To evaluate radiation exposure during pediatric cardiac catheterization over a 10-year period at a central European tertiary center and to establish contemporary, procedure-specific dose benchmarks and conversion factors for estimating effective dose (ED). All cardiac catheterization procedures in patients < 18years performed between 2015 and 2024 were retrospectively reviewed. For procedures with multiple components, cumulative dose area product (DAP) was proportionally allocated using weight-adjusted (DAP/BW) median values from single-intervention cases. ED was estimated in silico in randomly selected examinations using Monte Carlo simulation. Dose conversion factors between DAP and ED were derived. Additionally, a structured review of the literature on recently published data on radiation doses was performed. A total of 3683 procedures in 2494 patients (median age 3.8years) were included. Body weight showed a stronger association with DAP than age. Median DAP/BW was 11.7cGy·cm2/kg for diagnostic and 9.7cGy·cm2/kg for interventional procedures. For most procedure types, DAP/BW was substantially lower than previously published benchmarks. Simulated conversion factors declined logarithmically with increasing body weight and differed only slightly between posterior-anterior and lateral projections. Only 0.9% of patients exceeded a cumulative ED of 30mSv. Radiation exposure in contemporary pediatric cardiac catheterization is markedly lower than in earlier reports, with procedure complexity being the primary determinant of effective dose.

The Systemic Immune-Inflammation Index (SII), calculated as neutrophils × platelets / lymphocytes, reflects the interplay between systemic inflammation and immune status. Its prognostic relevance in patients undergoing transcatheter aortic valve implantation (TAVI) remains poorly understood. To evaluate the prognostic significance of preprocedural SII in patients undergoing TAVI. This retrospective cohort study included 1822 patients undergoing TAVI for severe aortic stenosis between 2014 and 2023 at two TAVI centers in Germany. Patients were divided into derivation and validation cohorts. Preprocedural SII was calculated from differential blood counts. In the derivation cohort, patients were stratified into tertiles based on preprocedural SII. Using receiver operating characteristics (ROC) analysis an optimized cut-off value for the validation cohort was identified to stratify patients into high- and low-risk groups. A generalized linear model (GLM) was used to identify clinical predictors of SII. In the derivation cohort, multivariate analysis showed that SII was independently associated with both major adverse cardiovascular events (MACE) (hazard ration [HR]: 1.0001 [1.00001; 1.00002], p = 0.020) and stroke (HR: 1.0003 [1.00002; 1.00004], p < 0.001). In the GLM, SII positively correlated with age (p = 0.013) and C-reactive protein (p < 0.001), and inversely with mean aortic gradient (p = 0.022) and hemoglobin (p = 0.011). In the external validation cohort, high risk patients (cut-off > 1204) showed an increased risk for one-year all-cause mortality (HR: 2.19 [1.59; 3.02], p < 0.001). Higher preprocedural SII was independently associated with increase rates of MACE and stroke at one-year following TAVI. A SII cut-off of 1204 effectively stratifies patients into high- and low-risk groups and may provide additional value for preprocedural risk stratification.

Preliminary studies have demonstrated the feasibility of pulsed field ablation (PFA) for the treatment of paroxysmal supraventricular tachycardia (PSVT); however, direct comparative data between PFA and radiofrequency ablation (RFA) with longer-term follow-up are lacking. This study aimed to compare the safety and efficacy profiles of PFA and RFA in PSVT treatment through propensity score matching over a 12-month follow-up period. This multicenter prospective study enrolled 621 consecutive patients with PSVT who underwent catheter ablation with PFA (n = 212) or RFA (n = 409) across 8 centers in China. Propensity score matching was performed separately for atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) patients, yielding 107 and 67 matched pairs. The primary and secondary end points were acute ablation and 12-month follow-up success rates, respectively. The acute procedural success rate was 100% for both modalities in all matched patients. The 12-month success rates were comparable between the PFA and RFA groups for both AVNRT (97.2% vs. 96.3%, P = 0.701) and AVRT (92.5% vs. 89.6%, P = 0.545). In the AVNRT cohort, all PFA recurrences were observed between 6 and 12months. Although PFA required more ablation applications (AVNRT: 11.5 vs. 9.0, P < 0.001; AVRT: 15.5 vs. 7.0, P < 0.001), the overall procedure time remained comparable to that of RFA. Transient first-degree AV block was observed in one patient per group in the matched AVNRT cohort and in one RFA-treated patient in the matched AVRT cohort. All patients resolved spontaneously without permanent complications. PFA demonstrated safety and efficacy outcomes comparable to those of RFA, supporting its potential role as an alternative therapeutic option for PSVT management. These findings should be considered hypothesis-generating, and further large-scale randomized trials with longer follow-up and different PFA systems are required for confirmation.

Implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy with defibrillation-function (CRT-D) are widely used in patients with life-threatening arrhythmias or heart failure. We aim to investigate the impact of sex-specific differences on defibrillation-capable cardiac devices' implantation and outcomes. The German DEVICE registry is a prospective, multicentre database of ICD and CRT device implantation. A total of 5330 patients receiving a defibrillation-capable device were prospectively enrolled in 44 centres between March 2007 and February 2014 and followed for 17 (13, 23) months. A minority of patients in this registry was female 1017 (19.1%). The rate of CRT-D use among the defibrillator recipients was higher in women (32.4% vs. 28.0%; p = 0.006). The incidence of major periprocedural complications and in-hospital complications were higher in women (3.3% vs. 1.6%; p = 0.001 and 5.5% vs. 3.6%; p = 0.017, respectively). The 1-year all-cause mortality was 5.5% for women and 7.4% for men (p = 0.039), while the 1-year cardiovascular mortality was 4.1% and 6.2%, respectively (p = 0.012). Less women received device shocks during 1-year follow-up (10.7% vs. 13.8%; p = 0.023). Women receiving CRT-D had a lower non-device-related cardiovascular hospitalization rate than men. System revision until discharge, in-hospital death and non-fatal complications during follow-up were comparable for men and women. Similar rates of all-cause and cardiac rehospitalizations were found. In this real-life patient cohort only a minority of patients was female. Female patients had a higher risk of major periprocedural complications and in-hospital complications but a lower all-cause and cardiovascular mortality. Less women experienced device-shocks during follow-up.

Safety and efficacy have been well demonstrated for Micra™ leadless cardiac pacemakers (LCPs). However, the presence of sex-specific disparities remains unclear. The aim of this single-centre observational study was to assess the sex-specific short- and long-term outcomes in patients undergoing LCP implantation. In total, 378 LCPs were implanted in 127 women (33.6%) and 251 men (66.4%). The most frequent indications included atrial fibrillation with slow conduction (women: 31.5%, men: 44.6%), third-degree atrioventricular block (women: 31.5%, men: 33.5%) and sick sinus syndrome (women: 21.3%, men: 9.6%). Electrical performance parameters of LCPs were similar between sexes. Procedure-related complications during LCP implantation occurred more frequently in women (3.1%) compared to men (0.4%), though no difference was observed for all complications during the index stay (women: 3.9%, men: 1.6%, p = 0.18). In-hospital mortality was low for women (0.8%) and men (0.8%, p = 0.96). A multivariable logistic regression analysis adjusted for sex, age, diabetes, chronic kidney disease, coronary artery disease and transcatheter and surgical valve replacement revealed concomitant lead extraction (OR 9.153, p = 0.001) as the only predictor for complication or death during index stay. All-cause mortality was 30.7% in women (n = 39) and 27.5% in men (n = 69, p = 0.28) during a median follow-up of 41 months (IQR 22-65 months). No sex-specific disparities were observed with respect to complications during index stay, in-hospital and all-cause mortality. Less frequent use of LCP therapy in women may relate to differing indications between sexes. Further prospective studies may help to develop sex-specific recommendations for LCP therapy.

PR-interval reflects atrioventricular timing but does not well characterize adverse hemodynamics. Novel ECG parameters of conduction may identify benefit from non-dyssynchronous ventricular pacing to correct long atrioventricular conduction delays. Evaluating novel ECG parameters to identify risk of heart failure (HF)/death and benefit vs harm by CRT-D in MADIT-CRT non-LBBB patients. We analyzed intervals from ECGs in 535 non-LBBB patients enrolled in MADIT-CRT, using ImageJ. Onset of atrial activation, P wave zero crossing in V1, latest P offset, earliest QRS onset, and time to the first R peak in V1 and V6 were determined. Endpoints included HF or death. Associations between novel conduction measures and clinical outcomes in ICD patients (n = 209), and CRT-D (n = 326) vs. ICD benefit, were assessed using Kaplan-Meier and multivariable Cox regression analyses. We identified the delay from P zero crossing to the first R peak in V1 (P0PV1) at quintile 5 as the strongest risk predictor in ICD patients (n = 159, 30%), over PR-interval, for all endpoints (p < 0.001), with a more than threefold risk increase. In this group, CRT-D was associated with a 66% lower risk of HF/Death (95% CI: 0.22-0.68, p = 0.001) vs. an ICD. However, in patients with a P0PV1 < 201ms, CRT-D vs. an ICD was associated with a 64% increased risk of HF/death (95% CI: 1.12-2.55, p = 0.012), with significant bidirectional interaction (p-value < 0.001). We propose a novel variable, P0PV1, to identify risk and benefit vs. harm from CRT-D in HF patients with non-LBBB. Prospective studies are warranted to confirm our findings.

Data on premature ventricular complex (PVC) burden after pulmonary vein isolation (PVI) for atrial fibrillation (AF) are inconsistent and often limited to selected populations. We retrospectively analyzed patients undergoing successful first-time PVI for paroxysmal or persistent AF between January 2019 and June 2023. PVC burden was quantified by long-term ECG at baseline, 3months, and 12months. Ablation energy sources included cryoballoon, radiofrequency, and pulsed field ablation. Among 1,069 patients, median PVC burden decreased from 6.82/h at baseline to 1.44/h at 3months and 3.75/h at 12months. In patients with complete follow-up (n = 165), PVC burden declined significantly overall (Friedman test p < 0.001). Post-hoc analyses confirmed reductions from baseline to 3 and 12months, with a modest increase between 3 and 12months (all p < 0.01). PVC burden was similar regardless of AF recurrence or ablation energy. At 12months, 4.6% of patients had high PVC burden (> 5%). Diabetes mellitus (OR = 4.43; 95% CI: 1.49-13.17; p = 0.007) and reduced left ventricular ejection fraction (OR = 6.36; 95% CI: 2.03-19.91; p = 0.002) were independently associated with elevated burden, while other covariates were not significant. PVI significantly reduces PVC burden in most patients, independent of AF recurrence or ablation modality. Diabetes and impaired ventricular function identify patients at risk of persistent high PVC burden. PVI may particularly benefit AF patients with symptomatic PVCs, but larger prospective studies are needed to validate these findings and assess clinical outcomes.

Noise pollution is increasingly recognized as a cardiovascular hazard, yet its contribution to early-onset myocardial infarction (EOMI) has not yet been investigated before. This study included patients aged ≤ 50years with myocardial infarction (MI) who were admitted to the Heart Center Bremen/Germany between 2015 and 2023. Based on traditional risk factors at the time of the index MI, the 10-year cardiovascular risk was estimated using the LIFE-CVD model. Residential noise exposure levels were extracted from the municipal GeoPortal. In this study involving 430 young MI patients, the mean age was 45 ± 5years, and 85.8% were male. Compared with low-noise peers, high-noise patients smoked less (31% vs. 54%), had fewer first-degree relatives with MI (18% vs. 34%), and less diabetes (6% vs. 12%; all p < 0.05). The average noise exposure increased as traditional risk factor exposure decreased (ANOVA p < 0.001 for LIFE-CVD score vs. noise exposure); this inverse association remained even after adjustment in multivariable analysis. In multivariable linear regression, higher noise exposure category was associated with a younger age at first MI (β = - 0.43years per category; 95% CI - 0.74 to - 0.12; p < 0.01). Among patients with EOMI and few traditional risk factors, elevated residential noise exposure was observed. Higher noise exposure was also associated with a younger age at first MI. These findings are hypothesis-generating and warrant further population-based studies to clarify whether residential noise contributes to MI risk and whether objectively assessed noise metrics could strengthen prevention strategies.