JACC. Clinical electrophysiology最新文献

Background: Sudden cardiac death (SCD) is a significant public health problem. Knowledge on SCD victims without a history of cardiovascular disease (CVD) is limited, presenting challenges for future prevention efforts.

Objectives: This study aims to examine the differences between SCD cases with and without a known history of CVD.

Methods: All Danish citizens were followed from January 1, 2010, until death or the end of the year. All deaths in Denmark during this period were reviewed by ≥1 medical doctor to identify cases of SCD. Data were analyzed from March 2023 until March 2024.

Results: A total of 6,851 SCD cases were identified, of which 3,046 (44.5%) had no history of CVD. Incidence rates of SCD increased with age and were higher in cases with a history of CVD across all age groups. The difference in SCD incidence between individuals with and without a history of CVD decreased with age, with incidence rate ratios ranging from 21.6 (95% CI: 5.2-66.7) in those aged 0 to 19 years to 1.8 (95% CI: 1.7-1.9) in those aged >90 years. Female sex and living alone were associated with a lower odds of having a CVD before SCD with ORs of 0.66 and 0.75, respectively.

Conclusions: The distribution of SCD cases is nearly equal between individuals with and without a history of CVD, although the risk remains higher in those with prior CVD. Future research should aim to uncover the distinct causes and mechanisms driving SCD in populations with a known CVD, as well as the general population.

Background: Postprocedural pericarditis (PP) can occur in up to 29.4% of patients undergoing epicardial catheter ablation of ventricular tachycardia (VT). Despite several proposed strategies to mitigate this adverse outcome, rates of PP and pericarditic pain remain high.

Objectives: This study sought to assess the impact of intrapericardial steroids instillation (ISI) combined with periprocedural colchicine on PP after epicardial VT ablation.

Methods: This prospective multicenter study included patients undergoing epicardial VT ablation between June 2021 and December 2023. The primary outcome was the occurrence of pericarditis, defined as the presence of pericarditic chest pain and pericarditic electrocardiographic (ECG) changes. Secondary outcomes included the pericarditic pain score at 6, 12, 24, and 48 hours after the procedure, pericardial effusion, postprocedural new-onset atrial fibrillation (AF), constrictive pericarditis, admission due to pericarditis, and gastrointestinal side effects. A systematic literature search was performed to identify historical control groups to compare with our cohort.

Results: A total of 129 patients underwent epicardial VT ablation with subsequent ISI and colchicine therapy. The combination of ISI and colchicine resulted in a nonsignificant trend of lower rates of pericarditis when compared with all historical control groups (3.1% [4 of 129] vs 7.0% [12 of 172]; P = 0.109) and a significant difference when compared to intrapericardial steroids (3.1% vs 13.2%; P = 0.030). The rates of pericarditic pain (10.9% [14 of 129] vs 30.9% [21 of 68]; P = 0.001), pericarditic ECG changes (5.4% [7 of 129] vs 33.8% [23 of 68]; P < 0.001) and new-onset atrial fibrillation (0.8% vs 19.5%; P = <0.001) were significantly lower in our study than in historical control groups.

Conclusions: The instillation of intrapericardial steroids along with periprocedural colchicine after epicardial VT ablation led to a decreased incidence of adverse effects associated with pericardial inflammation when compared with historical control groups. Further research with contemporary control groups is needed to confirm the suggested impact of the strategy described here.