A patient with hypoplastic left heart syndrome developed heart failure due to tachycardia-induced cardiomyopathy from junctional ectopic tachycardia. Conventional antiarrhythmic therapy was ineffective, but ivabradine successfully controlled the arrhythmia and improved both ventricular function and heart failure.
Sudden cardiac arrest is a leading cause of cardiovascular mortality, often occurring without warning and resulting in high fatality rates. Despite advances in prevention and emergency response, disparities in mortality remain rampant across demographic and geographic groups. This study examines long-term trends in sudden cardiac arrest-related mortality in the United States from 1999 to 2023, stratified by sex, race/ethnicity, region, and urbanization level.
Mortality data was extracted from the CDC WONDER database. Age-adjusted mortality rates (AAMRs) were calculated per 100 000 persons using the 2000 U.S. standard population. Joinpoint regression analysis was applied to estimate annual percent changes (APCs) and identify significant shifts in mortality trends.
A total of 8 523 980 SCA deaths were reported during the study period. Overall, the AAMR declined from 196.03 in 1999 to 131.55 in 2023, with the most marked reductions observed after 2021 (APC: –9.63; 95% CI: −13.51 to −5.20; p < 0.000001). Men consistently exhibited higher AAMRs than women (156.08 vs. 111.09 in 2023). Non-Hispanic Black individuals had the highest mortality rates (235.18), followed by Hispanics (184.38). Geographic disparities were evident, with the Northeast and metropolitan areas reporting the greatest AAMRs.
Mortality due to sudden cardiac arrest has declined substantially over the past 25 years, likely driven by improvements in cardiovascular prevention, acute care, and resuscitation practices. However, significant sex, racial, and regional disparities persist, highlighting the need for interventions that are tailored to reduce inequities and improve survival from sudden cardiac arrest.
Cardiac implantable electronic device (CIED) infections are a serious complication that occurs in ~1%–3% of device recipients. However, data on total healthcare costs associated with CIED infections in Australia are scant. This study aims to comprehensively estimate the total healthcare costs of CIED infections in Australia.
This retrospective cohort study included patients 18+ years diagnosed with CIED infections between July 2017 and September 2022 in New South Wales. Using linked administrative data, costs were estimated for in-hospital care, emergency department visits, outpatient services, Medicare claims, ambulance transport, and dispensed medications in the period from 28 days before to 42 days after CIED infection-related hospitalizations.
We identified 726 patients with CIED infections, of whom 233 (32.1%) died during a mean follow-up of 35.6 months. The average treatment costs of $77 746, predominantly driven by hospital expenses (88.3%). Key hospital cost drivers included device type, mechanical ventilation, intensive care unit (ICU) stays, temporary pacing, lengths of stay, high-risk patients, and multiple comorbidities. Patients undergoing complete system removal with reimplantation (31.7% of patients) had the highest costs ($120 792), followed by patients with complete system removal only (15.7%; $98 453), and without system removal (52.6%; $45 649). For patients undergoing complete system removal and/or reimplantation procedures, the cost varied by device type ($90 089 for pacemaker patients, $111 677 for cardiac resynchronization therapy (CRT)-pacemaker, $128 864 for implantable cardiac defibrillators, and $148 888 for CRT-defibrillator patients).
Our findings highlight the substantial health care costs associated with CIED infections, with wide variations across patient factors and clinical care pathways.
The example illustrates the analysis and measurement of the ventriculo-atrial (VA) interval following atrial overdrive pacing from both the right atrium and the coronary sinus. At first glance, VA linking does not appear to be present in response to the AOP; however, closer inspection reveals that VA linking is, in fact, observed in the subsequent cycle.
To compare demographic, clinical, and laboratory profiles and short-term outcomes between pre-existing (chronic) atrial fibrillation (AF) and newly diagnosed AF among patients admitted to coronary care units (CCUs) in Turkey, and to identify factors associated with in-hospital mortality within AF subtypes.
This multicenter, prospective national registry analysis included 540 consecutive AF patients from 50 CCU centers across seven geographic regions in Turkey (MORCOR-TURK National Registry; September 1–30, 2022). Patients were categorized as pre-existing AF (documented AF prior to or at admission) or newly diagnosed AF (first detected during hospitalization). Demographics, comorbidities, admission diagnoses, laboratory biomarkers (including NT-proBNP and hs-troponin I), management, and outcomes were recorded. Multivariable logistic regression identified independent predictors of in-hospital mortality.
Pre-existing AF (n = 324) had higher prevalences of diabetes mellitus (42.3% vs. 31.5%; p = 0.012) and acute coronary syndromes (58.6% vs. 34.7%; p < 0.001). Newly diagnosed AF (n = 216) more frequently presented with heart failure (45.8% vs. 28.4%; p < 0.001) and dyspnea (67.1% vs. 48.5%; p < 0.001). Newly diagnosed AF exhibited higher inflammatory burden (CRP median 28.4 vs. 12.6 mg/L; p < 0.001) and lower hemoglobin (11.8 ± 2.1 vs. 12.9 ± 1.8 g/dL; p < 0.001). NT-proBNP was elevated in both groups and higher in newly diagnosed AF (median 4850 vs. 3240 pg/mL; p = 0.003). In-hospital mortality was greater with newly diagnosed AF (12.0% vs. 6.8%; p = 0.042). Independent mortality predictors included age, chronic kidney disease, cardiogenic shock, and log-transformed NT-proBNP, hs-troponin I, and CRP.
In Turkish CCUs, pre-existing and newly diagnosed AF constitute distinct clinical phenotypes with differing presentations, biomarker profiles, and short-term risk. Newly diagnosed AF is associated with greater inflammatory and hemodynamic stress and higher in-hospital mortality. Biomarker-enriched risk stratification may refine prognostication and guide targeted management within AF subtypes.
Pulsed Field Ablation (PFA) is a tissue-selective ablation energy source that has been introduced recently for atrial fibrillation (AF) ablation. Data on the use of 3D electroanatomic mapping (EAM) is limited in AF ablation by PFA with many centers electing to omit it.
This study sought to investigate the utility of high-density 3D EAM using PFA for AF ablation.
Seventy-four patients with symptomatic AF underwent PFA-based pulmonary vein isolation (PVI). Additional ablation, including left atrial posterior wall (LAPW) and mitral-isthmus (MI) ablation was performed in a subset of patients. The primary efficacy endpoint was freedom from atrial arrhythmia at 12 months. The primary safety endpoint was freedom from a composite of serious procedure- and device-related adverse events.
In 74 patients, 3D EAM post-PFA showed early PV reconnection in 7/74 cases, (9% cases; 289/296 PVs, 2.4% PVs), most commonly in the right superior PV (6/7, 85.7%). The LAPW reconnected in 3/55 cases (5.5%), while the MI line reconnected in 6/14 cases (30%), more commonly with an anterior approach compared to a posterior (57% vs. 15%). The procedure time was 88.3 ± 40.7 min and fluoroscopic time was 12.1 ± 8.0 min. At 1 year, estimated freedom from atrial arrhythmia was 78.4% (95% CI, 70.1 to 88.7). There was 1 case of pericardial tamponade.
Our results suggest that although there is a low incidence, early PV reconnection can still occur using PFA for PVI. Overall 3D EAM retains clinical value in AF ablation by PFA.
PVI by catheter ablation for atrial fibrillation via a superior approach is technically challenging. However, the circular multielectrode PFA catheter is feasible for PVI via a superior jugular vein approach. AP, anteroposterior; LAO, left anterior oblique; PA, posteroanterior; PFA, pulsed field ablation; PVI, pulmonary vein isolation.
Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation; however, recurrences often originate from non-pulmonary vein (non-PV) foci. The Complex Signal Identification (CSI) algorithm in CARTO 3 assigns electrogram-fractionation scores (0–10). This study evaluated the feasibility of CSI-assisted mapping for identifying non-PV triggers.
We retrospectively analyzed 23 consecutive patients undergoing first-time AF ablation between January and June 2024. After PVI, non-PV triggers were induced using isoproterenol and adenosine triphosphate (ATP). When ectopy was absent, rapid pacing during isoproterenol infusion followed by defibrillation was performed, and ATP testing was repeated. High-density CSI mapping was conducted during sinus rhythm or high right atrial pacing using system default settings, targeting atrial components after ventricular blanking.
A total of 33 non-PV foci were localized (20 left atrium [LA], 13 right atrium [RA]). The mean CSI scores of LA and RA foci were 9.0 ± 2.3 and 8.8 ± 2.7, respectively. ROC analysis showed an AUC of 0.917 for discriminating non-PV foci, with an optimal cutoff of 8.5 (sensitivity 87.9%, specificity 88.3%). At 12 months, arrhythmia-free survival was 82.4% under symptom-driven follow-up. Ablation was selectively performed at the earliest activation and adjacent high-CSI points, avoiding indiscriminate lesion delivery.
CSI-assisted mapping provided practical, adjunctive guidance to provocation and activation mapping for non-PV focus localization. While apparent discrimination was promising, the 8.5 threshold remains exploratory. Larger multicenter studies with standardized CSI settings and systematic post-ablation assessment are warranted to validate these preliminary findings.
Atrial fibrillation (AF), the most frequently occurring sustained arrhythmia in patients with hypertrophic cardiomyopathy (HCM), is linked to poor quality of life and increased thromboembolic risk. Chronic kidney disease (CKD) and reduced kidney function are known cardiovascular risk factors; however, their contributions to new-onset AF in patients with HCM remain unclear. Estimated glomerular filtration rate (eGFR) is a key marker for CKD management. This study aimed to elucidate the incidence of new-onset AF and to identify predictive factors in patients with HCM.
We analyzed 198 patients with HCM (121 men; mean age, 58 ± 17 years) without prior AF. The incidence and predictors of new-onset AF were evaluated with a focus on kidney function and left atrial (LA) size. Cox proportional hazards modeling was used to assess the associations.
Impaired kidney function (eGFR < 60 mL/min/1.73 m2) was present in 35 patients (17.7%). Over a median follow-up of 7.52 years, 43 patients (21.7%) developed new-onset AF for an incidence rate of 2.8 per 100 person-years. The multivariate analysis identified reduced eGFR and increased LA diameter (LAD) as independent predictors of AF. Kaplan–Meier curves showed a significantly higher cumulative AF incidence among patients with an eGFR ≤ 76.1 mL/min/1.73 m2 or an LAD ≥ 48.0 mm.
Decreased kidney function and LA dilatation were significantly associated with new-onset AF among patients with HCM. These findings suggest that this patient population requires closer monitoring for the early detection of AF.
Lead extraction and reimplantation in adult congenital heart disease (CHD) patients is challenging due to anatomical complexity.
A 76-year-old man with prior ventricular septal defect (VSD) patch repair and pacemaker implantation developed a device infection. Complete transvenous lead extraction (TLE) was achieved using laser and mechanical sheaths. A leadless pacemaker (Aveir VR) was implanted at the right ventricular outflow tract (RVOT) using pre-fixation mapping to avoid the VSD patch.
This case illustrates the effectiveness of pre-mapping in achieving safe reimplantation of a leadless pacemaker after TLE in complex CHD anatomy.
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