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The objective was to compare the efficacy of treatment options for right heart thrombi (RHT) in transit. All published reports between 1992 and 2013 were identified and pooled. We analyzed 328 patients with RHT and pulmonary embolism (PE). The treatments administered were none in 11 patients (3.4%), anticoagulation (AC) with heparin in 70 patients (21.3%), thrombolytics in 122 patients (37.2%), catheter-related treatments in five patients (1.5%) and surgical embolectomy in 120 patients (36.6%). The overall short-term mortality for the entire cohort was 23.2%. The mortality rate associated with no therapy was highest at 90.9%. The mortality associated with AC alone was significantly higher than surgical embolectomy or thrombolysis (37.1% vs 18.3% vs 13.7%, respectively). In univariate analysis, any therapy was better than no therapy with a favorable odds of 16.92 (95% CI 2.05–139.87) for AC, 61.76 (95% CI 7.42–513.81) for thrombolysis and 44.54 (95% CI 5.42–366.32) for surgical embolectomy. In multivariate analysis with age and hemodynamic status entered as covariates, thrombolytic therapy was better than AC with favorable odds of 4.83 (95% CI 1.52–15.36). Similarly, there was a trend in favor of surgical embolectomy with an odds of 2.61 (95% CI 0.90–7.58). The estimated probability of survival in hemodynamically unstable patients with AC, surgical embolectomy and thrombolysis was 47.7%, 70.45% and 81.5%, respectively. There was no significantly increased risk of complications with thrombolytic therapy. In conclusion, left untreated, patients with RHT and PE have very high mortality. Aggressive management with thrombolysis or surgical thrombectomy may be more effective than AC alone in the management of these patients.

Introduction Catheter placement and stability are well‐known challenges in atrial fibrillation (AF) ablation. As a result, steerable sheaths (SS) were developed to improve catheter stabilization and maintain proper catheter–tissue contact. The purpose of this systematic review and meta‐analysis is to see if employing a SS influences procedure outcome. Method We performed a comprehensive literature search for studies that evaluated the efficacy and safety of SS compared to nonsteerable sheaths (NSS) in AF ablation. The primary outcome was the rate of atrial arrhythmia (AA) freedom by the time of the last follow‐up. The secondary outcomes were the procedure‐related complications and procedural characteristics. Risk ratio (RR) or the mean difference (MD) and corresponding 95% confidence intervals (CIs) were calculated using the random‐effects model. Results A total of 10 studies, including 967 AF patients (mean age: 59.2 ± 11.1 years, 516 patients managed with SS vs. 454 with NSS), were included. SS group showed a higher rate of freedom of AA compared to NSS (RR: 1.19; 95% CI 1.09–1.29; p < .001). Both techniques had similar rate for procedural‐related complication (RR: 1.09, 95% CI 0.50–2.39; p = .83). The SS strategy had a shorter procedure time (MD −10.6 [min], 95% CI −20.97, −0.20; p = .05) but comparable fluoroscopic and radiofrequency application times to the NSS group. Conclusions The SS for AF catheter ablation not only reduced the total procedure time but also significantly increased the rate of successful ablation while maintaining a similar safety profile when compared to the traditional NSS. This meta‐analysis reveals that the use of a steerable sheath for atrial fibrillation ablation resulted in a better success rate and a lower risk of late atrial arrhythmia recurrence. However, this should be weighed against the possibility of an increase in periprocedural complications and procedure costs.

Introduction Endocardial catheter ablation (ECA) for atrial fibrillation (AF) has limited efficacy. Hybrid convergent procedure (HCP) with both epicardial and endocardial ablation is a novel strategy for AF treatment. In this meta‐analysis, we aimed to evaluate the efficacy and safety of HCP in AF ablation. Method We performed a comprehensive literature search for studies that evaluated the efficacy and safety of HCP compared with ECA for AF. The primary outcome was freedom of atrial arrhythmia (AA). The secondary outcome was the periprocedural complication rate. Pooled relative risk (RR) and corresponding 95% confidence intervals (CIs) were calculated using the random effects model. Results A total of eight studies, including 797 AF patients (mean age: 60.7 ± 9.8 years, 366 patients with HCP vs. 431 patients with ECA alone), were included. HCP showed a higher rate of freedom of AA compared with ECA (RR: 1.48, 95% CI: 1.13–1.94, p = .004). However, HCP was associated with higher rates of periprocedural complications (RR: 3.64, 95% CI: 2.06–6.43; p = .00001). Moreover, the HCP had a longer procedure time and postprocedural hospital stay. Conclusions Although hybrid ablation was associated with a higher success rate, this should be judged for increased periprocedural adverse events and extended hospital stay. Prospective large‐scale randomized trials are needed to validate these results. Graphical showing the outcomes of our study. Although hybrid ablation was associated with a higher success rate, this should be judged for increased periprocedural adverse events and extended hospital stay.

Atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) are frequent co-morbid conditions. In patients with symptomatic AF and preserved left ventricular ejection fraction the clinical diagnosis of HFpEF may be difficult, as history, examination, and echocardiography are not sensitive or specific. This study sought to assess the prevalence of HFpEF in patients undergoing AF ablation utilizing resting and post-tachycardia pacing left atrial pressure (LAP) measurements. This retrospective cohort study consisted of consecutive patients with symptomatic AF and preserved left ventricular ejection fraction who had invasive hemodynamic assessment (IHA) of LAP under resting and post-tachycardia pacing conditions while undergoing AF ablation from 2020 to 2022 at a tertiary care academic medical center. Elevated LAP was defined as ≥15 mm Hg at rest and ≥15 mm Hg post-tachycardia pacing. Patients were stratified into 3 groups: (1) normal resting and post-tachycardia pacing LAP (control group), (2) elevated resting LAP (apparent HFpEF), (3) normal resting but elevated post-tachycardia pacing LAP (occult HFpEF). A total of 78 patients were included with age 64.6 ± 9.1 years, 28 (36%) female, body mass index 33.3 ± 6.5 kg/m2, 5 (6%) paroxysmal and 73 (94%) persistent AF, and CHA2DS2-VASc 3.0 ± 1.5. IHA categorized 31 (40%), 32 (41%), and 15 patients (19%) into groups 1, 2, and 3 respectively. Notably, while only 9 patients (12%) were diagnosed with HFpEF based on clinical evaluation, 47 patients (60%) were diagnosed by IHA. IHA in patients undergoing AF ablation suggests a high prevalence of clinically undiagnosed HFpEF through a novel methodology measuring resting and post-tachycardia pacing LAP. [Display omitted]

Abstract Background Individuals recovering from COVID-19 infection have reported experiencing symptoms of postural orthostatic tachycardia syndrome (POTS). These observations have raised concerns about COVID-19 as a significant precipitating factor in the development of post-viral POTS. Given the increasing number of POTS cases reported after COVID-19, we sought to examine the baseline characteristics of POTS patients before and after COVID-19. Methods We conducted an interrupted time series analysis on data obtained from the TriNetX database, which included a cohort of 65 141 065 patients aged 18 and older across 64 healthcare organizations. Monthly data on incidence rates (IR), incidence cases (IC), and prevalence cases (PC) of POTS were collected from January 2018 to June 2024, with 1 March 2020 defined as the cutoff date for pre- and post-COVID analysis. Results There was a significant increase in the IR of POTS post-COVID (P < 0.0001), with the IR increasing from 1.42/1000 000 to 20.3/1000 000 cases per person-year. Similarly, the monthly IC trend showed a significant rise from 4.21 to 22.66 cases (P < 0.001). The month-to-month prevalence showed an initial decline after COVID with a robust increase starting January 2023. Additionally, the prevalence of autonomic nervous system disorders and related comorbidities significantly decreased in the post-COVID cohort. Conclusion Our findings demonstrate a significant increase in the incidence of POTS following the COVID-19 pandemic, suggesting a potential association between COVID-19 infection and the development of post-viral POTS. Future research should explore the underlying mechanisms and treatment strategies for POTS in the context of post-COVID recovery. Graphical Abstract Graphical Abstract

The timing of when to perform ventricular tachycardia (VT) ablation while receiving an implantable cardioverter defibrillator (ICD) during the same hospitalization has not been explored. This study aimed to investigate the use and outcomes of VT catheter ablation in patients with sustained VT receiving ICD in the same hospital stay. The Nationwide Readmission Database 2016 to 2019 was queried for all hospitalizations with a primary diagnosis of VT with subsequent ICD during the same admission. Hospitalizations were later stratified according to whether a VT ablation was performed. All catheter ablation of VT were performed before ICD implantation. The outcomes of interest were in-hospital mortality and 90-day readmission. A total of 29,385 VT hospitalizations were included. VT ablation was performed with subsequent ICD placement in 2,255 (7.6%), whereas 27,130 (92.3%) received an ICD only. No differences were found regarding in-hospital mortality (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.35 to 1.9, p = 0.67) and all-cause 90-day readmission rate (aOR 1.1, 95% CI 0.95 to 1.3, p = 0.16). An increase in readmission because of recurrent VT was noted in the VT ablation group (aOR 1.53, 8% vs 5% CI 1.2 to 1.9, p <0.01); the VT ablation group encompassed a higher number of patients with heart failure with reduced ejection fraction (p <0.01), cardiogenic shock (p <0.01), and mechanical circulatory support use (p <0.01). In conclusion, the use of VT ablation in patients admitted with sustained VT is low and reserved for higher risk patients with significant co-morbidities. Despite the higher risk profile of VT ablation cohort, no differences were found in the short-term mortality and readmission rate between the groups.

While dengue virus infection leads to a mild to moderate elevation of liver transaminases in almost all cases, hepatic failure rarely dominates the clinical picture in adults. We present a case of dengue haemorrhagic fever in a young adult, leading to the rare complication of acute liver failure. He was managed with supportive care and discharged after 5 days. At follow-up after 1 week, he had complete recovery and no residual symptoms.

Abstract Aims Ventricular tachycardia (VT) ablation is an established therapy for patients with structural heart disease and recurrent VT. However, the impact of left ventricular function on peri-procedural and long-term outcomes remains incompletely understood. We evaluated the association of left ventricular ejection fraction (LVEF) on clinical outcomes after VT ablation. Methods and results We conducted a retrospective cohort study using the TriNetX Research Network (2010–21) to evaluate outcomes after VT ablation, stratifying patients by LVEF (>30 vs. ≤30%). Propensity score matching (1:1) was used to balance baseline characteristics. The primary outcome was a 30-day composite safety endpoint defined as all-cause mortality, acute kidney injury (AKI), mechanical circulatory support (MCS) use, or cardiac tamponade. Secondary outcomes included 3-year all-cause mortality, ventricular arrhythmia recurrence, and rehospitalization. The individual components of the 30-day composite were evaluated in exploratory analyses. Among 2549 patients who underwent VT ablation, 623 were matched in each subgroup. The 30-day composite safety endpoint was significantly lower in patients with LVEF >30% (17.9 vs. 26.3%; P = 0.0004). In exploratory analyses, patients with LVEF ≤30% had higher 30-day mortality, AKI, and MCS use, while tamponade rates were similar between groups. At 3-year follow-up, all-cause mortality (15.2 vs. 28.7%) and rehospitalization (31.6 vs. 44.1%) remained significantly lower (P < 0.01) in the higher LVEF group. Ventricular tachycardia recurrence rates were high in both groups (71 vs. 67%) without a significant difference. Conclusion In this large real-world study, patients with LVEF >30% undergoing VT ablation experienced significantly better peri-procedural and long-term outcomes. Graphical Abstract Graphical Abstract

Atrial fibrillation (AF) poses significant risks of stroke and mortality. Catheter ablation (CA) has emerged as a superior rhythm control strategy compared to medical therapy, but its long-term benefits in AF, in ischemic stroke prevention, remain underexplored.BACKGROUNDAtrial fibrillation (AF) poses significant risks of stroke and mortality. Catheter ablation (CA) has emerged as a superior rhythm control strategy compared to medical therapy, but its long-term benefits in AF, in ischemic stroke prevention, remain underexplored.This observational study analyzed data from the TriNetX Research Network, encompassing over 115 million patients. Adults diagnosed with paroxysmal atrial fibrillation (PAF) between 2012 and 2019 were stratified into CA and non-CA groups. Propensity score matching (PSM) accounted for baseline differences in demographics, comorbidities, and medication use. The primary outcome was ischemic stroke rates at five years, with and without prior ischemic stroke. Secondary outcomes included all-cause mortality. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to estimate adjusted hazard ratios (HRs).METHODSThis observational study analyzed data from the TriNetX Research Network, encompassing over 115 million patients. Adults diagnosed with paroxysmal atrial fibrillation (PAF) between 2012 and 2019 were stratified into CA and non-CA groups. Propensity score matching (PSM) accounted for baseline differences in demographics, comorbidities, and medication use. The primary outcome was ischemic stroke rates at five years, with and without prior ischemic stroke. Secondary outcomes included all-cause mortality. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to estimate adjusted hazard ratios (HRs).Among 791,013 patients with PAF, 53,178 (6.7%) underwent CA. Post-PSM, ischemic stroke rates were significantly lower in the CA group (7.96% vs. 9.52%, HR: 0.823, 95% CI: 0.785-0.863, p < 0.0001), even after excluding patients with prior ischemic stroke (de-novo ischemic stroke) (4.70% vs. 6.43% HR: 0.709, 95% CI: 0.665-0.756, p < 0.0001). All-cause mortality was markedly reduced (9.33% vs. 20.68% HR: 0.388, 95% CI: 0.373-0.404, p < 0.0001).RESULTSAmong 791,013 patients with PAF, 53,178 (6.7%) underwent CA. Post-PSM, ischemic stroke rates were significantly lower in the CA group (7.96% vs. 9.52%, HR: 0.823, 95% CI: 0.785-0.863, p < 0.0001), even after excluding patients with prior ischemic stroke (de-novo ischemic stroke) (4.70% vs. 6.43% HR: 0.709, 95% CI: 0.665-0.756, p < 0.0001). All-cause mortality was markedly reduced (9.33% vs. 20.68% HR: 0.388, 95% CI: 0.373-0.404, p < 0.0001).This large-scale study demonstrates that in PAF patients CA is associated with lower ischemic stroke rates and all-cause mortality compared to a PSM group without CA. These findings support urgent evaluation of CA in managing PAF and highlight its role in potentially improving survival and reducing stroke risk. Further trials are needed to support these findings.CONCLUSIONThis large-scale study demonstrates that in PAF patients CA is associated with lower ischemic stroke rates and all-cause mortality compared to a PSM group without CA. These findings support urgent evaluation of CA in managing PAF and highlight its role in potentially improving survival and reducing stroke risk. Further trials are needed to support these findings.

Takotsubo cardiomyopathy causes transient left ventricular dysfunction. It typically has a favorable prognosis but rarely leads to complications such as cardiogenic shock. Also known as stress-induced cardiomyopathy, it is precipitated by emotional or physical stress. Serotonin syndrome can cause severe stress due to excessive serotonergic activity in the central nervous system. We report a case of cardiogenic shock precipitated by serotonin syndrome-induced takotsubo cardiomyopathy. Only one other documented case has exhibited cardiogenic shock in this setting.