An octogenarian man with a history of multiple catheter ablation failures for atrial fibrillation and tachycardia was diagnosed with transthyretin amyloid cardiomyopathy. After 1 year of tafamidis therapy, the patient experienced spontaneous restoration of sinus rhythm, and follow-up image of 99mTc-pyrophosphate scintigraphy revealed a marked decrease of tracer accumulation.
Cardiac resynchronization therapy (CRT) essentially targets electrical dyssynchrony, one of the key drivers in heart failure (HF). Its efficacy depends on both the quality (QRS morphology) and quantity (QRS duration) of dyssynchrony, requiring individualized patient selection. While drug therapy for HF has a limited effect on this substrate, early implantation of CRT can prevent irreversible remodeling and facilitate optimization of medical therapy. CRT should be recognized as an essential component within a comprehensive strategy for HF management in patients with appropriate indications.
Falsely detected atrial tachycardia episode in a patient with CRT-P due to FFRW oversensing resulting in ventricular sensed response triggered BiV pacing and auto adjusting sensitivity phenomenon.
Right ventricular (RV) dysfunction is independently predictive of sudden cardiac death. This study aimed to compare the performance of different risk stratification methods for death and appropriate implantable cardioverter-defibrillator (ICD) therapy using echocardiography and cardiac magnetic resonance imaging (CMR) to quantify RV function.
Consecutive patients undergoing ICD implantations who had completed both preprocedural echocardiography and CMR were retrospectively enrolled. Patients with channelopathies or arrhythmogenic right ventricular disease were excluded. The RV fractional area change (RVFAC) and estimated pulmonary artery pressure (EPAP) were calculated from echocardiography. The contraction pressure index (CPI) was defined as the quotient of the RVFAC divided by the EPAP. Both metrics were used to predict the composite endpoint of death and an appropriate ICD therapy. RV dysfunction was defined by either RVFAC < 35% or RV ejection fraction (RVEF) < 45%.
In total, 88 patients (60.4 ± 14.7 years, 61 males) including 15 with ischemic cardiomyopathy were retrospectively enrolled. Forty-two patients received ICDs as secondary prevention. The mean RVFAC, CPI, and RVEF were 35.9% ± 9.22%, 1.4% ± 0.7%/mmHg, and 39.5% ± 14.4%, respectively. Regarding the composite endpoint, the best cut-off value of the CPI was 1.59 (specificity 0.45, sensitivity 0.96, ROC-AUC 0.68). The hazard ratio of a low RVFAC was 3.28 (95% CI: 1.39–7.77, p = 0.007, concordance = 0.622), a low CPI, 14.2 (95% CI: 1.91–104.9, p = 0.010, c = 0.665), and a low RVEF, 3.44 (95% CI: 1.17–10.1, p = 0.003, c = 0.620).
Both CMR-derived RVEF and the echocardiographic CPI predicted appropriate ICD therapy and death. The CPI may provide superior risk stratification.
Research regarding the adverse outcomes of atrial fibrillation (AF) in patients with acute pancreatitis (AP) is limited. We hypothesize that the presence of AF is associated with worse inpatient outcomes, including increased mortality and complications in patients admitted with AP.
In this cohort study, de-identified patient data from the US Collaborative Network in TriNetX was used to assess the risk of all-cause mortality and adverse events in patients with AP having AF compared to those without AF within 30 days of the index event from January 1, 2010 to July 6, 2024. Analyses were performed before and after propensity score matching, with risks expressed as odds ratios (OR) with 95% confidence intervals (95% CI), and Kaplan–Meier curves were generated for outcomes.
A total of 267 429 patients with AP were identified, of whom 44 621 had a diagnosis of AF. Patients with AP having AF presented with higher comorbidity burdens compared to the non-AF cohort before propensity score matching. After matching, patients with AF exhibited increased risks of all-cause mortality (OR, 1.24; 95% CI, 1.18–1.3), acute kidney injury (OR, 1.17; 95% CI, 1.14–1.2), deep venous thrombosis (OR, 1.33; 95% CI, 1.27–1.39), hemorrhage (OR, 1.06; 95% CI, 1.01–1.11), severe sepsis (OR, 1.3; 95% CI, 1.25–1.35), and requiring critical care services (OR, 1.19; 95% CI, 1.16–1.23).
Our results suggest that AF significantly increases the risk of mortality in patients with AP, even after accounting for confounding etiological, comorbid, and pharmacological factors.
Implantable cardioverter-defibrillator undersensing may delay therapy in ventricular fibrillation with low-amplitude signals. Ventricular fibrillation therapy assurance (VFTA) detected persistent VF after initial shock failure, enabling timely shock delivery and successful resuscitation. VFTA may help optimize device programming by preventing misclassification and treatment delay in life-threatening arrhythmias.
This case illustrates both termination and re-initiation of repetitive non-reentrant ventriculoatrial synchrony (RNRVAS) visualized on a standard 12-lead ECG. It highlights how pacemaker algorithms such as VIP and PVC response, together with abnormal atrial refractoriness, can trigger or terminate RNRVAS.
Pulsed-field ablation (PFA) is increasingly used for catheter ablation of atrial fibrillation (AF), but older patients remain underrepresented in clinical trials. This study aimed to compare procedural outcomes and mid-term effectiveness of PFA in patients aged ≤ 75 and > 75 years.
In this retrospective single-center cohort, 479 consecutive patients underwent PFA for AF between January 2022 and April 2024. Patients were grouped by age (≤ 75 vs. > 75 years at ablation). Procedural parameters and acute complications were compared. Arrhythmia-free survival was assessed with Kaplan–Meier analysis after an 8-weeks blanking period, and predictors of recurrence were evaluated using Cox regressions.
Of 479 patients (mean age 65.0 ± 12.1 years; 73.6% males), 104 (21.7%) were > 75 years at ablation. Patients > 75 years had more comorbidities, including hypertension and impaired renal function. Pulmonary vein isolation was achieved in 99.8% of cases. Acute complication rates were similar between groups (7.7% in > 75 vs. 8.5% in ≤ 75, p = 1.00), with low rates of tamponade (1.5%) and stroke (1.3%). Kaplan–Meier analysis showed no difference in arrhythmia-free survival. At 6 months, freedom from atrial arrhythmia was 81.4% in the > 75 group and 83.8% in the ≤ 75 group (p = 0.57); corresponding rates at 12 months were 60.1% and 68.6%. Age was not an independent predictor of recurrence. At last follow-up, 75.7% of patients were off antiarrhythmic drugs.
PFA in patients > 75 years is associated with low complication rates and favorable rhythm outcomes, comparable to those in younger patients. These findings support the use of PFA in elderly patients with AF.
E. Aydin, M. M. Öğütveren, G. Ö. Mert, et al., “Clinical Profiles and In-Hospital Outcomes of Pre-Existing Versus Newly Diagnosed Atrial Fibrillation in Coronary Care Units: Insights From the MORCOR-TURK National Registry,” Journal of Arrhythmia 41, no. 6 (2025): e70238, https://doi.org/10.1002/joa3.70238.
The name of the last author is corrected from “Aymet Seyda Yilmaz” to “Ahmet Seyda Yılmaz.” The online version of this article has been corrected accordingly.
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