Daily Cardiology Research Analysis

INTRODUCTION: Atrial fibrillation (AF) is the most common cardiac arrhythmia, which significantly contributes to morbidity, mortality, and a diminished quality of life. Despite advancements in pharmacological treatments, many AF patients do not achieve adequate symptom control with oral medications. This network meta-analysis seeks to provide comprehensive evidence to guide clinical decision-making and optimize ablation strategies for patients with atrial fibrillation. METHODS: This network meta-analysis (NMA) was conducted in accordance to PRISMA NMA Checklist of Items (PROSPERO No. CRD42024577782). A comprehensive search was performed across major literature databases (PubMed, Scopus, CENTRAL, ProQuest, and Web of Science) up to July 10, 2024. Data analyses were performed using Rstudio v.4.4.1 employing Bayesian NMA with random-effects models. Sensitivity, subgroup, and network meta-regression analyses were also conducted. SUCRA values were estimated to present the ranking of each treatment in the network. Meta-proportions with GLMM (Generalized Linear Mixed Model) also performed to analyze the safety outcomes. RESULTS: A total of 6332 AF patients from 46 randomized controlled trials (RCTs) were included. NMA demonstrate epicardial (surgical) approach, especially video-assisted thoracoscopic surgery (VATS) (OR 1.54; 95%CrI [1.03,2.38]; SUCRA 89.61) exhibited superiority to reduce the AF recurrence in AF patients. Hybrid epicardial-endocardial ablation (OR 1.51; 95% CrI [0.82,2.82]; SUCRA 85.7) had a similar freedom from AF rate to VATS. Subgroup and network meta-regression analysis revealed that AF type ((β -0.415; [-0.776;-0.042]) and AF duration (β 0.602; [0.066;1.079]) influence the freedom from AF rate. Meta-proportion indicated that surgical or hybrid ablation exhibited a higher risk of mortality (Prop = 5.07%), pericardial effusion (Prop = 4.35%), and phrenic nerve injury (Prop = 4.35%). CONCLUSION: NMA demonstrated higher effectiveness of VATS and hybrid ablation in reducing the recurrence rate of AF. Despite complications associated with surgical and hybrid approaches have higher prevalence, type of complications encountered in this approaches are less diverse.

OBJECTIVE: To evaluate the applicability of current guidelines for patients with postoperative hypertrophic cardiomyopathy and identify key risk factors for sudden cardiac death (SCD). METHODS: We retrospectively analyzed 1915 adult patients who underwent septal myectomy from 2010 to 2019. Competing risk models assessed the effectiveness of the updated 2024 American Heart Association (AHA)/American College of Cardiology and 2023 European Society of Cardiology (ESC) guidelines in guiding implantable cardioverter defibrillator (ICD) recommendations for preventing SCD after surgery. RESULTS: Over a follow-up period of 4.6 ± 2.7 years, 19 SCD events and 1 ICD discharge were observed. No significant differences were found in AHA (Class 2a: 55% vs 39.3%; Class 2b: 5% vs 5.4%; Class 3: 40% vs 55.3%, P = .354) or ESC (Class 2a: 45% vs 45.3%; Class 2b: 20% vs 22.8%; Class 3: 35% vs 31.9%, P = .937) ICD recommendations, prevalence of major SCD risk factors, or 5-year SCD risk between event and nonevent groups. Survival analysis showed that ESC and AHA stratification did not significantly predict SCD (both P > .05). Left ventricular wall thickness (LVWT) (P = .028) and late gadolinium enhancement (LGE) (P = .015) were significant predictors. Cardiac index showed a potential association with SCD (nonlinear trend, P = .012; overall, P = .027). Patients with LVWT ≥30 mm and LGE ≥15% had a greater risk of SCD (subdistribution hazard ratio, 5.60; 95% confidence interval, 1.90-16.5, P = .002). CONCLUSIONS: Current guidelines are inadequate for assessing postoperative SCD risk in patients with hypertrophic cardiomyopathy. LGE and LVWT are reliable indicators, highlighting the need for novel approaches to guide ICD implantation.

BACKGROUND: Emerging evidence indicates sinus node dysfunction (SND) may be an important marker of a biatrial myopathy. However, the relative risk of ischemic stroke in isolated SND has not been clearly delineated in comparative prospective studies. OBJECTIVE: This study examined the association between SND (with and without concomitant atrial fibrillation [AF]) and ischemic stroke (IS) in the UK Biobank. METHODS: The UK Biobank is a prospective, population-based cohort of >500,000 individuals aged 40-69 years recruited across the United Kingdom between 2006 and 2010, with follow-up extending beyond 10 years. Incident health events were longitudinally tracked through electronic health record linkages with hospital admissions, primary care records, and death registration data using International Classification of Diseases, Tenth Revision coding. Individuals with SND, AF, or both were identified. Patients with prosthetic heart valves, rheumatic mitral valve diseases, mitral stenosis, and prior IS were excluded. The primary end point was time to IS. RESULTS: Of the 451,493 participants (median age 57 years, 44.2% male) included in this study: 593 had isolated SND, 955 had combined SND and AF, 37,065 had isolated AF, and 412,880 comprised controls with neither SND nor AF. During a median follow-up of 13.2 years, yearly IS incidence was 0.37%, 0.60%, 0.59%, and 0.10% in these groups, respectively. In multivariable competing-risk regression modeling accounting for death, isolated SND conferred a significantly increased risk of IS compared to controls (subdistribution hazard ratio 2.28; 95% confidence interval, 1.57-3.31; P < .001). Participants with AF and SND had a similar risk of IS, compared to those with isolated AF (subdistribution hazard ratio 1.07; 95% confidence interval, 0.84-1.37; P = .58). CONCLUSION: SND is an independent risk marker for the development of IS in individuals without AF. This provides further evidence of SND being an electrical marker of a biatrial myopathy.