Tokavanich, Nithi

ABSTRACT Background Pulmonary vein isolation (PVI) is the mainstay treatment for rhythm control in patients with persistent atrial fibrillation (PsAF). However, due to the complex mechanisms of PsAF, the efficacy of PVI alone remains modest. Spatiotemporal electrogram dispersion (STED) ablation is a promising strategy to enhance outcomes. This study aims to evaluate the efficacy of STED ablation plus PVI versus PVI alone in PsAF ablation. Methods A systematic search was conducted to identify studies published up to November 2024 comparing PVI plus STED ablation (PVI‐STED group) versus PVI alone (PVI group) in patients with PsAF. The primary outcomes were AF recurrence and sinus rhythm (SR) conversion. Results Eleven studies (three randomized controlled trials, three prospective cohorts, five retrospective cohorts) involving 1607 patients (mean age of 63.9 ± 9.3 years) were included. The PVI‐STED group was significantly associated with a lower risk of AF recurrence (OR: 0.40, 95% CI: 0.27–0.59, I ² = 25%) and a higher likelihood of SR conversion (OR: 7.04, 95% CI: 1.62–30.62, I 2 = 79%). No significant differences were observed in procedural time (MD: 27.61 min, 95% CI: −29.12 to 84.33, I ² = 97%), ablation time (MD: 4.4 min, 95% CI: −11.3 to 20.0, I 2 = 98%), or fluoroscopy time (0.25 min, 95% CI: −3.4 to 3.9, I 2 = 95%). The overall rate of AEs in the PVI‐STED group was 1% (95% CI: 1%–3%, I 2 = 0%). Conclusion The PVI‐STED approach demonstrated both efficacy and safety in treating PsAF, as evidenced by reduced AF recurrence and improved SR conversion rates.

Background: Pulsed field ablation (PFA) and high-power short-duration radiofrequency ablation (HPSD) are emerging techniques for treating atrial fibrillation (AF), offering promising results compared to cryoballoon ablation (CBA). This network meta-analysis aims to evaluates the efficacy and safety of PFA, HPSD, and CBA. Method: PubMed, Embase, Cochrane Central Register of Controlled Trials, and EBSCO Information Services were systematically searched for relevant studies until April 2024. The primary outcome is freedom from atrial arrhythmia. A random-effects model was used for data synthesis, and P-scores were employed for outcome ranking. Point estimation (odd ratios) was calculated for comparisons. Results: Fifteen studies were included in our network meta-analysis, involving 5,093 atrial fibrillation patients: 812 (16%), 2,659 (52%), and 1,622 (32%) patients underwent PFA, CBA, and HPSD, respectively. PFA demonstrated the highest efficacy (P-scores 99.3%). Point estimation between PFA and HPSD, and PFA and CBA, were 1.394 (95% CI: 1.047-1.858) and 1.479 (95% CI: 1.134–1.929), respectively. PFA had higher complications compared to HPSD (OR=4.44, 95% CI: 1.405-14.031) and CBA (OR=2.581, 95% CI: 0.992–6.720). HPSD had the shortest fluoroscopic time (P-scores 100%), while CBA had the longest (P-scores 0%). PFA had the shortest procedural time compared to CBA and HPSD with P-scores of 100% 50% and 0%, respectively. Conclusion: PFA showed higher efficacy but higher complication risk than HPSD and CBA. HPSD and CBA demonstrated similar efficacy and safety.

Abstract Background: The relationships between exercise timing and health outcomes including anthropometric indices, metabolic markers, and sleep health have not been clearly established. To gain better insights, we performed the meta-analysis to determine the effects of morning versus evening exercise on various health outcomes. Methods: We collected studies from MEDLINE, EMBASE, and Cochrane databases from inception to March 2023 to perform a meta-analysis. Exercise is defined as performing activity at least moderate intensity. For the outcomes of interest, the mean differences (MD) were employed using a random-effects model, the generic inverse variance method of DerSimonian and Laird. Results: A total of 716 patients were analyzed from 14 studies including randomized controlled trial and observational studies. We found no significant associations between exercise timing and several health-related parameters. Specifically, the data showed no notable differences in body weight (MD: -0.12 kg [95% CI −0.81 to 0.58]) and BMI (MD: -0.07 kg/m2 [95% CI −0.46 to 0.32]) when comparing morning and evening exercise sessions. Similarly, sleep latency was not significantly affected by exercise timing (MD: -2.24 minutes [95% CI −5.83 to 1.35]). Furthermore, changes in metabolic biomarkers, including LDL (MD: -6.64 mg/dL [95% CI −20.08 to 6.79]) and HDL (MD: 0.09 mg/dL [95% CI 0 to 0.17]), were not significantly associated with the timing of exercise. Conclusion: This meta-analysis found no significant relationship between exercise timing and health outcomes including anthropometric indices, metabolic markers, and sleep health. While considered as hypothesis generating, timing of exercise should equally prune patients’ health outcomes.

AbstractIntroductionAtrioventricular nodal reentrant tachycardia (AVNRT) is the most common supraventricular tachycardia referred for ablation. Periprocedural conduction system damage was a primary concern during AVNRT ablation. This study aimed to assess the incidence of permanent atrioventricular (AV) block and the success rate associated with different types of catheters in slow pathway ablation.MethodA literature search was performed to identify studies that compared various techniques, including types of radiofrequency ablation (irrigated and nonirrigated) and different sizes of catheter tip cryoablation (4, 6, and 8‐mm), in terms of their outcomes related to permanent atrioventricular block and success rate. To assess and rank the treatments for the different outcomes, a random‐effects model of network meta‐analysis, along with p‐scores, was employed.ResultsA total of 27 studies with 5110 patients were included in the analysis. Overall success rates ranged from 89.78% to 100%. Point estimation showed 4‐mm cryoablation exhibited an odds ratio of 0.649 (95%CI: 0.202–2.087) when compared to nonirrigated RFA. Similarly, 6‐mm cryoablation had an odds ratio of 0.944 (95%CI: 0.307–2.905), 8‐mm cryoablation had an odds ratio of 0.848 (95%CI: 0.089–8.107), and irrigated RFA had an odds ratio of 0.424 (95%CI: 0.058–3.121) compared to nonirrigated RFA.ConclusionOur study found no significant difference in the incidence of permanent AV block between the types of catheters. The success rates were consistently high across all groups. These findings emphasize the potential of both RF ablation (irrigated and nonirrigated catheter) and cryoablation as viable options for the treatment of AVNRT, with similar safety and efficacy profile.

AbstractIntroductionCardiac resynchronization therapy (CRT) is a standard treatment for patients with heart failure with reduced ejection fraction. However, there is still a gap of evidence in congenital heart disease (CHD) patients regarding resynchronization therapy.MethodsWe performed a meta‐analysis and systematic review of CHD patients who received CRT implantation. We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane database from inception to June 2023. Studies that reported response rate to CRT, total mortality rate, change in QRS duration, change in left ventricular ejection fraction, and change in New York Heart Association functional class were included.ResultsA total of 14 studies were included in the study. There were 10 studies that reported response rates after implantation. The overall response rate to CRT in CHD patients was 68% (95% confidence interval [CI] 61%–75%, I2 32%). The response rates in patients with systemic right ventricle (RV), systemic left ventricle (LV), and single ventricle were 58% (95% CI 46%–70%, I2 0%), 80% (95% CI 74%–86% I2 14%), and 67% (95% CI 49%–80% I2 0%). Response to CRT in systemic RV was inferior to systemic LV with an odds ratio of 0.38 (95% CI 0.15–0.95, I2 38%). The total mortality rate from seven studies was 12% (95% CI 8%–18%, I2 55%). The parameters which represented ventricular dyssynchrony improved after CRT implantation.ConclusionThe overall response rate to CRT in CHD was 68%. Patients with systemic RV had a lower response rate to CRT when compared to patients with systemic LV. The total mortality rate after CRT implantation was 12%.

Introduction Premature birth has a causal relationship with hypertension and diabetes, which are significant risk factors for major cardiovascular disease. Nonetheless, little is known whether premature birth portends future risks of acquired heart diseases, for example, ischemic heart disease (IHD), heart failure (HF), and valvular heart disease (VHD). Methods We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane database from inception to December 2021. Studies with prospective and retrospective cohort designs that reported the association between premature birth and acquired heart disease, including IHD, HF, and VHD, were included. Data from each study were combined with a random-effects model. The results were reported in the hazard ratio (HR) with 95% confidence intervals. Results The selected studies were comprised of 7 studies, with 5 studies involving premature birth and the development of IHD in adulthood and 2 studies involving premature birth and HF. No studies reporting the relationship between premature birth and VHD met our initial inclusion criteria. Our study did not find any association between premature birth and IHD in the adulthood (HR 1.14 95% CI 0.91-1.19, P = .16, I 2 = 51%). We found the association between premature birth and acquired HF (HR 1.53 95% CI 1.08-2.16, P = .01, I 2 = 0) Conclusion Premature birth was not statistically associated with IHD in adulthood, but there was a significant association between preterm and HF.

AbstractBackgroundHigh‐power short‐duration (HPSD) atrial fibrillation (AF) ablation with a power of 40–50 W was proved to be safe and effective. Very high‐power short‐duration (vHPSD) AF ablation is a novel method using >50 W to obtain more durable AF ablation. This study aimed to evaluate the efficacy and safety of vHPSD ablation compared with HPSD ablation and conventional power ablation.MethodsA literature search for studies that reported AF ablation outcomes, including short‐term freedom from atrial arrhythmia, first‐pass isolation (FPI) rate, procedure time, and major complications, was conducted utilizing MEDLINE, EMBASE, and Cochrane databases. All relevant studies were included in this analysis. A random‐effects model of network meta‐analysis and surface under cumulative ranking curve (SUCRA) were used to rank the treatment for all outcomes.ResultsA total of 29 studies with 9721 patients were included in the analysis. According to the SUCRA analysis, HPSD ablation had the highest probability of maintaining sinus rhythm. Point estimation showed an odds ratio of 1.5 (95% confidence interval [CI]: 1.2–1.9) between HPSD ablation and conventional power ablation and an odds ratio of 1.3 (95% CI: 0.78–2.2) between vHPSD ablation and conventional power ablation. While the odds ratio of FPI between HPSD ablation and conventional power ablation was 3.6 (95% CI: 1.5–8.9), the odds ratio between vHPSD ablation and conventional power ablation was 2.2 (95% CI: 0.61–8.6). The procedure times of vHPSD and HPSD ablations were comparable and, therefore, shorter than that of conventional power ablation. Major complications were low in all techniques.ConclusionvHPSD ablation did not yield higher efficacy than HPSD ablation and conventional power ablation. With the safety concern, vHPSD ablation outcomes were comparable with those of other techniques.

AbstractIntroductionAtrial fibrillation (AF) ablation is increasingly performed worldwide. As comfort with AF ablation increases, the procedure is increasingly used in patients that are older and in those with more comorbidities. However, it is not well established whether AF ablation in the elderly, especially those >75 years old, has comparable safety and efficacy to younger populations.ObjectiveTo compare the efficacy and safety profiles in patients older than 75 years undergoing AF ablation with younger patients.MethodsDatabases from EMBASE, Medline, PubMed, and Cochrane, were searched from inception through September 2021. Studies that compared the success rates in AF catheter ablation and all complications rates between patients who were older vs under 75 years were included. Effect estimates from the individual studies were extracted and combined using random effect, generic inverse variance method of DerSimonian and Laird.ResultsTwenty‐seven observational studies were included in the analysis consisting of 363,542 patients who underwent AF ablation. Comparing patients older than 75 years old to younger patients, there was no difference in the success of ablation rates between elderly and younger patients (pooled OR 0.85: 95% CI:0.69–1.05, p = .131). On the other hand, AF ablation in the elderly was associated with higher complication rates (pooled OR 1.42: 95% CI:1.21–1.68, p < .001).ConclusionAs AF ablation is expanded to elderly populations, our study found that AF ablation success rates were similar in both elderly and younger patients. However, older patients experience higher rates of complications that should be considered when offering the procedure and as a means to improve outcomes with future innovations.

AbstractIntroductionReal‐world data on atrial fibrillation (AF) ablation among moderate and advanced chronic kidney disease (CKD) patients have so far remained scarce, especially in‐hospital AF ablation outcomes.MethodsWe drew data from the US National Inpatient Sample to identify hospitalized patients who underwent AF ablation between 2005 and 2018, and further stratified by CKD classification. We assessed the trend of AF ablation, as well as its complications.ResultsA total of 152 630 patients who were primarily hospitalized for AF and underwent ablation were estimated. Among these, CKD patients were found in a total of 1509 participants, with 978, 206, and 325 under CKD3, CKD4, and CKD5/ESKD, respectively. There was a significant increment in admission rates for AF ablation in the CKD population across all CKD classifications (p < .001). All CKD patients were statistically older, with higher coexisting comorbidities, while hypertension was found substantially lower than non‐CKD patients (p ≤ .001). Importantly, CKD, especially CKD3 and CKD5/ESKD, was significantly associated with an increased risk of total complications, and total bleeding, Neurological complications were found statistically lower in CKD patients (p = .029), and no mortality rates were significantly different (p = .287).ConclusionOur study observed an increase in admission trends for AF ablation among moderate and advanced CKD patients from 2005 to 2018. CKD was strongly associated with higher procedure‐related complications and bleeding, but neurological safety profiles and mortalities rates were nonsignificantly different.