Arrhythmia Rate Research Articles

Enhancing Patients Satisfaction and their outcomes through implementing Nurse-Caring Behavior Protocols in Acute Diabetic Crisis Management

Background: Integrating nurse-caring behavior protocols in acute diabetic crisis management enhances patient satisfaction and outcomes by addressing both clinical and emotional care needs. Aim: evaluate the effect of implementing nurse-caring behavior protocols on enhancing patients’ satisfaction and their outcomes in acute diabetic crisis management. Design: Quasi-experimental research design was used in the present study. Setting: ICU and emergency care unit at Aswan university hospital. Sample: This study was performed on 60 patients who were not randomly selected and assigned in to control and study group. Tools: Tree tools were used to collect data include Tool (I): Patient assessment tool contained personal characteristic. Tool (II): Patients satisfaction with NCBs evaluation scale. Tool (III) Patients Outcomes assessment tool. Results: the majority being aged 50-60 years in study and control group (70.1% and 66.7% respectively), Gender distribution was nearly equal, with slightly more females in (56.0 % and 50%) respectively, a higher percentage of participants with higher education (33.3% and 50%) respectively. A higher percentage of patients in the study group reported satisfactory levels of satisfaction (73.3%) compared to the control group (33.3%) Conversely. The study group had a significantly higher percentage of patients staying less than 5 days (63.3%). The study group had significantly more patients discharged to home (76.7%). A significantly lower rates of complications, including hypoglycemia, hypokalemia, cerebral edema, arrhythmia and acidosis among study group. Conclusion: The nurse-caring behaviors have a positive impact on patient satisfaction, outcomes, and a reduction in complications associated with acute diabetic crises. Recommendation: Implementing and evaluating nurse-caring behavior protocols, to enhance early discharge and complication management in acute diabetic crisis management

Myocardial Protection Using Antegrade Cardioplegia Alone Compared to Antegrade Combined with Vein Cardioplegia in On-Pump Coronary Artery Bypass Graft Surgery

Cardioplegia is an integral component of myocardial protection. Standard delivery of cardioplegia includes antegrade and retrograde method. Retrograde technique may cause injury to the coronary sinus and inadequate right ventricular protection while antegrade alone may be inadequate especially delivery of cardioplegia through very stenotic vessels. Therefore, in this study we compare myocardial protection using antegrade cardioplegia alone compared to combination of antegrade and vein cardioplegia in on pump coronary artery bypass graft surgery. This is a cross sectional retrospective study. Two groups of patients (antegrade combined with vein cardioplegia-study group and antegrade cardioplegia alone- control group) were studied. The study group consists of 42 patients while the control group consists of 39 patients. Study population are patients aged between 30-80 years old between 1 January 2019 and 30 April 2023. Intraoperative characteristics such as cardiopulmonary bypass time, aortic cross clamp time, cardioplegia volume, number of post-operative inotropes, ventricular tachycardia and fibrillation after aortic unclamping and postoperative characteristics such as hospital stay, ICU stay, mortality, intra-aortic balloon pump insertion, chest reopen for bleeding and postoperative atrial fibrillation were compared. The results of this study showed that cardiopulmonary bypass time, hospital stay, mortality, postoperative IABP insertion and postoperative arrhythmia rate for both groups were similar, however not statistically significant. The study group required less inotropes before transfer to ICU. (2.83 VS 3.10, P=0.04). The primary finding of this study shows that there is no difference in terms of myocardial protection with antegrade combined with vein cardioplegia as compared antegrade cardioplegia alone.

Efficacy of parenteral bronchodilators on ventilatory outcomes in pediatric critical asthma: a national cohort study.

Objective: To evaluate the association of parenteral epinephrine and terbutaline use on ventilatory support in children admitted to the intensive care unit (ICU) with critical asthma in the United States. Methods: Data were obtained from the Pediatric Health Information System data base for children ages 2 to 18 years admitted to the ICU with a diagnosis of asthma exacerbation from January 1, 2016, to December 31, 2023. The primary outcomes included noninvasive ventilation (NIV) and/or invasive mechanical ventilation (IMV) use after receipt of terbutaline and/or epinephrine. Secondary outcomes included serious adverse events from parenteral bronchodilators, including arrhythmias and elevated troponins. Results: Our study population included 53,328 patient encounters. Terbutaline and epinephrine were associated with decreased odds of subsequent NIV (terbutaline: odds ratio [OR] 0.52 [95% confidence interval {CI}, 0.44-0.63], p < 0.001; and epinephrine: OR 0.49 [95% CI, 0.43-0.55], p < 0.001) and subsequent IMV (terbutaline: OR 0.51 [95% CI, 0.42-0.61], p < 0.001; and epinephrine: OR 0.34 [95% CI, 0.29-0.41], p < 0.001). There were no differences in adverse events in the terbutaline group when compared with the epinephrine group for both arrhythmia and elevated troponins (arrhythmia: terbutaline = 1.9%, epinephrine = 1.7%; p = 0.6; and elevated troponins: terbutaline = 0.1%, epinephrine = 0.1%, p > 0.9). Conclusion: Parenteral bronchodilator use was associated with decreased odds of receiving subsequent ventilatory support in critical asthma. There were low rates of arrhythmia and elevated troponin overall. Our findings should inform future clinical trials to evaluate the use of parenteral bronchodilators in critical asthma in the United States.

Cardiovascular and Metabolic Adverse Events of Endocrine Therapies in Women with Breast Cancer: A Disproportionality Analysis of Reports in the FDA Adverse Event Reporting System

ABSTRACTIntroductionEmerging evidence suggests potential cardiovascular toxicities from oral endocrine therapies (ETs); however, results are conflicting. This study comprehensively examined adverse reactions of ETs and investigated cardiovascular and metabolic safety signals within the FDA Adverse Event Reporting System (FAERS).MethodsReports in the FAERS through December 2023 were analyzed for documented reactions to tamoxifen, letrozole, anastrozole, and exemestane in female breast cancer patients. Standardized queries were used to identify cases of cardiovascular (myocardial infarction, heart failure, arrhythmia, stroke) and metabolic (hypertension, dyslipidemia, hyperglycemia) disorders. Descriptive and disproportionality analyses were performed to assess reports and detect safety signals.ResultsAmong 14,327 unique ET‐related reports, arthralgia (n = 1873 events) was the most prevalent reaction. We identified 2170 cardiovascular and 2252 metabolic events associated with ETs. Letrozole had the highest reporting rate of cardiac arrhythmia (7.7%) and showed positive signals for both arrhythmia (reporting odds ratio [ROR] = 2.2; 95% confidence interval [CI]: 1.8–2.5) and myocardial infarction (ROR = 1.9; 95% CI: 1.4–2.6). We also observed a significantly increased risk of heart failure with letrozole (ROR = 1.3; 95% CI: 1.1–1.6) and stroke with tamoxifen (ROR = 1.7; 95% CI: 1.5–2.1). Only anastrozole was significantly associated with metabolic dysfunctions with a notable hyperglycemia reporting rate of 12.2%.ConclusionOur findings provide valuable evidence on common reactions as well as controversial cardiovascular and metabolic abnormalities associated with the real‐world use of ETs for breast cancer. Ongoing benefit–risk assessment and close monitoring of cardiac function during treatment, particularly in high‐risk women, are warranted to optimize cancer outcomes while minimizing cardiovascular injury.

Racial Disparities in Cardiometabolic Disorders Among Alzheimer's Disease Patients: A Study on Native Hawaiians and Pacific Islanders.

Cardiometabolic disorders may accelerate the progression of Alzheimer's disease (AD), potentially impacting ethnic-racial groups with a higher prevalence of diabetes, obesity, and cardiovascular disease, though limited data exists on Native Hawaiians and Pacific Islanders (NHPI) populations. This study aims to examine the prevalence of diabetes and associated comorbidities among AD patients from different ethnic-racial groups - Asians, Whites, and NHPIs - in Hawaii, with a focus on identifying risk factors linked to AD. A retrospective review was conducted on AD patient records from a single center in Hawaii, spanning June 2018 to June 2024. Variables assessed included age at diagnosis, sex, race, insurance type, alcohol use, comorbidities, and Mini-Mental State Examination (MMSE) scores. Statistical comparisons were conducted to identify group differences. Among 540 patients (256Asians, 89 NHPIs, 182 Whites, and 13 Others), NHPIs exhibited the highest rates of hypertension (66.3%), diabetes (31.5%), obesity (23.6%), congestive heart failure (13.5%), and coronary artery disease (6.7%). Whites exhibited a higher prevalence of anxiety (18.1%), cardiac arrhythmia (15.4%), and alcohol use (37.4%) compared to Asians and NHPIs. Females had lower mean MMSE scores compared to males (18.3 ± 7.4 vs. 21.0 ± 6.2, respectively), along with higher rates of anxiety (16.3%), hypertension (62.2%), hyperlipidemia (47.4%), and underweight body mass index (10.8%). NHPI AD patients in Hawaii face a higher prevalence of diabetes and a greater burden of cardiometabolic disorders compared to other racial groups. White AD patients demonstrate higher rates of anxiety, alcohol consumption, and cardiac arrhythmia compared to Asians and NHPIs. Females with AD had worse cognitive function compared to males.

Comparison of outcomes of Impella-assisted high-risk percutaneous coronary intervention in patients with and without prior coronary artery bypass graft.

Limited data is available regarding in-hospital outcomes of patients undergoing high-risk percutaneous coronary intervention (HR-PCI) with Impella with and without a prior history of coronary artery bypass grafting (CABG). We performed a retrospective study from the Nationwide Inpatient Sample from year 2016 to 2020. We identified patients who underwent Impella and percutaneous coronary intervention on the same day and excluded those with cardiogenic shock. Subsequently, we stratified them into those with and without prior CABG. During the study period, 18 925 patients underwent HR-PCI. Among these, 2043 (10.8%) patients had prior CABG. Patients without prior CABG had a higher percentage of acute coronary syndrome at presentation (62.7 vs 56.1%, P = 0.008). The proportion of females was significantly higher in those without prior CABG (32.4 vs 21.7%, P < 0.001). On multivariate analysis, there was no statistically significant difference in the in-hospital mortality (5.8% in CABG vs 8.5% in non-CABG, P = 0.52). Patients without prior CABG had higher rates of acute kidney injury, major bleeding, and blood transfusions. There were no significant differences in rates of cardiac arrest, ventricular arrhythmias, acute stroke, coronary dissections, and coronary perforations. Those without prior CABG had a longer duration of hospitalization (6.8 vs 9.3 days, P < 0.001) and higher hospital charges ($292 267 vs $322 206, P < 0.035). Our study highlights that a history of previous CABG does not increase the risk of in-hospital mortality in patients undergoing Impella-assisted HR-PCI but is associated with reduced rates of complications.

Sodium-Glucose Co-Transporter 2 Inhibitor Use in Type II Diabetes Mellitus is Associated with a Lower Rate of Atrial Arrhythmias in a Hospitalized Real-World Population

Sodium-Glucose Co-Transporter 2 Inhibitor Use in Type II Diabetes Mellitus is Associated with a Lower Rate of Atrial Arrhythmias in a Hospitalized Real-World Population

Impact of Diabetes on Excessive Cardiovascular Risk: Matched Analysis Based on the European Health Interview Survey.

Background and Objectives: Diabetes represents a major public health challenge due to its strong link to cardiovascular risk, therefore the aim was to explore the excessive cardiovascular risk attributed to diabetes. Materials and Methods: This cross-sectional study was based on data from the European Health Interview Surveys in Hungary. Propensity score matching was used to control confounding factors including age, gender, education, marital status, income, health status, obesity, smoking, place of residence, and physical activity. Results: A total of 15,874 individuals were analyzed, of whom 1447 (9.12%) reported having diabetes. Furthermore, diabetes was significantly associated with higher prevalence rates of hypertension (by 23.4%), arrhythmia (by 3.85%), heart attack (by 3.42%), and coronary artery disease (by 6.92%) after adjusting for potential confounders. Conclusions: These findings highlight the importance of managing cardiovascular risk factors in individuals with diabetes.

Comparison of Therapeutic Effects Between Pulsed Field Ablation and Cryoballoon Ablation in the Treatment of Atrial Fibrillation: A Systematic Review and Meta-analysis.

Pulsed field ablation (PFA) is a novel nonthermal ablation technique for the treatment of atrial fibrillation (AF) patients, with safety comparable to traditional catheter ablation surgery. The present study aims to evaluate and compare the procedural efficiency and safety profiles of PFA and cryoballoon ablation (CBA) in the management of AF. We performed a systematic search across PubMed, the Cochrane Library, and Embase databases, encompassing the literature up to February 2024, to inform our systematic review and meta-analysis. When assessing outcome indicators, the risk ratio and its corresponding 95% confidence interval (CI) were calculated for dichotomous variables. For continuous variables, the mean difference (MD) and the associated 95% CI were determined. In this scenario, a relative risk (RR) value of less than 1 and an MD value of less than 0 are deemed favorable for the PFA group. This could translate to a reduced likelihood of procedural complications or enhanced procedural performance within the PFA group. In this analysis, 9 observational studies encompassing 2875 patients with AF were included. Among these, 38% (n = 1105) were treated with PFA, while 62% (n = 1770) received CBA. The results indicated that PFA was associated with a significantly shorter procedural duration compared with CBA, with an MD of -10.49 minutes (95% CI, -15.50 to -5.49; P < 0.0001). Nevertheless, no statistically significant differences were observed when comparing the 2 treatment cohorts concerning fluoroscopy time (MD, 0.71; 95% CI, -0.45 to 1.86; P = 0.23) and the recurrence of atrial arrhythmias during follow-up (RR, 0.95; 95% CI, 0.78-1.14; P = 0.57). In terms of perioperative complications, the PFA group showed a significantly decreased risk of phrenic nerve palsy (RR, 0.15; 95% CI, 0.06-0.39; P < 0.0001) and an increased risk of cardiac tamponade (RR, 3.48; 95% CI, 1.26-9.66; P = 0.02) compared with the CBA group. No significant differences were noted between the PFA and CBA groups regarding the incidence of stroke/transient ischemic attack (RR, 0.99; 95% CI, 0.30-3.22; P = 0.99), vascular access complication (RR, 0.87; 95% CI, 0.36-2.10; P = 0.76), atrial esophageal fistula (RR, 0.33; 95% CI, 0.01-8.13; P = 0.50), and major or minor bleeding events (RR, 0.39; 95% CI, 0.09-1.74; P = 0.22). Our research results indicate that compared with CBA, PFA not only shortens the procedure time but also demonstrates noninferiority in terms of fluoroscopy duration and the recurrence rate of atrial arrhythmias. PFA and CBA have both demonstrated their respective advantages in perioperative complications.

Abstract 4136804: Effect of Obesity on Arrhythmia Recurrence and Complications following Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation in the REAL-AF Registry

Introduction: Obesity is an important risk factor for atrial fibrillation and its prevalence in the United States is rising. The effect of obesity on outcomes following pulmonary vein isolation in a contemporary setting has not been extensively evaluated. Research Questions: - Is higher body mass index (BMI) associated with increased risk of atrial arrhythmia recurrence following pulmonary vein isolation? - Is higher BMI associated with increased risk of post-procedural complications? Method: - The REAL-AF (Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation; ClinicalTrials.gov Identifier: NCT04088071) Registry is a multicenter, prospective observational registry of patients undergoing radiofrequency catheter ablation of atrial fibrillation. We included 2666 patients with paroxysmal atrial fibrillation undergoing index ablation from January 2018 through April 2023. We excluded patients with missing covariates. - The primary outcome was freedom from atrial arrhythmia following ablation. Rhythm monitoring was standardized using patch monitor at 6 month and 1 year. Time-to-event analysis was performed using a 3-month blanking period. Results: - Baseline characteristics are shown in Table 1. The median follow-up was 382 days (IQR: 363-410). - There was a trend toward higher rate of atrial arrhythmia following ablation for patients in the highest BMI group compared with the reference group (BMI&lt;25) ( BMI≥40: HR = 1.41 (0.94-2.12), p= 0.092). There was no difference in the rate of atrial arrhythmia for other BMI groups ( BMI 25 - &lt;30: HR = 0.90 (0.65-1.23), p = 0.5; BMI 30 - &lt;35: HR = 0.89 (0.64-1.23), p = 0.5; BMI 35 - &lt;40: HR = 0.87 (0.57-1.32), p = 0.5). This trend persisted following adjustment for baseline covariates ( BMI 25 - &lt;30: HR = 1.01 (0.77-1.33), p &gt; 0.9; BMI 30 - &lt;35: HR = 0.97 (0.72-1.32), p = 0.9; BMI 35 - &lt;40: HR = 1.01 (0.66-1.55), p &gt; 0.9; BMI≥40: HR = 1.57 (0.96-2.57), p =0.071). - First-pass isolation rates progressively decreased with higher BMI (Table 2). - Complication rates were low across all BMI groups (Table 2). Conclusions: - Severely obese patients with BMI ≥40 experience higher risk of atrial arrhythmia following radiofrequency catheter ablation of paroxysmal atrial fibrillation compared with normal weight individuals. This corresponds with lower rates of first-pass isolation at higher BMI. - Patients across BMI categories experience similarly low rates of procedural complication.

Abstract 4129453: Comparing Cardiovascular Outcomes in Patients with Lyme Disease and Babesiosis: A Retrospective Cohort Study

Intro: In the U.S, Lyme disease and Babesiosis are among the four most common tick-borne illnesses, with an annual average of 36,000 and 2200 cases respectively from 2016-2019. Both have cardiac involvement; 1% of lyme disease cases result in lyme carditis, while babesiosis is associated with arrhythmias and heart failure. Little research has explored the comparative risk of developing cardiac complications between the two. This study investigates cardiovascular complications in cases of Lyme and Babesiosis. Methods: We conducted a retrospective cohort study utilizing data from the TriNetX database and the US Collaborative Network, which together cover 60 healthcare organizations providing real-world electronic health records. We included all individuals diagnosed with either Lyme disease (Cohort A, pre-match n = 317368/post-match n = 4115 ) or babesiosis (Cohort B, pre-match n=4173/post-match n = 4115), identified using ICD-10-CM codes. Patients under 18 years of age, diagnosed with both diseases, or with incomplete follow-up data were excluded. We employed propensity score matching to adjust for age, race, sex, and other clinical parameters to compare the two cohorts equitably. We focused on 4 key outcomes over a 5-year period: arrhythmias, the need for PPM implantation, ACS and HF, utilizing both risk analysis and Kaplan-Meier survival analysis. Results: Interestingly, patients with babesia exhibited a greater likelihood of developing HF (OR: 1.279, 95% CI (1.073,1.524)). The development of arrhythmias between the two groups was not statistically significant with an OR of 1.013 (95% CI (0.837, 1.227)). The need for PPM implantation was not statistically significant between the two groups with an OR of 1.269 (95% CI (0.785, 2.052)). The risk of developing ACS was not statistically significant with an OR of 1.103 (95% CI (0.838, 1.451)) . Conclusion/Discussion: Our findings indicate that patients with babesiosis have a higher likelihood of developing HF compared to those with lyme disease. Surprisingly, there were no significant differences in the rates of arrhythmias or pacemaker implantations between the two cohorts. These results suggest that while overall cardiovascular risks are comparable between the groups, the increased risk of HF in babesiosis needs to be further explored.

Abstract 4117406: The Safety and Efficacy of Surgical Cardiac Sympathetic Denervation for Ventricular Arrhythmias: An Updated Systematic Review&amp;Meta-Analysis

Objectives: This meta-analysis sought to explore the long-term arrhythmic outcomes of cardiac sympathetic denervation (CS) by measuring event rates of recurrent ventricular arrhythmias (VA) and implantable cardiac defibrillator shocks (ICD) post CSD. Background: The role of sympathetic nervous system in the beginning and continuation of ventricular arrhythmias (VAs) is well known. CS has been associated with improved arrhythmic outcomes in patients with refractory ventricular arrhythmias. However, whether CSD lowers shock event rates after the procedure is still uncertain and therefore, we performed a systematic review and meta-analysis to evaluate this. Methods&amp;Materials: A comprehensive literature search was performed at Medline and Embase until March 2023. Our primary outcome was event rate of ICD shocks at 30 days, 90 days, and 1 year following CS. All analysis was conducted using Comprehensive Meta-Analysis software. Results: The initial search found 1,324 articles. After all articles were examined, a total of 29 studies fit our criteria. ICD shocks 1 year post CSD had a pooled event rate of 66.5% with a 95% confidence interval (CI) of 57.7% to 74.3% and the I-squared (I2) statistics. ICD shocks at 6 months had an event rate at 61.7% with a 95% confidence interval of 53.3% to 69.4% with I2 at 46. VA in one year post CSD had a pooled event rate of 62.5 with a 95% with a CI of 53.3% to 69.1% and I2 at 22%. At 6 months the event rate was 64.2 with a 95% CI of 56.3% to 71.4% with I2 at 33% Mortality from cardiac arrhythmia and classified 0-30 days (short term), 21-364 days (medium term), and &gt;365 days (long term). The pooled event rate for short term morality was 6.8% with a 95% CI of 4.2%-11.0% with I2 at 0%, medium term was 5.2% with a 95% CI of 2.9% to 8.9% with I2 at 0%, and long term was 5.0% with a 95% CI of 2.7% to 9.2% and I2 at 0%. Conclusion: CSD may be an alternative form of therapy that reduces shock event rates and recurrent VA in patients that are refractory to ablation and medical therapy. However larger prospective studies are needed to further evaluate the usefulness and safety of CSD.

Abstract 4148085: Transfer to ‘Hub’ Hospitals and Outcomes in Cardiogenic Shock

Introduction: Patients with cardiogenic shock (CS) have high mortality. Many CS patients present to non-tertiary care centers. Limited data exist on outcomes for patients transferred to “hub” CS centers for both acute myocardial infarction (AMI) and non-AMI etiologies. This study sought to compare the characteristics and outcomes of transferred CS patients compared to patients presenting to a hub center. Methodology: Adults (≥18 years) with a primary or secondary diagnosis of CS were identified from the National Readmissions Database (2016-2020) and stratified by transfer status. Overlap propensity score (PS) weighting was performed to assess the association between in-hospital mortality, length of stay (LOS) and transfer status. Results: Of 314,098 CS patients (AMICS 27%, non-AMICS 73%), 30,630 (9.8%) were transferred. Compared to non-transferred patients, transferred patients were on average younger (65 [interquartile range {IQR} 55-73] vs. 68 [IQR 58-77] years), more likely to be female (34% vs. 37%), less frequently with Medicare as primary payor (55% vs. 62%), and with higher comorbidity (Elixhauser index 8 [IQR 6-9] vs. 6 [IQR 5-8]) (all p &lt;0.001). Transferred patients had higher rates of respiratory failure (70% vs. 64%), renal failure (71% vs. 60%), hepatic failure (25% vs. 17%), bleeding complications (28% vs. 17%), and arrhythmias (59% vs. 52%) (all p &lt;0.001). Transferred patients were also more likely to undergo percutaneous coronary intervention (22% vs. 19%), coronary artery bypass grafting (13% vs. 8%), pulmonary artery catheter insertion (36% vs.16%), placement of intra-aortic balloon pump (25% vs.13%), percutaneous left ventricular assist device (13% vs. 7%), and extracorporeal membrane oxygenation (7% vs. 2%), receive invasive mechanical ventilation (3% vs. 2%), and undergo hemodialysis (17% vs. 11%) (all p &lt;0.001). In-hospital mortality was significantly lower in transferred patients – 39% vs. 47.1%; unadjusted odds ratio 0.71 (95% confidence interval 0.70-0.73); adjusted PS weighting odds ratio 0.73 (95% confidence interval 0.71-0.76), p &lt;0.001. Transferred patients had a longer median LOS (13 [IQR 7-22] vs. 6 [IQR 3-11] days, p &lt;0.001). Conclusion: Transferred CS patients had higher use of cardiovascular procedures and organ support therapies and lower in-hospital mortality suggesting patients were appropriately selected for transfer.

Cardiovascular Effects of Splenomegaly and Splenectomy in Beta-Thalassemia Major.

Background Beta-thalassemia major is a genetic blood disease complicated by splenomegaly, and splenectomy is a standard therapy for this medical condition. Although splenectomy results not only in the improvement of the hematological status, the long-term consequences to the cardiovascular system are still questionable. Objective The aim of the study was to assess and compare the cardiovascular impact of splenomegaly and splenectomy in patients with beta-thalassemia major. Methodology This is a cross-sectional survey conducted at Hayatabad Medical Complex, Peshawar, from January 2024 to June 2024. A total of 88 beta-thalassemia major patients were divided into two groups: 44 patients with splenomegaly were recruited and compared with 44 post-splenectomy patients. Outcomes that were assessed in this study from the medical records were cardiac function test, ejection fraction, left ventricular hypertrophy, thromboembolic incidences, pulmonary embolism, deep vein thrombosis, blood pressure level, and the biochemical markers, B-type natriuretic peptide (BNP)and troponin. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 26 (IBM Corp., Armonk, USA). Results Patients with splenectomy exhibited slightly lower hemoglobin levels and higher transfusion requirements but had better ejection fractions compared to those with splenomegaly. In contrast, the splenomegaly group demonstrated worse cardiovascular outcomes, including higher rates of left ventricular hypertrophy, pulmonary hypertension, arrhythmias, thromboembolic events, and elevated BNP levels, indicating increased cardiovascular morbidity and hemodynamic strain. Logistic regression analysis further suggested that splenectomy reduces the risk of cardiomyopathy, particularly in younger patients, while the splenomegaly group experiences a greater burden of acute cardiovascular complications. Conclusion Splenectomy in beta-thalassemia major patients offers improved cardiac function and hemoglobin levels while reducing transfusion needs, but it does not eliminate the risks of long-term cardiovascular and thromboembolic complications, such as deep vein thrombosis and pulmonary embolism. On the other hand, patients with splenomegaly face more severe and immediate cardiovascular risks, including hypertension, arrhythmias, and thromboembolic events. These findings underscore the importance of tailored management strategies to optimize outcomes for both groups.

Semaglutide improves contractile function in isolated human atrium

Abstract Background Recently, the results of the STEP-HFpEF trial were announced, in which high-dose treatment with the antidiabetic glucagon-like-peptide 1 agonist semaglutide resulted in a significant improvement of HFpEF-associated symptoms and reduction of NT-proBNP levels. Interestingly, treatment effects were independent of initial body weight and left-ventricular ejection fraction, sparking interest regarding the precise mechanism of action. Purpose We tested the effects of acute semaglutide treatment in isolated human right-atrial trabeculae. Methods Trabeculae were prepared from right atrial appendage biopsies from 32 patients undergoing elective coronary artery bypass grafting and/or valve surgery. Regular contractions were elicited by electrical field stimulation (1Hz, 5V/50ms, 37°C). Paired experiments were performed simultaneously per patient with a control group and one exposed to semaglutide (100 or 300nM). Developed tension was analysed at steady state after 30 min. Arrhythmias were defined as deviations from baseline not arising from electrical stimulation. L-type calcium channel blockade was achieved with nifedipine (2µM) in some experiments. Rapid cooling contraction was elicited to assess sarcoplasmic reticulum Ca2+ content (RCC1) by rapidly superfusing the trabeculae with chilled solution (2°C). After a short rewarming period of 10s to 37°C, RCC was repeated to assess the Na+/Ca2+ exchanger function (RCC2). Statistical analysis was conducted using paired t-test or Wilcoxon test as appropriate (for 2 groups) and one-way ANOVA with test for trend (for &amp;gt;2 groups). Results Exposure to semaglutide increased developed tension by over 3-fold in human atrial trabeculae in a dose-dependent manner: from 3.14±1.14 for control to 5.43±2.35mN/mm2 for 100nM semaglutide (p=0.03 vs. control) to 12.5±3.53 for 300nM semaglutide (p=0.004 vs. control, mean±SEM, fig. A-D, p=0.005 for linear trend). L-type calcium channel blockade with nifedipine blunted developed tension overall but did not abolish the effect of semaglutide (fig. E, p=0.02). In contrast, the developed tensions upon RCC1 and RCC2 were increased by semaglutide (300nM) compared to control, while the ratio of RCC2:RCC1 was elevated by semaglutide, indicating both increased SR Ca2+ reuptake and less external Ca2+ removal in the presence of semaglutide (fig. H-J). Relaxation time to 50% of baseline was unaltered (not shown), while relaxation time to 90% of baseline was mildly prolonged by semaglutide at 300 nM (fig. F). No increase in the rate of arrhythmias was observed by semaglutide treatment (fig. G). Conclusion Acute exposure of human atrial trabeculae to semaglutide results in a strong positive inotropic effect in a dose-dependent manner without increasing the propensity for arrhythmias. This effect is most likely due to increased SR Ca2+ reuptake. Treatment of heart failure patients with high-dose semaglutide can improve atrial function, which may ameliorate symptoms.

Efficacy and safety of catheter ablation for paroxysmal atrial fibrillation as first-line therapy vs. after drug failure -analysis from Japan Nationwide Ablation (J-AB) Registry-

Abstract Background Catheter ablation is an effective rhythm control therapy for atrial fibrillation (AF). Recent advancements in technology have improved the efficacy and safety of this procedure. Current European Society of Cardiology and Japanese Circulation Society guidelines recommend that catheter ablation (CA) for patients with paroxysmal AF (PAF) after failure of drug therapy is classified as Class I, and CA as first-line therapy is categorized as Class IIa. However, there are limited clinical studies directly comparing these groups. Objective This study aimed to compare the efficacy and safety of CA as first-line therapy vs. those after failed drug therapy using data from the Japan Nationwide Ablation (J-AB) Registry led by the Japanese Heart Rhythm Society. Methods Detailed data of patients who underwent catheter ablation for PAF extracted from the J-AB registry were analyzed. Patients were divided into two groups: those who underwent CA as first-line therapy (First-line group) or those who underwent CA after failed drug therapy (Drug failure group). Patients’ characteristics, efficacy and safety of CA were compared between the two groups. Efficacy was assessed by evaluating the recurrence rate of any atrial arrhythmia within one year after the 90-day blanking period, and major safety outcomes were set as severe bleeding complication, stroke, and gastrointestinal disorders during the perioperative period. Result This analysis included 5,011 cases with a median age of 69 years (range 61-75) and 35% females. Comparing patient characteristics between the first-line therapy group (n = 3,447) and the drug failure group (n = 1,564), there are no statistically significant differences between the two groups except in left atrium diameter in echocardiogram (LAD) (38 [34-42] mm vs. 38 [34-43] mm, P &amp;lt;0.001), serum creatinine levels (0.8 [0.7-1.0] mg/dl vs. 0.9 [0.7-1.0] mg/dl, P &amp;lt;0.001), and beta-blocker usage (38.2% vs. 46.7%, P &amp;lt;0.01). A total of 501 recurrence events were observed in this analysis during a median follow-up of 365 [254-390] days. Recurrence rates did not statistically differ between the two groups (log-rank P=0.49). After adjusting for contributing factors with age, gender, body mass index, LAD, and left ventricular ejection fraction in echocardiogram using a multivariate Cox proportional hazards model, efficacy outcomes showed no significant difference between the two groups (adjusted hazard ratio; 1.06 95% confidence interval; 0.88-1.28, P = 0.55). Besides, the two groups had no significant difference in major safety outcomes. Conclusions Catheter ablation as the first-line therapy for paroxysmal atrial fibrillation showed a similar recurrence rate of atrial arrhythmias and adverse events compared to those who underwent catheter ablation after drug failure.

Reverse remodelling and clinical outcomes in patients with chagas cardiomyopathy with reduced ejection fraction

Abstract Introduction Chagas disease affects around 8 million individuals globally and about 30% develop cardiac manifestations and, in time, heart failure with reduced ejection fraction (HFrEF). Chagas cardiomyopathy (CC) patients often have a poorer prognosis compared to other causes of HFrEF, owing to a higher rate of ventricular arrhythmias and thromboembolic conditions. Reverse remodelling (RR) has been linked to enhanced mortality and morbidity outcomes in HFrEF due to non-Chagas causes, but the effect of RR on CC prognosis is still unclear. Methods This retrospective study assessed 1043 patients diagnosed with CC via positive serology for Trypanosoma cruzi infection coupled with cardiopathy and ventricular dysfunction [left ventricular ejection fraction (LVEF) &amp;lt; 40%] during the follow-up period from January 2006 to September 2021. The primary outcome measured included overall mortality and heart transplantation in relation to RR status. Propensity score matching was utilised to adjust for confounding factors. Positive reverse remodelling (PRR) was characterised as patients displaying improved LVEF, and negative reverse remodelling (NRR) as those with persistent ventricular dysfunction during follow-up. Results Initially, 221 (21.2%) were categorised as PRR and 822 (78.8%) as NRR. Participants in the PRR group were predominantly female (51.6% versus 41.4%; p &amp;lt; 0.001), older [59 years (53 – 66) versus 56 years (47 – 64); p = 0.007], more prone to hypertension (43.4% versus 35.8%; p = 0.036), and presented with higher initial heart rates [70 bpm (60 – 80) versus 65 bpm (60 – 75); p = 0.002], systolic blood pressure [120 mmHg (110 – 130) versus 110 mmHg (100 – 120); p &amp;lt; 0.001], diastolic blood pressure [80 mmHg (69 – 82) versus 70 mmHg (60 – 80); p &amp;lt; 0.001], and LVEF [30.0% (26.0 – 35.0) versus 29% (25.0 – 34.0); p &amp;lt; 0.001] compared to the NRR group. Moreover, the PRR group had a lower intake of beta-blockers (BB) (76.6% versus 87.0%; p = 0.004), spironolactone (38.5% versus 59.5%; p &amp;lt; 0.001), and triple therapy (30.9% versus 50.4%; p &amp;lt; 0.001). Following propensity score matching, 200 patients remained for the final analysis, with 100 in each group. Cox proportional hazards model analysis revealed PRR as an independent predictor [hazard ratio (HR): 0.367; 95% confidence interval (CI) 0.218 – 0.616; p &amp;lt; 0.001] of mortality from all causes or heart transplantation. The PRR group exhibited a longer event-free survival duration than the NRR group (10.332 years; 95% CI 9.557 – 11.107 versus 7.348 years; 95% CI 6.606 – 8.089; p &amp;lt; 0.001). Discussion This study suggests a positive association between the PRR and increased survival in patients with CHD and HFrEF. Previously published studies didn’t demonstrate this association, possibly due to the small number of patients included. Conclusion PRR predicts a better long-term survival free from all-cause mortality and cardiac transplantation in Chagas cardiomyopathy with LVEF &amp;lt; 40%.Kaplan-Meier event-free survival curve

Sudden cardiac death in acute coronary occlusion: potential roles of sino-atrial nodal artery and conus artery

Abstract An estimated 80% of sudden cardiac death (SCD) is due to coronary artery disease1. Ventricular arrhythmia (VA) is most commonly associated with LAD infarctions, likely due to the larger extent of affected myocardium, but non-LAD territory infarctions also present with VA. We propose two potential contributors, the sinoatrial nodal artery (SANa) and conus artery (CA). We retrospectively analyzed 2 cohorts of patients presenting with STEMI complicated by SCD due to VA, and whether these arteries were compromised in non-LAD territory STEMI, compared with uncomplicated STEMI. In the first, cohort A, we compared 127 consecutive STEMI patients presenting with cardiac arrest, with 100 uncomplicated STEMI. SANa and CA involvement was assessed in patients presenting with non-LAD territory STEMI. In the second, cohort B, we looked at patients presenting with inferior STEMI involving the RCA only, 20 complicated by aborted SCD due to VA compared with 24 uncomplicated patients. Cohort A (see table) showed a preponderance of single vessel and proximal LAD culprits in the arrest group and a significant number of non-LAD culprits. The extent and complexity of coronary disease and amount of myocardium at risk, reflected in SYNTAX and modified Jeopardy scores, were not significantly different between arrest and non-arrest groups. In those with RCA or Circumflex culprits, 77% in the Arrest group had the SANa arising from the culprit vessel, with only 33% of patients in the Control group, p&amp;lt;0.005. In cohort B, 70% of arrest and 21% of non-arrest patients had SANa involvement, p&amp;lt;0.005. In this cohort, we also observed that 74% of the arrest patients had CA involvement, compared with only 21% of Control patients, p&amp;lt;0.005. There were no significant differences in heart rate nor incidence of complete heart block and atrial arrhythmia in either cohort. There was significantly more ST elevation in standard leads V1-V2, suggesting RVOT ischemia, in those with aborted SCD and RCA culprit in both cohorts (cohort B: Arrests 85% vs non-arrest 21%, p&amp;lt;0.005. The SANa arises from the proximal RCA in 60% of people, and 40% from the left system. Transient ischemia leading to sinus bradycardia may not result in as marked QT prolongation compared with AV block at comparable heart rates, but in the ischemic environment, with hypotension provoking sympathetic upregulation, may lead to enough repolarization heterogeneity to induce VA. The CA arises from the RCA in 50% or more, and otherwise from the right coronary sinus, supplying the RVOT, a region prone to arrhythmogenesis, even in structurally normal hearts, more so if ischemic. Recognizing the potential role of these arterial branches in the VA mechanism would alert operators into preserving their patency. Transient disturbances may not translate into long term adverse outcomes, but whereas permanent damage to the SAN is more readily remedied, further study is needed to assess any long-term sequelae of RVOT infarction.

No improvement in atrial arrhythmia rates in patients on baroreflex activation therapy

Abstract Background Atrial arrhythmias encompass a wide range of abnormal cardiac rhythms including atrial fibrillation, atrial flutter, and atrial tachycardia. Patients with heart failure with reduced ejection fraction (HFrEF) have increased risk of atrial arrhythmias, ultimately leading to increased morbidity. Baroreflex Activation Therapy (BAT) employs an implantable device to increase parasympathetic nervous system activity by stimulating the carotid baroreceptors thereby reducing afterload and heart failure symptoms. In our prior study, BAT therapy has been shown to reduce hospitalization rates in patients with HFrEF. However, the effects of BAT on atrial arrhythmia has never been studied. Objective In this study, we analyzed the effects of BAT on atrial arrhythmia rates in patients with HFrEF. Methods Patients with HFrEF with BAT therapy for at least 12-months at a hospital were retrospectively studied. Inclusion criteria includes implantable cardioverter-defibrillator (ICD) placement of at least 12-months pre- and post-BAT therapy. Additionally, patients diagnosed with atrial arrhythmias prior to the study timeline were excluded. Atrial arrhythmia rates 6 and 12-months pre-BAT therapy and 6 and 12-months post-BAT therapy were compared. Atrial arrhythmia episodes were recorded through ICD interrogation every 1-3 months in the clinic. Of the 31 identified patients on BAT therapy, 11 patients fit the inclusion criteria. For the 11 patients in the study, 3 identified as female and 8 identified as male, 6 identified as white, 4 identified as Hispanic, and 1 identified as African-American with a mean age of 59.8 ± 17.4 years. The average left ventricular ejection fraction pre-BAT therapy was 23.8 ± 10.8%. Results The mean average atrial arrhythmia rates for 6-month pre-BAT therapy and 6-month post-BAT therapy were 0.12/month ± 0.40 and 1.32/month ± 2.76 respectively (p=0.18), suggesting no differences in atrial arrhythmia rates at 6-months with BAT therapy. The mean average atrial arrhythmia rates for 12-month pre-BAT therapy and 12-month post-BAT therapy were 0.11/month ± 0.35 and 2.40/month ± 5.84 respectively (p=0.22), suggesting no differences in atrial arrhythmia rates at 12-months with BAT therapy. Conclusion Although BAT therapy has been shown to decrease hospitalization rates, BAT therapy is not associated with decreased atrial arrhythmia rates at 6 months and 12 months.

Effects of dialysate potassium concentration of 3.0mEq/l with sodium zirconium cyclosilicate on dialysis-free days versus dialysate potassium concentration of 2.0mEq/l alone on rates of cardiac arrhythmias in hemodialysis patients with hyperkalemia

The optimal approach towards managing serum potassium and hemodialysate potassium concentrations is uncertain. To study this, adults receiving hemodialysis for three months or more with hyperkalemia (pre-dialysis serum potassium (sK+) 5.1-6.5 mEq/l) had cardiac monitors implanted and were randomized to either eight weeks of 2.0 potassium/2.5 calcium mEq/l dialysate without sodium zirconium cyclosilicate (SZC) (2.0 potassium/noSZC) or 3.0 potassium/2.5 calcium mEq/l dialysate combined with SZC (3.0 potassium/SZC) on non-dialysis days to maintain pre-dialysis sK+ 4.0-5.5 mEq/l, followed by treatment crossover for another eight weeks. The primary outcome was the rate of adjudicated atrial fibrillation (AF) episodes of 2 minutes or more duration. Secondary outcomes included clinically significant arrhythmias (bradycardia, ventricular tachycardia, and/or asystole) and the proportion of sK+ measurements within an optimal window of 4.0-5.5 mEq/l. Among 88 participants (mean age: 57.1 years; 51% male; mean pre-dialysis sK+: 5.5 mmol/l) with 25.5 person-years of follow-up, 296 AF episodes were detected in nine patients. The unadjusted AF rate was lower with 3.0 potassium/SZC versus 2.0 potassium/noSZC; 9.7 vs. 13.4/person-year (modeled rate ratio 0.52; 95% confidence interval: 0.41; 0.65). Clinically significant arrhythmias were reduced with 3.0 potassium/SZC vs. 2.0 potassium/noSZC 6.8 vs. 10.2/person-year modeled rate ratio 0.47: 0.38;0.58). Fewer sK+ measurements outside the optimal window occurred with 3.0 potassium/SZC (modeled odds ratio: 0.27:0.12, 0.35). Hypokalemia was less frequent (33 vs. 58 patients) with 3.0 potassium/SZC compared with 2.0 potassium/noSZC. Thus, in patients with hyperkalemia on maintenance hemodialysis, a combination of potassium 3.0 mEq/l and SZC on non-hemodialysis days reduced the rates of AF, other clinically significant arrhythmias, and post-dialysis hypokalemia compared with potassium 2.0/noSZC.