmic disease associated with an increased risk of major arrhythmic events (MAE). Previous studies reported that a wide QRS complex may be useful as a predictor of MAE in BrS patients. We aimed to assess the correlation of wide QRS complex with MAE by a systematic review and meta‐analysis. Methods We comprehensively searched the databases of MEDLINE and EMBASE from inception to June 2019. Included studies were cohort and case control studies that reported QRS duration and the relationship between wide QRS complex (>120 milliseconds) and MAE (sudden cardiac death, sudden cardiac arrest, ventricular fibrillation, sustained ventricular tachycardia, or appropriate shock). Data from each study were combined using the random‐effects model. Results Twenty‐two studies from 2007 to 2018 were included in this meta‐analysis involving 4,814 BrS patients. The mean age was 46.1 ± 12.8 years. The patients were predominately men (77.6%). Wide QRS duration was an independent predictor of MAE (pooled risk ratio 1.55, 95% confidence interval: 1.04‐2.30, P = .30, I 2 = 38.4%). QRS duration was wider in BrS who had history of MAE (weight mean difference = 8.12 milliseconds, 95% confidence interval: 5.75‐10.51 milliseconds). Conclusions Our study demonstrated that QRS duration is wider in BrS who had history of MAE, and a wide QRS complex is associated with 1.55 times higher risk of MAE in BrS populations. Wide QRS complex can be considered for risk stratification in prediction of MAE in patients with BrS, especially when considering implantable cardioverter‐defibrillator placement in asymptomatic patients., Our study demonstrated that a wide QRS complex is associated with 1.55 times higher risk of major arrhythmic events in Brugada syndrome populations. Wide QRS complex can be considered for risk stratification in prediction of MAE in patients with BrS, especially when considering implantable cardioverter‐defibrillator placement in asymptomatic patients.

Introduction: Syncope was reported to be associated with sudden cardiac death in heart failure patients regardless of the etiology of syncope. We attempted to use unsupervised machine learning to identify the prognostically distinct phenotypes in a large population of heart failure patients presenting with syncope. Hypothesis: Unsupervised machine learning can identify prognostically distinct phenotypes in a large population of heart failure patients presenting with syncope. Methods: Patients with a diagnosis of systolic or diastolic heart failure and syncope at Mayo Clinic sites were identified for baseline and follow-up data. Variables with ≥ 20% missing data were excluded; a total of 57 variables were used for k-means clustering analysis. Patients were grouped according to 4 distinct k-means determined clusters for statistical analysis. Results: A total of 3,557 patients with proper follow-up and echocardiography data were included in the final analysis. The median follow-up duration was 36.3 months, and 2908 (81.7%) patients died. Cluster 2 (n= 680) was identified as the cluster with the highest mortality (92%), which contained patients with high proportions of cardiovascular comorbidities, especially chronic kidney disease. The Kaplan-Meier survival curves are shown in Figure 1. In multivariate Cox regression analysis, the presence of CKD independently predicts mortality (HR 1.62, 95%CI 1.50-1.76, p Conclusions: Unsupervised machine learning identified patients with CKD, CAD and DM are high-risk phenotypes in heart failure patients with syncope, and can be used to guide future studies in this highly heterogeneous, unexplored population.

Introduction: Catheter ablation of the arrhythmogenic substrate reduces the recurrence of ventricular tachycardia (VT) in patients with ischemic cardiomyopathy and implantable cardioverter-defibrillator (ICD). However, the all-cause mortality benefit in this population is unclear. Hypothesis: Prophylactic ablation of the arrhythmogenic substrate decreases all-cause mortality and prevents the recurrence of VT/ventricular fibrillation (VF) in patients with ischemic cardiomyopathy. Methods: We searched the MEDLINE and EMBASE databases from inception through May 2021. We included randomized controlled trials that compared all-cause mortality and ventricular arrhythmia recurrence in patients with ischemic cardiomyopathy who underwent ICD implantation with and without prophylactic ablation. The data from each study was combined using a fixed effects model to calculate the hazard ratio and 95% confidence interval (CI). Results: Four randomized controlled trials during 2007-2020 involving 505 patients (249 patients with and 256 patients without prophylactic VT ablation) were included in our meta-analysis. Compared with control, prophylactic VT ablation did not decrease the all-cause mortality (pooled hazard ratio = 0.94, 95% CI 0.54-1.63, p = 0.818, I2 = 5.8%). However, prophylactic VT ablation significantly decreased appropriate ICD therapy (pooled hazard ratio = 0.58, 95% CI 0.41-0.82, p = 0.002, I 2 = 26.1%) and VT/VF recurrence (pooled hazard ratio = 0.70, 95% CI 0.52-0.93, p = 0.015, I 2 = 0.0%). Conclusions: Prophylactic VT ablation in patients with ischemic cardiomyopathy did not decrease all-cause mortality; however, it did lead to decreased appropriate ICD therapy and VT/VF recurrence.

Previous studies examining the association of retinal vein occlusion (RVO) and cardiovascular events have been inconsistent and have mostly focused on stroke and myocardial infarction. The goal of this study is to use meta-analysis to examine the available evidence examining the association of RVO with incident cardiovascular events and mortality.Systematic review and meta-analysis of all longitudinal cohort studies published in PubMed, Embase, and the Cochrane Library from inception to April 7, 2018, that evaluated the association of baseline RVO and incident cardiovascular events and/or mortality, that provided multivariate-adjusted risk estimates with 95% confidence intervals (95% CIs), and that had average follow-up ≥1 year. The Newcastle-Ottawa scale was used to assess study quality. Multivariate-adjusted risk estimates with 95% CI along with study characteristics were extracted from each study, and pooled risk ratios (RRs) with 95% CI were generated using a random-effects model with inverse-variance weighting to account for heterogeneity. Main outcomes were incident stroke (fatal or nonfatal), myocardial infarction, heart failure, peripheral arterial disease, all-cause mortality, and cardiovascular mortality.Fifteen cohort studies with a total of 474,466 patients (60,069 with RVO and 414,397 without RVO) were included. Each study had Newcastle-Ottawa scale score ≥6, indicating moderate-to-high quality. Retinal vein occlusion was associated with increased risk of stroke (RR = 1.45; 95% CI, 1.31-1.60), myocardial infarction (RR = 1.26; 95% CI, 1.17-1.37), heart failure (RR = 1.53; 95% CI, 1.22-1.92), peripheral arterial disease (RR = 1.26; 95% CI, 1.09-1.46), and all-cause mortality (RR = 1.36; 95% CI, 1.02-1.81), but was not associated with increased risk of cardiovascular mortality (RR = 1.78; 95% CI, 0.70-4.48).This review suggests patients with RVO have an increased risk of cardiovascular events and all-cause mortality. More studies are needed to determine the highest risk periods for cardiovascular events and mortality after RVO and whether immediate cardiovascular evaluation and intervention will improve outcomes.

Atrial fibrillation (AF) is a well-established risk factor of thromboembolism (TE). Thromboembolism is one of the most common complications in patients supported by continuous-flow left ventricular assisted devices (CF-LVADs). However, the association between AF and TE complications in this population is controversial. We conducted a systematic review and meta-analysis to assess the association between AF and overall TE, stroke, and device thrombosis events in CF-LVAD patients. We performed a comprehensive literature search through September 2017 in the databases of MEDLINE and EMBASE. Included studies were prospective or retrospective cohort studies that compared the risk of developing overall TE, stroke, and device thrombosis events in CF-LVAD patients with AF and those without AF. We calculated pooled risk ratio (RR) with 95% confidence intervals (CI) and I statistic using the random-effects model. Eleven studies were included involving 6,351 patients who underwent CF-LVAD implantation. Overall, TE outcome was available in four studies involving 1,106 AF and 3,556 non-AF patients. Stroke outcome was available in seven studies (1,455 AF and 4,037 non-AF patients). Device thrombosis outcome was available in three studies (1,010 AF and 3,327 non-AF patients). There was no association between AF and TE events (RR = 0.95; 95% CI: 0.57-1.59, I = 79%, p = 0.85), stroke (RR = 1.10; 95% CI: 0.74-1.64, I = 73%, p = 0.65), and device thrombosis (RR = 0.97; 95% CI: 0.56-1.67, I = 42%, p = 0.91). AF in CF-LVAD patients was not associated with overall TE, stroke, or device thrombosis events. These findings might be explained by the highly thrombogenic property of CF-LVADs that exceeds the thromboembolic risk driven by AF.

Introduction: Orthostatic hypotension (OH) is common among elderly patients. Its presence may herald severe underlying comorbidities and be associated with a higher risk of mortality. Interestingly, recent studies suggest that OH is associated with new-onset atrial fibrillation (AF). However, a systematic review and meta-analysis of the literature has not been performed. We assessed the association between AF and OH through a systematic review of the literature and a meta-analysis. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to November 2018. Published prospective or retrospective cohort studies that compared new-onset AF between male patients with and without OH were included. Data from each study were combined using the random-effects, generic inverse-variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. Results: Four studies from October 2010 to March 2018 were included in the meta-analysis involving 76,963 subjects (of which 3318 were diagnosed with OH). The presence of OH was associated with new-onset AF (pooled risk ratio 1.48; 95% confidence interval [1.21, 1.81], p?< 0.001; I2 = 69.4%). In hypertensive patients, analysis revealed an association between OH and the occurrence of new-onset AF (OR 1.46; 95% CI [1.27, 1.68], p

Significant tricuspid regurgitation is a well recognized indicator of right ventricular dysfunction. Recent studies have shown that significant tricuspid regurgitation is potentially associated with increased mortality in patients with severe aortic stenosis who underwent transcatheter aortic valve replacement (TAVR). However, data remained sparse and inconclusive. Thus, we performed a systematic review and meta-analysis of the literature to assess the association between significant tricuspid regurgitation and mortality in post TAVR patients.Significant tricuspid regurgitation is predictive for higher mortality in patients undergoing TAVR.We comprehensively searched the databases of MEDLINE and EMBASE from inception to October 2018. Included studies were published observational studies that reported multivariate analysis of the effects of significant tricuspid regurgitation on all-cause mortality among patients undergoing TAVR. Data from each study were combined utilizing the random-effects, generic inverse variance method of DerSimonian and Laird to calculate odds ratios (ORs) and 95% confidence intervals (CIs).Nine cohort studies from August 2011 to May 2018 consisting of 27 614 patients with severe aortic stenosis undergoing TAVR (6255 with and 21 359 without significant tricuspid regurgitation) were included in this meta-analysis. The presence of significant tricuspid regurgitation was associated with higher all-cause mortality (pooled OR = 2.26, 95% CI: 1.45-3.52, P 0.001). We found that all-cause mortality remained statistically substantial in all subgroups (30-day all-cause mortality: OR = 2.05, 95% CI: 1.20-3.49, P = 0.009; midterm all-cause mortality: OR = 9.67, 95% CI: 2.44-38.31, P = 0.001; and long-term all-cause mortality: OR = 1.48, 95% CI: 1.19-1.85, P 0.001). Funnel plots and Egger's regression asymmetry test were performed and showed no publication bias.Significant tricuspid regurgitation increased risk of mortality by up to two-fold among patients with severe aortic stenosis undergoing TAVR. Our study suggests that significant tricuspid regurgitation should be considered a component of risk stratification tools.

Objective: Recent studies have shown that fragmented QRS (fQRS) is associated with unfavourable outcomes in STEMI patients. However, there is controversy amongst studies. We performed a systematic review and meta-analysis to explore the effect of fQRS on reperfusion failure and in-hospital mortality among this population.Methods: We searched the databases of MEDLINE and EMBASE from inception to October 2018. Included studies were published cohort studies of STEMI patients that underwent primary percutaneous coronary intervention (pPCI) and thrombolysis. Data from each study were combined using the random-effects model.Results: Ten studies from January 2011 to October 2018 (2753 patients, 1075 patients with fQRS), were included. The fQRS was associated with higher risk of reperfusion failure in pPCI when defined by ST-segment resolution (OR = 3.08, 95% CI = 1.27-7.46, p-value = .013) but not when defined by TIMI flow grade (pooled OR = 1.45, 95% CI = 0.83-2.54, p-value = .192). In thrombolysis, fQRS was associated with higher risk of reperfusion failure when defined by both ST-segment resolution (pooled OR = 4.35, 95% CI = 1.80-10.49, p-value = .001) and TIMI flow grade (OR = 3.70, 95% CI = 2.10-6.53, p-value < .001). The fQRS was also associated with an increased risk of in-hospital mortality in both pPCI (pooled OR = 4.41, 95% CI = 1.60-12.16, p-value = .004) and thrombolysis (pooled OR = 2.38, 95% CI = 1.06-5.35, p-value = .036).Conclusions: Our meta-analysis demonstrated that fQRS in STEMI patients was associated with reperfusion failure as well as in-hospital mortality.

Introduction Transcatheter edge-to-edge repair (TEER) of the mitral valve with MitraClip therapy is an emerging treatment in selected patients with severe mitral regurgitation. Identifying the patient with increased risk of poorer outcomes, including mortality, is crucial in these patients. Recent studies suggested conflicting data regarding the effects of gender on outcome in this patient population. We evaluate the impact of gender on the outcome of patients undergoing MitraClip therapy by systematic review and meta-analysis. Methods The authors comprehensively searched the databases of EMBASE and MEDLINE from inception to April 2021. Included studies were published cohorts reporting univariate or multivariate analysis of the effects of gender on in-hospital and overall mortality among patients undergoing MitraClip therapy. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonioan and Laird. Results A total of nine studies were included in this meta-analysis, including 9062 patients. Male gender is associated with higher in-hospital mortality with pooled OR 1.81 (95% confidence interval 1.01–3.22, p-value 0.045) and overall mortality with pooled OR 1.19 (95% CI 1.06–1.33, p-value 0.003). Conclusions According to our meta-analysis, the male gender increases the risk of in-hospital mortality up to 1.81 folds and overall mortality up to 1.19 folds.

Ablation of ventricular tachycardia is the main therapy for patients with drug-refractory ventricular tachycardia (VT). Although evidence suggests that VT ablation could lower the incidence of recurrent VT, many cases still develop VT in follow-up. In this study, we performed a systematic review and meta-analysis to examine risk factors for recurrent VT in patients with postinfarction VT who underwent VT ablation.We comprehensively searched the databases of MEDLINE and EMBASE from inception to March 2020. Included studies were cohort studies, experimental trials, or randomized controlled trials that evaluate the risk of recurrent VT in postinfarction VT patients who underwent VT ablation. Data from each study were combined using random-effects.Thirteen studies involving 1803 postinfarction patients who underwent VT ablation were included. Inducibility after the procedure (pooled HR=1.71, P0.001), lower baseline left ventricular ejection fraction (LVEF) (pooled HR=0.98, P0.001) and higher baseline New York Heart Association (NYHA) classification (pooled HR=1.34, P=0.003) were significantly associated with VT recurrence during the follow-up. There was no significant association between age, gender or diabetes mellitus and VT recurrence.Our meta-analysis demonstrated that inducibility after the procedure, lower baseline LVEF and higher baseline NYHA classification were associated with an increased risk of VT recurrence in postinfarction VT patients who underwent VT ablation.

BACKGROUND There is no consensus guidance on when to reinitiate Pneumocystis jirovecii pneumonia (PJP) prophylaxis in solid organ transplant (SOT) recipients at increased risk. The 2019 American Society of Transplantation Infectious Diseases Community of Practice (AST IDCOP) guidelines suggested to continue or reinstitute PJP prophylaxis in those receiving intensified immunosuppression for graft rejection, cytomegalovirus (CMV) infection, higher dose of corticosteroids, or prolonged neutropenia. METHODS A literature search was conducted evaluating all literature from existence through April 22, 2020, using MEDLINE and EMBASE. (The International Prospective Register of Systematic Reviews registration number: CRD42019134204). RESULTS A total of 30 studies with 413 276 SOT recipients were included. The following factors were associated with PJP development: acute rejection (pooled odds ratio [pOR], 2.35; 95% confidence interval [CI], 1.69-3.26); study heterogeneity index [I2] = 23.4%), CMV-related illnesses (pOR, 3.14; 95% CI, 2.30-4.29; I2 = 48%), absolute lymphocyte count

Background: Although high power, shorter duration (HPSD) ablation and low power, longer duration (LPLD) ablation strategies for atrial fibrillation (AF) are frequently advocated to enhance safety and efficacy, there exists a need for comparative data from large populations. We performed a meta-analysis to compare arrhythmia-free survival, procedure time and complications rates between the two strategies. Methods: We searched the databases of MEDLINE and EMBASE from inception to April 2020. Included studies were case-control studies, cohort studies, or randomized controlled trials that compared patients undergoing HPSD and LPLD strategies for AF ablation and reported either of the following outcomes: freedom from atrial tachyarrhythmia (AT) including AF and atrial flutter, procedure time, or periprocedural complications. Data from each study were combined using the random-effects model to calculate odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI). Results: Ten studies from 2006 to 2020 involving 2,189 patients were included (1,350 patients underwent HPSD strategy and 839 patients underwent LPLD strategy). Both HPSD and LPLD strategies resulted in a similar freedom from AT at 12-month follow-up (OR=1.36, 95% CI:0.91-2.04, p=0.13, Figure 1A). HPSD strategy did result in a significant reduction in total procedure time (WMD=47.34, 95% CI:29.47-65.21, p Conclusions: In this large meta-analysis both LPLD and HPSD are equally effective and safe. Although HPSD is often advocated to reduce esophageal injury, risk was similar between approaches. However, HPSD strategy significantly lowers procedure times.

Introduction: Drug challenge testing is performed to unmask Type-1 Brugada pattern. The safety and prevalence of its complications during the test are unclear. We aimed to assess the relation of complications in patients with positive and negative results by a systematic review and meta-analysis. Hypothesis: The prevalence of arrhythmic complications is higher in patients with positive drug challenge testing. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to June 2020. Included studies were cohort studies that reported ventricular arrhythmia that required interventions (VAI) (sustained ventricular tachycardia [VT], polymorphic VT, ventricular fibrillation, appropriate implantable cardioverter defibrillator [ICD] shock, or sudden cardiac arrest) and ventricular arrhythmias that did not required interventions (VANI) (premature ventricular complexes and non-sustained VT) during drug challenge testing. Data were combined using the random-effects model. Results: Thirteen studies involving 2,688 patients (62.7% positive) were included. The overall prevalence of VAI and VANI were 3.7% (95% confidence interval [CI]: 1.8-5.7) and 0.5% (95% CI: 0.1-0.9), respectively. VAI were more common in positive when compared to negative test result patients (1.5% [95% CI: 0.6-2.4] and 0%, respectively) but the prevalence of VANI were similar (2.7% [95% CI: 0.8-4.6] and 2.6% [95% CI: 0.8-4.6], respectively). VAI in positive result patients were more common with flecainide followed by pilsicainide and ajmaline (2.4% [95% CI: -4.3 to 9.2], 2.2% [95% CI: 0.5-4.0], and 1.5% [95% CI: 0.6 to 2.4], respectively). Most of patients with VAI during drug challenge testing underwent ICD implantation (94%). VAI during drug challenge testing in positive result patients carries an increased risk of VAI during 8.6 ± 4.9 years follow-up (odds ratio 3.73, 95% CI: 1.77-7.86, p=0.001). Conclusions: VAI were more common in patients with positive drug challenge testing, more often occurring with positive flecainide challenge, and carries an increased risk of VAI over long-term follow-up in patients with positive drug challenge testing.

INTRODUCTION Heart failure (HF) is one of the world leading causes of admission and readmission. Recent studies have shown that the presence of depression is associated with hospital readmission in patients after an index admission for heart failure (HF). However, there is disagreement between published studies regarding this finding. We performed a systematic review and meta-analysis to evaluate the effect of depression on readmission rates in HF patients. EVIDENCE ACQUISITION We searched the databases of MEDLINE and EMBASE from inception to March 2020. Included studies were published study evaluating readmission rate of HF patients, with and without depression. Data from each study were combined using a random-effects model, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. EVIDENCE SYNTHESIS Ten studies were included in the meta-analysis with a total of 53,165 patients (6194 patients with depression). The presence of depression was associated with an increased risk of readmission in patients with HF (pooled HR=1.54, 95% CI: 1.22-1.94, P 90 days) follow-up (pooled HR=1.58, 95% CI: 1.32-1.90, P

Background Heart failure (HF) is one of the world leading causes of admission and readmission. Recent studies have shown that the presence of depression is associated with hospital readmission in patients after an index admission for heart failure (HF). However, there is disagreement between published studies regarding this finding. We performed a systematic review and meta-analysis to evaluate the effect of depression on readmission rates in HF patients. Methods We searched the databases of MEDLINE and EMBASE from inception to March 2020. Included studies were published study evaluating readmission rate of HF patients, with and without depression. Data from each study were combined using a random-effects model, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. Results Ten studies were included in the meta-analysis with a total of 53,165 patients (6,194 patients with depression). The presence of depression was associated with an increased risk of readmission in patients with HF (pooled HR=1.54, 95%CI=1.22-1.94, pvalue 90 days) follow-up (pooled HR=1.58, 95% CI =1.32-1.90, p-value Conclusions Our meta-analysis demonstrated that depression is associated with an increased risk of hospital readmission in patients with HF.

Atrial fibrillation is a common clinical manifestation in hospitalized patients with coronavirus disease 2019 (COVID‐19). Medications used to treat atrial fibrillation, such as antiarrhythmic drugs and anticoagulants, may have significant drug interactions with emerging COVID‐19 treatments. Common unintended nontherapeutic target effects of COVID‐19 treatment include potassium channel blockade, cytochrome P 450 isoenzyme inhibition or activation, and P‐glycoprotein inhibition. Drug‐drug interactions with antiarrhythmic drugs and anticoagulants in these patients may lead to significant bradycardia, ventricular arrhythmias, or severe bleeding. It is important for clinicians to be aware of these interactions, drug metabolism changes, and clinical consequences when choosing antiarrhythmic drugs and anticoagulants for COVID‐19 patients with atrial fibrillation. The objective of this review is to provide a practical guide for clinicians who are managing COVID‐19 patients with concomitant atrial fibrillation.

Background Frailty is a multidimensional syndrome that reflects the physiological reserve of elderly. It is related to unfavorable outcomes in various cardiovascular conditions. We conducted a systematic review and meta-analysis of the association of frailty with all-cause mortality and bleeding after acute myocardial infarction (AMI) in the elderly. Methods We comprehensively searched the databases of MEDLINE and EMBASE from inception to March 2019. The studies that reported mortality and bleeding in AMI patients who were evaluated and classified by frailty status were included. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate hazard ratio (HR), and 95% confidence interval (CI). Results Twenty-one studies from 2011 to 2019 were included in this meta-analysis involving 143,301 subjects (mean age 75.33-year-old, 60.0% male). Frailty status was evaluated using different methods such as Fried Frailty Index. Frailty was statistically associated with increased early mortality in nine studies (pooled HR = 2.07, 95% CI: 1.67–2.56, P < 0.001, I2 = 41.2%) and late mortality in 11 studies (pooled HR = 2.30, 95% CI: 1.70–3.11, P < 0.001, I2 = 65.8%). Moreover, frailty was also statistically associated with higher bleeding in 7 studies (pooled HR = 1.34, 95% CI: 1.12–1.59, P < 0.001, I2 = 4.7%). Conclusion Frailty is strongly and independently associated with bleeding, early and late mortality in elderly with AMI. Frailty assessment should be considered as an additional risk factor and used to guide toward personalized treatment strategies.

Introduction: Patients with previous coronary artery bypass graft (CABG) are usually considered as high-risk groups perioperatively. Recent studies suggest that previous CABG is not associa...

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.

Atrial fibrillation (AF) is the most common arrhythmia worldwide. The sympathetic nervous system plays an important role in initiation and maintenance of AF. Recent studies have shown that renal sympathetic denervation (RSD) reduced AF recurrences after conventional pulmonary vein isolation (PVI). Studies that have evaluated the role of RSD as an adjuvant to PVI have included different patient populations, ablation strategies, and follow-up approaches. We performed a meta-analysis to assess the potential incremental impact of RSD to PVI. We searched the databases of MEDLINE and EMBASE from inception to January 2020. Included studies were randomized controlled trials (RCTs) that compared the recurrence rates of AF in patients who underwent PVI and RSD versus PVI alone. Data from each study were combined using the random effects model to calculate odds ratios (OR) and 95% confidence intervals (CIs). Three RCTs consisted of four different studies during 2014–2020 involving 451 AF patients (223 patients underwent PVI alone and 228 patients underwent PVI with RSD) were included in the meta-analysis. Compared with PVI alone, the PVI with RSD group had a significantly lower risk of AF recurrence (pooled OR = 0.63, 95%CI 0.50–0.80, p