Disparities in management of atrial fibrillation in rural and urban hospitals across the U.S. have been reported. However, studies investigating disparities regarding outcomes and complications after left atrial appendage occlusion (LAAO) based on hospital location are lacking. To evaluate differences in outcomes and complications related to LAAO among rural and urban hospitals. The National Inpatient Sample was used to identify patients who underwent LAAO implantations in the U.S. from 2016-2020. Study endpoints assessed included inpatient complications, outcomes, and resource utilization after LAAO procedures among rural and urban hospitals. From 2016-2020, there were a total of 87 315 and 1985 LAAO device placements in urban and rural hospitals, respectively. Baseline characteristics were similar among both groups, with a few exceptions. After multivariable adjustment for confounders, odds of inpatient complications and mortality were similar among both groups. However, rural LAAO recipients experienced greater rates of discharge to an acute care facility (3.3% vs 2.4%, p = 0.01), as well as lower costs (aOR: 0.58, 95% CI: 0.49-0.69) and length of stay (aOR: 0.89, 95% CI: 0.81-0.98). A majority of LAAO implantations occurred in urban hospitals in the U.S. Baseline characteristics and adjusted odds of inpatient complications and mortality were similar in rural and urban recipients. However, important differences were described regarding resource utilization and disposition. Further investigation into the specific factors driving these inequities is encouraged to promote improved access to and outcomes of cardiovascular care for rural residents.

How to reduce the occurrence of in-hospital cardiac arrest (IHCA), screen potential IHCA patients, and advance the treatment of IHCA are urgent problems to be solved in clinic. In this study, we tried to develop a model to predict whether patients will develop IHCA based on the data of patients who have just been admitted to hospital and evaluate the influence of different feature selection methods on machine learning (ML) models. A total of 25 149 patients were included in the study; 320 developed IHCA. We chose three feature selection methods (Student's t-test and Chi-square test, regression analysis and correlation analysis) and four ML models (AdaBoost, XGBoost, Random Forest, and Logistic Regression). Each ML model was trained and evaluated using raw and feature-selected data; as a result, we got 16 models. AUROC, AUPRC, accuracy, recall, precision, and specificity are used to evaluate the model. The XGBoost model has the best performance with an AUROC of 0.987 (95% CI 0.984-0.988), an AUPRC of 0.763, an accuracy of 0.992, a recall of 0.695, a precision of 0.723, and a specificity of 0.996. The most significant predictors are age, albumin, sinus arrhythmia, activated partial thromboplastin time, and protein. Different feature selection methods have different effects on different ML models. The predictive model developed using the XGBoost algorithm is the best predictor of whether patients will develop IHCA.

Heart failure with preserved ejection fraction (HFpEF) is closely linked to aging and cardiometabolic risk factors and frequently coexists with obstructive sleep apnea (OSA). We aimed to investigate the prevalence and clinical correlates of an HFpEF-like phenotype in a revascularized coronary artery disease (CAD cohort), focusing on OSA and its severity. A total of 435 patients with preserved left ventricular ejection fraction from the RICCADSA cohort were included. OSA was defined as apnea-hypopnea index (AHI) ≥ 15 events/h. HFpEF-like phenotype was defined by ≥ 2 of the following: elevated filling pressures (E/e' ≥ 15), left atrial enlargement, increased left ventricular mass index, elevated pulmonary artery systolic pressure (≥ 35 mmHg), and elevated NT-proBNP (≥ 125 pg/mL). Multivariable logistic regression analyses included age, sex, obesity, hypertension, diabetes, and OSA status. Additional models evaluated AHI and oxygen desaturation index (ODI) as continuous variables and assessed the impact of excluding body mass index (BMI). Mean age was 63.6 ± 8.6 years and BMI 28.1 ± 4.1 kg/m2; 69.9% met HFpEF-like criteria. Age and obesity were independently associated with HFpEF-like phenotype, whereas categorical OSA was not. AHI and ODI were not independently associated after adjustment; however, in models excluding BMI, both AHI (OR 1.019, 95% CI 1.005-1.033) and ODI (OR 1.030, 95% CI 1.010-1.050) were significant predictors. HFpEF-like phenotype is highly prevalent in CAD and primarily associated with aging and adiposity. The relationship between OSA severity and cardiac remodeling appears dependent on obesity, underscoring the interplay between cardiometabolic and sleep-related factors. The RICCADSA trial is registered at ClinicalTrials.gov (NCT00519597) and in the Swedish national research registry (FoU i Sverige-Research and Development in Sweden; registration no. VGSKAS-4731; April 29, 2005).

Despite advancements in radiofrequency ablation (RFCA) technology and strategy, the long-term rhythm outcomes of persistent atrial fibrillation (PeAF) remain suboptimal. Since the vein of Marshall (VOM) is situated within the mitral isthmus (MI) area and covers local neural innervation and fiber networks, its pathophysiological role in mediating and maintaining atrial fibrillation (AF) and causing arrhythmia recurrence has garnered increasing attention. Ethanol infusion into the vein of Marshall (EIVOM) may complement RFCA by delivering anatomically targeted chemical injury along the VOM course, thereby facilitating contiguous MI lesion formation and durable MI block. We performed a narrative review of mechanistic, procedural, and clinical evidence regarding EIVOM in AF ablation, with emphasis on MI block, rhythm outcomes, technical limitations, complications, and its potential role in pulsed field ablation (PFA)-based workflows. Available evidence indicates that EIVOM facilitates durable MI block by targeting VOM-related epicardial connections and may improve rhythm outcomes when combined with RFCA in selected PeAF ablation strategies. Its clinical application is influenced by procedural and anatomical factors, while safety considerations and its potential complementary role in PFA-based workflows remain important areas for further evaluation. EIVOM is a promising adjunct to RFCA, particularly for facilitating durable MI block and reducing residual epicardial conduction. Further standardized multicenter studies are needed to refine patient selection, procedural integration, safety optimization, and its role in contemporary AF ablation.

ABSTRACTBackgroundNicotine use is a major modifiable risk factor for acute myocardial infarction (AMI), yet national mortality patterns involving co‐listed nicotine dependence remain under‐characterized.MethodsUsing CDC WONDER Multiple Cause of Death data from 1999 to 2020, we evaluated AMI‐related mortality among US adults aged ≥ 25 years with co‐listed death‐certificate‐coded nicotine dependence, operationally defined using ICD‐10 F17.0–F17.9. AMI was identified using ICD‐10 I21.0–I22.9. Age‐adjusted mortality rates (AAMRs) per 100 000 population were calculated using the 2000 US standard population. Temporal trends were assessed using Joinpoint regression and stratified by sex, age, race/ethnicity, region, urbanization, state, and place of death.ResultsFrom 1999 to 2020, 357 167 AMI‐related deaths with co‐listed nicotine dependence occurred among adults aged ≥ 25 years. The AAMR increased from 1.64 to 9.46 per 100 000 population (average annual percent change, 10.27%; p < 0.001). Men had higher AAMRs than women (11.30 vs. 4.27), with significant increases in both groups. Mortality increased with age, highest among adults aged ≥ 85 years (33.55) and lowest among those aged 35–44 years (0.83). Non‐Hispanic American Indian/Alaska Native adults had the highest AAMR (10.30). Rates were higher in the Midwest and South, nonmetropolitan areas exceeded metropolitan areas, and the highest state‐level AAMRs occurred in North Dakota and Wyoming. Most deaths occurred in inpatient facilities or at home.ConclusionAMI‐related mortality with co‐listed nicotine dependence increased substantially from 1999 to 2020, with persistent demographic and geographic disparities. These findings may inform targeted tobacco‐control, nicotine‐cessation, and cardiovascular prevention strategies for high‐risk populations over time.

ABSTRACTBackground and AimsThis study aims to evaluate changes in quality of life, anxiety levels, and sleep quality before and after elective electrical cardioversion or ablation in patients diagnosed with chronic atrial fibrillation (AF).MethodsThis is a single‐center, quasi‐experimental study with a two‐group, pretest−posttest design conducted between January and December 2024 in a training and research hospital in Istanbul. A total of 57 patients who underwent either cardioversion (n = 30) or ablation (n = 27) were included. Data were collected using the AFEQT Quality of Life Questionnaire, Beck Anxiety Inventory, and Pittsburgh Sleep Quality Index, and analyzed with R software. Statistical analyses included Student's t‐test, Pearson's Chi‐square, Fisher's exact test, paired two‐sample t‐test, and Welch's unequal variance t‐test. A p value of < 0.05 was considered significant.ResultsPost‐treatment quality of life significantly improved in both groups (AFEQT: ablation +21, cardioversion +11 points). Anxiety levels decreased in the ablation group (–4.7 points), while sleep quality showed no significant change (p = 0.092). In the cardioversion group, significant improvements were observed in both anxiety and sleep quality (BAI –8.63; PSQI –1.10; p < 0.001). Regression analyses showed significant correlations between quality of life, anxiety, and sleep both before and after treatment.ConclusionImprovements in quality of life were observed following both ablation and cardioversion procedures in patients with AF. Greater reductions in anxiety and sleep disturbance scores were observed in the cardioversion group compared with the ablation group.

ABSTRACTBackgroundBaxdrostat is a selective aldosterone synthase (CYP11B2) inhibitor for treatment‐resistant and uncontrolled hypertension, evaluated in phase 2/3 RCTs.ObjectivesTo estimate pooled placebo‐corrected reductions in seated office and ambulatory SBP, characterize the dose–response relationship, assess cortisol selectivity, and quantify hyperkalemia risk.MethodsWe conducted a systematic review and meta‐analysis of phase 2/3 randomized, double‐blind, placebo‐controlled trials of baxdrostat in hypertension, searching MEDLINE/PubMed, EMBASE, ClinicalTrials.gov, and NEJM.org to March 2026. The primary outcome was placebo‐corrected change in seated office SBP, analyzed using random‐effects meta‐analysis (REML) with metafor in R. Risk of bias and certainty were evaluated using Cochrane RoB 2.0 and GRADE, respectively.ResultsThree RCTs (BrigHTN, BaxHTN, Bax24; N = 1285) were included. The pooled seated SBP reduction was −9.44 mmHg (95% CI: −11.09 to −7.79; I2 = 0.0%), with dose subgroup estimates of −8.57 mmHg (1 mg) and −10.11 mmHg (2 mg) and a clear dose–response in BrigHTN (slope −4.2 mmHg/mg; R2 = 0.96). Bax24 demonstrated a 24 h ambulatory SBP reduction of −14.0 mmHg (95% CI: −17.2 to −10.8). Serum cortisol was unsuppressed at all doses, while the pooled OR for potassium ≥ 6.0 mmol/L was 5.14 (95% CI: 1.76 to 14.97). GRADE certainty was moderate for seated SBP, low to moderate for ambulatory outcomes, and low for hyperkalemia.ConclusionsBaxdrostat produces meaningful, selective BP reductions across hypertensive populations. Hyperkalemia is manageable with structured monitoring. Certainty is limited by a few trials, a short follow‐up, and safety imprecision. Long‐term cardiovascular outcome data are needed before guideline incorporation.