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In a randomized trial involving patients with paroxysmal atrial fibrillation, pulsed field ablation was noninferior to thermal ablation with respect to freedom from a composite of procedural and arrhythmia events at 1 year.

In a randomized trial, over 500 patients with sepsis received levosimendan or placebo in addition to usual care. Levosimendan did not result in a lower likelihood of organ dysfunction or lower mortality. Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection 1 and is a leading cause of death worldwide. Septic shock is the most severe form of the condition and results in circulatory and metabolic abnormalities. 2 Persisting hypotension despite adequate fluid resuscitation is due to a combination of profound vasodilatation, vascular hyporeactivity to catecholamines, and myocardial depression. 3 Although catecholamines are the recommended first-line therapy for septic shock, 4 high doses of administered catecholamines and high levels of circulating catecholamines are associated with poor outcomes and severe side effects, including myocardial injury and peripheral ischemia. 5 – 7 Levosimendan is . . .

Patients with symptomatic, paroxysmal, untreated atrial fibrillation were randomly assigned to antiarrhythmic drug therapy or cryoablation. At 1 year, there was a significantly lower rate of recurrence of atrial fibrillation with cryoablation than with drug therapy.

Initial treatment of paroxysmal atrial fibrillation with cryoballoon ablation was associated with a lower incidence of persistent atrial fibrillation and other atrial tachyarrhythmias over 3 years than rhythm-control medications.

Although isolated cardiac sarcoidosis (CS) is not uncommon, little is known about the risk of life-threatening ventricular tachyarrhythmia. We aimed to evaluate the incidence of ventricular tachyarrhythmia in patients with isolated CS. A total of 94 patients with CS were enrolled. Isolated CS was diagnosed by histologic or clinical confirmation in the heart alone. The end points were sudden cardiac death, ventricular fibrillation, sustained ventricular tachycardia, or implantable cardioverter-defibrillator therapy for ventricular fibrillation or sustained ventricular tachycardia. A total of 25 patients were diagnosed with isolated CS, and 69 were diagnosed with CS with extracardiac involvement. As the initial cardiac manifestation leading to the CS diagnosis, 10 patients (40%) with isolated CS had ventricular tachyarrhythmia. Over the median follow-up of 48 months after the CS diagnosis, sudden cardiac death occurred in 2 patients (8%) with isolated CS. Ventricular fibrillation or sustained ventricular tachycardia, including implantable cardioverter-defibrillator therapy, occurred in 15 patients (60%) with isolated CS and 13 (19%) with CS with extracardiac involvement. The rate of ventricular tachyarrhythmia was higher in patients with isolated CS than in those with CS with extracardiac involvement (log-rank, p <0.01). Cox proportional hazard analysis showed that isolated CS was independently associated with ventricular tachyarrhythmia. A total of 2 or more ventricular tachyarrhythmias more frequently occurred in patients with isolated CS (52% vs 13%, p <0.01). Electric storm more frequently occurred in patients with isolated CS (24% vs 6%, p = 0.01). In conclusion, patients with isolated CS have ventricular tachyarrhythmia at a higher rate than those with CS with extracardiac involvement. •Isolated cardiac sarcoidosis (CS) frequently had ventricular tachyarrhythmia as the initial manifestation.•Ventricular tachyarrhythmia rate was higher in isolated CS.•Electric storm more frequently occurred in isolated CS.•Multidisciplinary therapy for ventricular tachyarrhythmia is required in isolated CS.

Patients who have pacemakers or defibrillators are often denied the opportunity to undergo magnetic resonance imaging (MRI) because of safety concerns, unless the devices meet certain criteria specified by the Food and Drug Administration (termed \"MRI-conditional\" devices). We performed a prospective, nonrandomized study to assess the safety of MRI at a magnetic field strength of 1.5 Tesla in 1509 patients who had a pacemaker (58%) or an implantable cardioverter-defibrillator (42%) that was not considered to be MRI-conditional (termed a \"legacy\" device). Overall, the patients underwent 2103 thoracic and nonthoracic MRI examinations that were deemed to be clinically necessary. The pacing mode was changed to asynchronous mode for pacing-dependent patients and to demand mode for other patients. Tachyarrhythmia functions were disabled. Outcome assessments included adverse events and changes in the variables that indicate lead and generator function and interaction with surrounding tissue (device parameters). No long-term clinically significant adverse events were reported. In nine MRI examinations (0.4%; 95% confidence interval, 0.2 to 0.7), the patient's device reset to a backup mode. The reset was transient in eight of the nine examinations. In one case, a pacemaker with less than 1 month left of battery life reset to ventricular inhibited pacing and could not be reprogrammed; the device was subsequently replaced. The most common notable change in device parameters (>50% change from baseline) immediately after MRI was a decrease in P-wave amplitude, which occurred in 1% of the patients. At long-term follow-up (results of which were available for 63% of the patients), the most common notable changes from baseline were decreases in P-wave amplitude (in 4% of the patients), increases in atrial capture threshold (4%), increases in right ventricular capture threshold (4%), and increases in left ventricular capture threshold (3%). The observed changes in lead parameters were not clinically significant and did not require device revision or reprogramming. We evaluated the safety of MRI, performed with the use of a prespecified safety protocol, in 1509 patients who had a legacy pacemaker or a legacy implantable cardioverter-defibrillator system. No long-term clinically significant adverse events were reported. (Funded by Johns Hopkins University and the National Institutes of Health; ClinicalTrials.gov number, NCT01130896 .).

Patients with acute MI and an ejection fraction of 35% or less were randomly assigned to receive a wearable cardioverter–defibrillator plus medical therapy or medical therapy alone. At 90 days, there was no significant between-group difference in the rate of arrhythmic death.

Background Catheter ablation has become a widely accepted treatment for atrial fibrillation, but early recurrences remain a challenge, often attributed to inflammatory responses triggered during the procedure. This systematic review and meta-analysis aimed to evaluate the effectiveness of colchicine in preventing short-term AF recurrence post-ablation. Method PubMed, Embase, and Cochrane Library were searched for studies comparing use of colchicine and placebo in patients after AF ablation. Outcomes included AF recurrence, GI side effects, and hospitalization. R program (version 4.3.2) was used for statistical analysis. Heterogeneity was assessed with I 2 statistics. Results Five studies, including 1592 patients, were analyzed. Pooled results revealed no statistically significant decrease in AF recurrence (OR 0.74; 95% CI 0.48–1.12; p  = 0.153) and pericarditis rates (OR 0.67; 95% CI 0.26–1.72; p  = 0.403) with colchicine use. No significant difference in hospitalization rates was observed between colchicine and placebo groups (OR 1.00; 95% CI 0.63–1.59; p  = 0.996). In addition, gastrointestinal side effects were notably higher in the colchicine group (OR 4.84; 95% CI 2.58–9.05; p  < 0.001). Conclusion Prophylactic use of colchicine after atrial ablation was not associated with a reduction in AF recurrence and pericarditis rates. In addition, there was no difference in the rate of all-cause hospitalization between the groups, and colchicine use was associated with gastrointestinal adverse events. Graphical Abstract

In a randomized trial, pulsed field ablation was noninferior to cryoballoon ablation with respect to the incidence of a first recurrence of atrial tachyarrhythmia, as assessed by continuous rhythm monitoring.

Background The impact of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on atrial tachyarrhythmia (ATa) recurrence in patients undergoing cryoballoon ablation is not well understood. Methods To evaluate the impact of SGLT2i on Ata recurrence in atrial fibrillation (AF) patients with and without diabetes, we conducted a prospective observational cohort study at a tertiary care hospital in China. A total of 582 adult patients who underwent cryoballoon ablation were included. Of these, 209 patients received SGLT2i treatment prospectively (intervention group), while 373 patients received standard care (control group). The primary endpoint was ATa recurrence during the longest follow-up period. We utilized multivariate Cox proportional hazards regression models to assess the risk of ATa recurrence. Results The mean age was 61.2 ± 9.9 years and 61.2% were men. 13.1% of patients had type 2 diabetes and 66.5% had paroxysmal AF. The AF duration was 26.3 ± 36.6 months. Over a median follow-up of 13 months, ATa recurrence was observed in 40 patients (19.1%) receiving SGLT2i and in 131 patients (35.1%) in the control group. After multivariate adjustment, SGLT2i use remained independently associated with a lower risk of ATa recurrence (hazard ratio [HR], 0.34 [95% CI, 0.20–0.59], P  < 0.001). SGLT2i use consistently demonstrated a significant association with a reduced risk of ATa recurrence, in patients with and without diabetes, and in patients with paroxysmal and persistent AF. Conclusion SGLT2i was associated with a decreased risk of ATa recurrence following an initial AF cryoballoon ablation, irrespective of their diabetes status and AF type. Trial registration This study was prospectively registered at the Chinese Clinical Trial Registry (ChiCTR2200058691) on April 14, 2022, prior to participant enrollment.