IJC Heart and Vasculature最新文献

{"title":"Diabetes and atrial fibrillation: Causality is still a black-box","authors":"Florian Bruns, Dobromir Dobrev, Anke Fender","doi":"10.1016/j.ijcha.2025.101669","DOIUrl":"10.1016/j.ijcha.2025.101669","url":null,"abstract":"","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"58 ","pages":"Article 101669"},"PeriodicalIF":2.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between phenotypic age and in-hospital outcomes in patients with acute myocardial infarction: A retrospective observational study","authors":"Yajie Gao ,&nbsp;Ke Gao ,&nbsp;Ruijuan Shi ,&nbsp;Xiaorui Huang ,&nbsp;Peizhu Dang ,&nbsp;Hui Liu ,&nbsp;Xiaopu Zheng ,&nbsp;Yanbo Xue","doi":"10.1016/j.ijcha.2025.101670","DOIUrl":"10.1016/j.ijcha.2025.101670","url":null,"abstract":"<div><h3>Background</h3><div>Phenotypic age (PhenoAge) has emerged as a superior predictor of age-related morbidity and mortality. This study aimed to assess the associations between PhenoAge and in-hospital outcomes in patients with acute myocardial infarction (AMI).</div></div><div><h3>Methods</h3><div>2896 AMI patients admitted to the First Affiliated Hospital of Xi’an Jiaotong University from 2019 to 2022 were analyzed in this retrospective study. PhenoAge was calculated by using the phenotypic age calculator, an equation for chronologic age and 9 clinical biomarkers, and Phenotypic Age Accelerate (PhenoAgeAccel) was measured using the residuals of regression PhenoAge on chronological age. Clinical outcomes were defined as in-hospital major adverse cardiovascular events (MACEs), including cardiogenic shock, malignant arrhythmia, acute heart failure, and mechanical complications.</div></div><div><h3>Results</h3><div>Overall, patients with high PhenoAge had a higher Gensini score and a higher likelihood of receiving supportive care, as well as worse clinical outcomes. The same results were observed in patients with positive PhenoAgeAccel. Moreover, PhenoAge and PhenoAgeAccel were significantly associated with in-hospital MACEs even after adjusting for multiple traditional risk factors. The area under the curve for PhenoAge was 0.714 (<em>P &lt;</em> 0.001), which significantly outperformed chronologic age (AUC: 0.601, <em>P &lt;</em> 0.001) and other cardiovascular risk factors. Re-examination of the ROC curves using different combinations of variables, PhenoAge was also able to significantly improve the predictive value of several models.</div></div><div><h3>Conclusions</h3><div>PhenoAge is significantly associated with clinical outcomes and reliably predicts in-hospital MACEs. Compared with chronological age, PhenoAge is a better complementary biomarker for predicting the risk of in-hospital adverse cardiovascular events in patients with AMI.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"58 ","pages":"Article 101670"},"PeriodicalIF":2.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of echocardiographic pulmonary hypertension with all-cause mortality in hospitalized AECOPD patients","authors":"Zhiqi Zhao ,&nbsp;Xue He ,&nbsp;Ruoyan Xiong ,&nbsp;Yanan Cui ,&nbsp;Weiwei Meng ,&nbsp;Jiankang Wu ,&nbsp;Jiayu Wang ,&nbsp;Rui Zhao ,&nbsp;Huihui Zeng ,&nbsp;Yan Chen","doi":"10.1016/j.ijcha.2025.101661","DOIUrl":"10.1016/j.ijcha.2025.101661","url":null,"abstract":"<div><h3>Background</h3><div>Chronic obstructive pulmonary disease (COPD) often coexists with pulmonary hypertension (PH). However, whether pulmonary artery pressure (PAP) or even suspected PH assessed by echocardiography during acute exacerbation stage predicts mortality after discharge is unclear.</div></div><div><h3>Methods</h3><div>We conducted an retrospective study of hospitalized patients with acute exacerbation of COPD (AECOPD). Peak tricuspid regurgitation velocity (TRV) and additional variables were used to assess PH risk.</div></div><div><h3>Results</h3><div>Cox regression analysis showed that echocardiographic suspected PH was the independent risk factor for the significantly increased long-term mortality (adjusted HR 1.64; 95% CI 1.06–2.53) after discharge in AECOPD patients. Logistic regression analysis revealed a negative correlation between blood eosinophil (EOS) counts at admission and the prevalence of suspected PH (adjusted OR 0.18; 95% CI 0.04–0.89). Triple therapy (adjusted HR 0.18; 95% CI 0.05–0.61), neither LABA/ICS during stable stage was associated with a significant reduction in long-term mortality in hospitalized AECOPD patients with suspected PH.</div></div><div><h3>Conclusion</h3><div>Echocardiographic suspected PH was associated with adverse survival in hospitalized AECOPD patients. Low EOS counts at admission emerged as a potential biomarker for elevated estimated systolic PAP. Triple therapy during stable stage was associated with a significant reduction in long-term mortality in AECOPD patients with suspected PH.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"58 ","pages":"Article 101661"},"PeriodicalIF":2.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periprocedural care for frail older patients with aortic stenosis undergoing transcatheter aortic valve replacement","authors":"Joshua Eng ,&nbsp;Jie Jun Wong ,&nbsp;Kay Woon Ho ,&nbsp;Angela S. Koh ,&nbsp;Ru-San Tan","doi":"10.1016/j.ijcha.2025.101665","DOIUrl":"10.1016/j.ijcha.2025.101665","url":null,"abstract":"<div><div>Degenerative aortic stenosis (AS) is an aging-associated disease with alarmingly high mortality that has risen in prevalence in tandem with the global population aging. Treatment options for AS are currently limited to surgical or percutaneous valve intervention, which are associated with significant morbidity. It is increasingly recognized that the care of AS patients is frequently constrained by concomitant frailty, an under-recognized syndrome among older individuals. Many AS patients have concurrent aging-associated diseases, including atherosclerotic diseases, organ impairment, physical frailty, and nutritional deficiencies which limit functional improvement after valve intervention. It has become increasingly crucial for clinicians to address these concurrent issues in frail, older individuals with AS to achieve the best possible outcomes. We aim to review the well-studied relationship between frailty and AS, as well as possible strategies for periprocedural optimization and risk management.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"58 ","pages":"Article 101665"},"PeriodicalIF":2.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of transcatheter vs surgical aortic valve replacement in pre-existing chronic liver disease patients: A meta-analysis of observational studies","authors":"Aizaz Ali ,&nbsp;Muhammad Abdullah Ali ,&nbsp;Asad Iqbal Khattak ,&nbsp;Fazia Khattak ,&nbsp;Abdullah Afridi ,&nbsp;Touba Azeem ,&nbsp;Umme Salma Shabbar Banatwala ,&nbsp;Umama Alam ,&nbsp;Ayesha Khan ,&nbsp;Urbe Jalal ,&nbsp;Abdul Moeez ,&nbsp;Malik W.Z. Khan ,&nbsp;Peter Collins ,&nbsp;Raheel Ahmed","doi":"10.1016/j.ijcha.2025.101651","DOIUrl":"10.1016/j.ijcha.2025.101651","url":null,"abstract":"<div><div>Aortic valve stenosis in patients with chronic liver diseases, particularly liver cirrhosis and End-Stage Liver Disease, poses significant management challenges due to the interplay between cardiovascular and hepatic dysfunction. This systematic review and meta-analysis compared the safety and efficacy of Transcatheter Aortic Valve Replacement (TAVR) and Surgical Aortic Valve Replacement in this high-risk population. An extensive search of PubMed, Embase, and Web of Science (inception to January 5, 2025) identified 11 retrospective studies comprising 19,097 patients. Risk ratios for dichotomous outcomes and mean differences (MD) for continuous outcomes, each with 95% confidence intervals, were calculated using random-effects models.</div><div>The analysis revealed that TAVR significantly reduced hospital mortality (RR 0.36, 95 % CI: 0.30–0.42; I² = 7.6 %), acute kidney injury (RR 0.51, 95 % CI: 0.33–0.78; I² = 57.2 %), bleeding (RR 0.33, 95 % CI: 0.28–0.39; I² = 0.0 %), stroke (RR 0.35, 95 % CI: 0.23–0.51; I² = 6.1 %), and blood transfusion (RR 0.48, 95 % CI: 0.40–0.57; I² = 7.6 %). TAVR was also associated with shorter hospital stays (MD −6.77 days, 95 % CI: −9.17 to −4.38; I² = 97.5 %). No significant differences were observed in vascular complications requiring surgery or hospital charges and post-operative infections.</div><div>These findings suggest TAVR offers significant advantages over SAVR in reducing complications such as mortality, acute kidney injury, and bleeding in patients with liver disease. However, further randomized trials are necessary to confirm long-term outcomes and establish optimal treatment strategies for this high-risk population.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"58 ","pages":"Article 101651"},"PeriodicalIF":2.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicians perspectives towards the application of shared decision making in tertiary CVD care including the multidisciplinary heart team","authors":"Mirjam M. Garvelink ,&nbsp;Tom Oirbans ,&nbsp;Lea M. Dijksman ,&nbsp;Paul B. van der Nat ,&nbsp;Dennis van Veghel ,&nbsp;Daniela N. Schulz ,&nbsp;Marcel G.W. Dijkgraaf ,&nbsp;Lucas V.A. Boersma","doi":"10.1016/j.ijcha.2025.101657","DOIUrl":"10.1016/j.ijcha.2025.101657","url":null,"abstract":"<div><h3>Background</h3><div>Shared decision-making (SDM), is a sine qua non in healthcare. Yet, it has been difficult to implement SDM in routine practice for patients with cardiovascular disease(CVD). To improve this, we aimed to determine HCPs perspectives on their SDM behavior in CVD context and influencing factors, and with special focus on multidisciplinary heartteams.</div></div><div><h3>Methods</h3><div>Cross-sectional survey between March-July 2022 with cardiologists, cardiothoracic surgeons, medical residents, and nurse practitioners within two of the largest tertiary cardiac Centers in the Netherlands. Descriptive statistics were used for quantitative data; open-ended questions were thematically analyzed.</div></div><div><h3>Results</h3><div>72 participants completed the survey. Respondents indicated to know “very well” what SDM entailed (70 %) and had positive attitudes towards SDM (90 %). Participants used SDM in daily practice (SDMQDoc = 73/100), but indicated that more SDM could be performed (67 %). In self-reported definitions of SDM, explaining the consequences of treatment (step 2) and discussing patients’ preferences (step 3) were most frequently mentioned. Barriers for SDM were patient and process characteristics: e.g. lack of time (70 %), understaffing (35 %). The heartteam was seen as potential facilitator, but its current role and process were seen as barrier for SDM. Facilitators for SDM were managerial support (16 %), decision aids (28 %), and SDM-training (13 %).</div></div><div><h3>Conclusion</h3><div>HCPs reported high knowledge and application of SDM, but overlooked some steps in the SDM-process. A multifaceted intervention is needed focusing on awareness, enhancing communication skills and system level support. Specific improvements were identified to improve SDM for patients discussed by the multidisciplinary heartteam.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"58 ","pages":"Article 101657"},"PeriodicalIF":2.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex differences in proteomics of cardiovascular disease – Results from the Yale-CMD registry","authors":"Yihan Liu ,&nbsp;Zuoheng Wang ,&nbsp;Sean P. Collins ,&nbsp;Jeffery Testani ,&nbsp;Basmah Safdar","doi":"10.1016/j.ijcha.2025.101667","DOIUrl":"10.1016/j.ijcha.2025.101667","url":null,"abstract":"<div><div>Aims This study assessed sex-specific proteomic profiles by cardiovascular disease (CVD) phenotype (coronary artery disease [CAD] vs coronary microvascular dysfunction [CMD]) and describe their role in sex-specific pathways. Methods: In a secondary biobank analysis of the Yale-CMD registry, adults with ischemic symptoms who underwent cardiac positron emission test/computed tomography were categorized as a) controls (normal coronary flow reserve (CFR) &gt; 2 without perfusion defect or coronary calcification), b) having CMD (CFR &lt; 2 without defect or calcification), or c) having CAD (known CAD or new perfusion defect). Using proximity extension assays (Olink® Explore 3072), we examined 2944 proteins. Differential protein expression was assessed using linear regression models, adjusting for age, race, body mass index, diabetes, dyslipidemia, hypertension, or smoking. Results: Of 190 patients, 91 provided blood samples (mean age, 56 years; 66 %, females; 48 %, controls; 24 %, CAD; 27 %, CMD). Among controls, 15 proteins showed sex differences (5 proteins upregulated in females, 10 in males; false discovery rate [FDR &lt; 0.05]). Upregulated in CAD patients were FSHB in females and INSL3 and EDDM3B in males (FDR &lt; 0.05). Among CMD patients, SCGB3A1 and HGFAC were higher in females; INSL3, SPINT3, EDDM3B, and KLK3 were higher in males (FDR &lt; 0.05). Per pathway analysis, females showed upregulation of immune pathways in CAD and lipid and glucose metabolism pathways in CMD. Males showed upregulated endothelial regulation of blood flow in CAD and increased angiogenesis in CMD. Conclusions: Sex differences exist in the proteomic profiles of CAD and CMD patients, highlighting a need for precision medicine.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"58 ","pages":"Article 101667"},"PeriodicalIF":2.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143703941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reappraisal of the clinical and anatomic characteristics of idiopathic outflow tract ventricular arrhythmias with an R wave pattern break in precordial lead: A multi-center study","authors":"Muhammad Rafdi Amadis ,&nbsp;Satoshi Higa ,&nbsp;Chin-Yu Lin ,&nbsp;Yuen Hoong Phang ,&nbsp;Chia-Hsin Chiang ,&nbsp;Jose Antonio Lopez Bautista ,&nbsp;Yenn-Jiang Lin ,&nbsp;Shih-Lin Chang ,&nbsp;Li-Wei Lo ,&nbsp;Yu-Feng Hu ,&nbsp;Fa-Po Chung ,&nbsp;Ting-Yung Chang ,&nbsp;Ling Kuo ,&nbsp;Cheng-I Wu ,&nbsp;Chih-Min Liu ,&nbsp;Shin-Huei Liu ,&nbsp;Ming-Jen Kuo ,&nbsp;Thien-Chuong Nguyen-Khac ,&nbsp;Guan-Yi Li ,&nbsp;Yu-Shan Huang ,&nbsp;Shih-Ann Chen","doi":"10.1016/j.ijcha.2025.101664","DOIUrl":"10.1016/j.ijcha.2025.101664","url":null,"abstract":"<div><h3>Background</h3><div>Idiopathic outflow tract ventricular arrhythmia (OT-VA) with a pattern break (PB) in the precordial leads is challenging to treat and is associated with low success rates.</div></div><div><h3>Objective</h3><div>Describe the anatomic characteristics and outcomes of patients with PB idiopathic OT-VA underwent catheter ablation.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed the electronic medical records of idiopathic OT-VA patients underwent catheter ablation at Taipei Veterans General Hospital, Taiwan, and Makiminato Central Hospital, Japan. Patients with a documented left bundle branch block (LBBB) pattern and inferior axis VA QRS morphology with PB were included. Clinical data, VA morphology, electrophysiological parameters, and anatomic characteristics were analyzed.</div></div><div><h3>Results</h3><div>A total of 66 patients (6.7 %) had a PB in V2 (N = 60) or V3 (N = 6) were identified. The acute and long-term success rates (after a median follow-up of 37 months) were 92.4 % and 78.8 %, respectively, higher than previously reported. The successful ablation sites were mainly the right ventricular outflow tract (RVOT, 81.8 % [54/66]). The earliest activation site in the LVOT was mainly the left coronary cusp (LCC)/right coronary cusp (RCC) commissure (95.7 %, 22/23). A long anatomic distance from the LCC/RCC commissure to the RVOT and diabetes mellitus (DM) independently predicted acute procedural failure or recurrence.</div></div><div><h3>Conclusion</h3><div>OT-VA with PB in the Asian population may not have worse clinical outcomes than previously reported in Western countries. The most common site of acute success for ablation was the RVOT. A long anatomic distance from the LCC/RCC commissure to the RVOT and DM diagnosis was associated with an unsatisfied ablation outcome.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"58 ","pages":"Article 101664"},"PeriodicalIF":2.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and associated factors with atrial fibrillation in patients with transthyretin amyloidosis cardiomyopathy: Insights from the multicenter REACT-SP registry","authors":"Cristhian Espinoza Romero ,&nbsp;Edileide B. Correia ,&nbsp;Alzira De Siqueira Carvalho ,&nbsp;Ariane Vieira Scarlatelli ,&nbsp;Otavio Rizzi Coelho Filho ,&nbsp;Phillip Scheinberg ,&nbsp;Murillo De Antunes ,&nbsp;Pedro Vellosa Schwartzmann ,&nbsp;Sandrigo Mangini ,&nbsp;Wilson Marques Junior ,&nbsp;Marcus Simões ,&nbsp;Renato D. Lopes ,&nbsp;Fabio Fernandes","doi":"10.1016/j.ijcha.2025.101658","DOIUrl":"10.1016/j.ijcha.2025.101658","url":null,"abstract":"<div><h3>Introduction</h3><div>Atrial fibrillation (AF) presents a treatment challenge in patients with amyloidosis cardiomyopathy, particularly in transthyretin amyloidosis cardiomyopathy (ATTR-CM). Identifying factors associated with AF is important for early diagnosis and intervention.</div></div><div><h3>Purpose</h3><div>This study aims to identify factors linked to AF in ATTR-CM patients.</div></div><div><h3>Methods</h3><div>The REACT registry, a retrospective, multicenter cohort study, enrolled patients with TTR mutation or wild type. ATTR-CM diagnosis was based on echocardiography and pyrophosphate scintigraphy, with some cases confirmed by biopsy. Binary logistic regression and multivariate analysis were used, with ROC curve analysis determining optimal cutoff points for continuous variables.</div></div><div><h3>Results</h3><div>The study included 273 patients, mostly male (73.2 %), with a median age of 73 years. The ATTR variant was found in 67.3 % (165 patients), and Val142Ile was the most common variant (29.3 %). AF was present in 25.2 % (59 patients). Logistic regression revealed age (per 10-year increase) and left atrial diameter (per 5-mm increase) as predictors of AF, with odds ratios of 1.714 (p = 0.009) and 1.631 (p = 0.002), respectively. ROC curve analysis identified age ≥ 70 years and left atrium &gt; 45 mm as optimal cutoff points (AUC 0.643 and 0.727).</div></div><div><h3>Conclusions</h3><div>In the ATTR amyloidosis registry, older age and increased left atrium size are associated with AF. These findings may help in the early diagnosis and management of AF in ATTR-CM patients.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"58 ","pages":"Article 101658"},"PeriodicalIF":2.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of empirical superior vena cava isolation in addition to pulmonary vein isolation on outcomes in atrial fibrillation – Systematic review, meta-analysis, and meta-regression","authors":"Raymond Pranata,&nbsp;William Kamarullah,&nbsp;Giky Karwiky,&nbsp;Chaerul Achmad,&nbsp;Mohammad Iqbal","doi":"10.1016/j.ijcha.2025.101662","DOIUrl":"10.1016/j.ijcha.2025.101662","url":null,"abstract":"<div><h3>Background</h3><div>Atrial tachyarrhythmia (ATa) recurrence remains high after pulmonary vein isolation (PVI), with the superior vena cava (SVC) being a common source of non-pulmonary vein foci.</div></div><div><h3>Objective</h3><div>This <em>meta</em>-analysis aimed to synthesize the latest evidence and provide elaborate comparative analysis and <em>meta</em>-regression analysis regarding the empirical SVC isolation (eSVCi) versus no eSVCi in atrial fibrillation (AF) ablation.</div></div><div><h3>Methods</h3><div>A systematic review was conducted on studies comparing eSVCi to no eSVCi (PVI-only or adjunctive SVC isolation). The primary outcome was ATa recurrence, defined as AF/atrial flutter/atrial tachycardia lasting over 30 s after a blanking period. Secondary outcomes included procedural duration, fluoroscopic duration, and complications.</div></div><div><h3>Results</h3><div>Thirteen studies involving 2,176 patients were analyzed, with a mean follow-up of 18 ± 9.6 months. ATa recurrence was significantly lower with eSVCi (OR 0.54 [95 % CI: 0.41, 0.72], p &lt; 0.001; I² = 40.7 %). Subgroup analysis revealed eSVCi reduced ATa recurrence in observational studies but not in RCTs, and in initial ablations but not repeat procedures. eSVCi was beneficial in both PVI-only and adjunctive SVC isolation subgroups. Meta-regression showed the benefit of eSVCi was less in patients with non-paroxysmal AF (p = 0.044) and hypertension (p = 0.012). Procedural time, fluoroscopic time, and complications were similar between the two groups.</div></div><div><h3>Conclusion</h3><div>eSVCi potentially reduce ATa recurrence compared to no eSVCi, without increasing complications or prolonging procedural times.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"58 ","pages":"Article 101662"},"PeriodicalIF":2.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}