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Social status gradients are powerful health determinants for individuals living in poverty. We tested whether winning an Academy award (Oscar) for acting was associated with long-term survival. We conducted a longitudinal cohort analysis of all actors and actresses nominated for an Academy award in a leading or a supporting role. For each, a control was identified based on age, sex, and co-staring in the same film. Overall, 2,111 individuals were analyzed with 1,122 total deaths occurring during a median follow-up of 68.8 years. Comparisons of winners to controls yielded a 4.8% relative difference average life-span (95% confidence interval: 1.6 to 7.9, p = 0.004), a 5.1 year absolute increase in life expectancy (95% confidence interval: 3.0 to 7.2, p < 0.001), and a 41% improvement in mortality hazard (95% confidence interval: 19 to 68, p < 0.001). The increased survival tended to be greater in recent years, for individuals winning at a younger age, and among those with multiple wins. The increased survival replicated in secondary analyses comparing winners to nominees and was not observed in analyses comparing nominees to controls. Academy award winning actors and actresses show a positive association between success and survival, suggesting the importance of behavioral, psychological, or other modifiable health factors unrelated to poverty.

Background Increased rates of cardiac events at the time of natural disasters have been reported. However, the relationship between myocardial infarctions and earthquakes is less clear. We report on the rate of myocardial infarction with no obstructive coronary artery (MINOCA) disease during the 2023 Turkiye earthquakes. Methods All patients with a positive troponin undergoing a coronary angiogram at the Adana City Training and Research Hospital 2 months prior and 2 months subsequent to the February 6th, 2023, Turkiye earthquakes were included. Patients with MINOCA were identified. Multivariate logistic regression analysis was performed to determine variables associated with a diagnosis of MINOCA. Results 619 patients underwent angiography during the study period—479 prior and 140 subsequent to the earthquake. The median age was 61 years and 73% male. MINOCA was diagnosed in 7.8% of the cohort. MINOCA was higher in the postearthquake period (pre: 3.8% vs. post: 21.4%; p < 0.001). The time period after the earthquake had the highest odds of a diagnosis of MINOCA (odds ratio: 5.76; 95% confidence interval: 2.90–11.44). Survival to hospital discharge was higher in the postearthquake period (pre: 89.4% vs. post: 97.9%; p < 0.001). Conclusion The rate of MINOCA increased after the Turkiye earthquakes on February 6th, 2023. This knowledge provides new insight into the spectrum of myocardial infarction after natural disasters. Our work also highlights a potential survivorship bias, which may confound studies reporting on cardiac events after natural disasters. Future work to assess the potential long‐term adverse consequences of MINOCA in this population is suggested.

A 56‐year‐old man presented following an aborted cardiac arrest. His initial ECGs showed episodes of transient repolarization abnormalities. Coronary vasospasm can be a precipitant for ventricular arrhythmia in these patients, underpinning the importance of continuous ECG for accurate diagnosis and management.

Surgical septal myectomy can achieve both of these goals. 1 While there is some suggestion that surgical myectomy may offer some protection against ventricular arrhythmia, one study of postseptal myectomy patients with implantable defibrillators suggested a 4%/year rate of appropriate defibrillator shocks. 2 Mechanisms of ventricular arrhythmia postseptal myectomy have not been reported. Because of the absence of risk factors for sudden death an implantable defibrillator was not offered postmyectomy. Pace mapping in the region of patchy scar adjacent to the septal myectomy demonstrated a 96% pacematch to the clinical VT with a short stimulus to QRS suggesting pacing at the exit site for the VT.

BACKGROUND:Administrative database research can provide insight into the real-world effectiveness of invasive electrophysiology procedures. However, no validated algorithm to identify these procedures within administrative data currently exists. OBJECTIVE:To develop and validate algorithms to identify atrial fibrillation (AF), atrial flutter (AFL), supraventricular tachycardia (SVT) catheter ablation procedures, and diagnostic electrophysiology studies (EPS) within administrative data. METHODS:Algorithms consisting of physician procedural billing codes and their associated most responsible hospital diagnosis codes were used to identify potential AF, AFL, SVT catheter ablation procedures and diagnostic EPS within large administrative databases in Ontario, Canada. The potential procedures were then limited to those performed between October 1, 2011 and March 31, 2013 at a single large regional cardiac center (Sunnybrook Health Sciences Center) in Ontario, Canada. These procedures were compared with a gold-standard cohort of patients known to have undergone invasive electrophysiology procedures during the same time period at the same institution. The sensitivity, specificity, positive and negative predictive values of each algorithm was determined. RESULTS:Algorithms specific to each of AF, AFL, and SVT ablation were associated with a moderate sensitivity (75%–86%), high specificity (95%–98%), positive (95%–98%), and negative (99%) predictive values. The best algorithm to identify diagnostic EPS was less optimal with a sensitivity of 61% and positive predictive value of 88%. CONCLUSIONS:Algorithms using a combination of physician procedural billing codes and accompanying most responsible hospital diagnosis may identify catheter ablation procedures within administrative data with a high degree of accuracy. Diagnostic EPS may be identified with reduced accuracy.

Purpose Catheter ablation of atrial fibrillation (CAAF) using the cryoballoon has emerged as an alternate strategy to point-by-point radiofrequency. However, there is little comparative data on long-term durability of pulmonary vein (PV) isolation comparing these two modalities. Methods In this multicenter, retrospective analysis, the incidences/patterns of late PV reconnection following an index CAAF using the second-generation cryoballoon versus open-irrigated, non-force-sensing radiofrequency were examined. Results Of the 2002 patients who underwent a first-time CAAF, 186/1126 patients (16.5 %) ablated using cryoballoon and 174/876 patients (19.9 %) with non-contact force-guided radiofrequency required a repeat procedure at 11 ± 5 months. During follow-up, the incidence of atrial flutters/tachycardias was lower (19.9 vs. 32.8 %; p  = 0.005) and fewer patients exhibited PV reconnection (47.3 vs. 60.9 %; p  = 0.007) with cryoballoon versus radiofrequency. Additionally, fewer PVs had reconnected with cryoballoon versus radiofrequency (18.8 vs. 34.6 %; p  < 0.001). With cryoballoon, the right inferior ( p  < 0.001) and left common ( p  = 0.039) PVs were more likely to exhibit late reconnection, versus the left superior PV with radiofrequency ( p  = 0.012). However, when comparing the two strategies, the left common PV was more likely to exhibit reconnection with cryoballoon, whereas all other PVs with the exception of the right inferior PV demonstrated a lower reconnection rate with cryoballoon versus radiofrequency. Lastly, in a logistic regression multivariate analysis, cryoballoon ablation and PV ablation time emerged as significant predictors of durable PV isolation at repeat procedure. Conclusions In this large multicenter, retrospective analysis, CAAF using the second-generation cryoballoon was associated with improved durability of PV isolation compared to open-irrigated, non-force-sensing radiofrequency.

Background Radiofrequency (RF) ablation has become a mainstay of treatment for ventricular tachycardia, yet adequate lesion formation remains challenging. This study aims to comprehensively describe the composition and evolution of acute left ventricular (LV) lesions using native-contrast cardiovascular magnetic resonance (CMR) during CMR-guided ablation procedures. Methods RF ablation was performed using an actively-tracked CMR-enabled catheter guided into the LV of 12 healthy swine to create 14 RF ablation lesions. T 2 maps were acquired immediately post-ablation to visualize myocardial edema at the ablation sites and T 1 -weighted inversion recovery prepared balanced steady-state free precession (IR-SSFP) imaging was used to visualize the lesions. These sequences were repeated concurrently to assess the physiological response following ablation for up to approximately 3 h. Multi-contrast late enhancement (MCLE) imaging was performed to confirm the final pattern of ablation, which was then validated using gross pathology and histology. Results Edema at the ablation site was detected in T 2 maps acquired as early as 3 min post-ablation. Acute T 2 -derived edematous regions consistently encompassed the T 1 -derived lesions, and expanded significantly throughout the 3-h period post-ablation to 1.7 ± 0.2 times their baseline volumes (mean ± SE, estimated using a linear mixed model determined from n  = 13 lesions). T 1 -derived lesions remained approximately stable in volume throughout the same time frame, decreasing to 0.9 ± 0.1 times the baseline volume (mean ± SE, estimated using a linear mixed model, n  = 9 lesions). Conclusions Combining native T 1 - and T 2 -based imaging showed that distinctive regions of ablation injury are reflected by these contrast mechanisms, and these regions evolve separately throughout the time period of an intervention. An integrated description of the T 1 -derived lesion and T 2 -derived edema provides a detailed picture of acute lesion composition that would be most clinically useful during an ablation case.

A 25-year-old man with a medical history of propionic acidemia was brought to hospital after he collapsed while jogging. He was unresponsive, received immediate bystander cardiopulmonary resuscitation and was defibrillated by paramedics from an initial rhythm of ventricular fibrillation with successful return of spontaneous circulation. He had been diagnosed with propionic acidemia at two years of age when he presented with developmental delay, and metabolic work-up showed the classic profile of 3-OH-propionic and methylcitric acids on analysis of organic acids in urine, low carnitine with increased propionylcarnitine on acylcarnitine profile and increased glycine on quantitative amino acid analysis of plasma. At the time of the patient's witnessed cardiac arrest, initial laboratory investigations showed an anion gap metabolic acidosis and lactic acidemia (lactate level 7.9 mM). Although the patient's ventricular arrhythmia may have been due to a reversible cause, we decided to proceed with insertion of an implantable cardioverter-defibrillator. We based this on