Trongtorsak, Angkawipa

Background: Obstructive sleep apnea (OSA) was associated with atrial fibrillation (AF) as well as the recurrence of AF after rhythm control strategy. However, the data on continuous positive airway pressure (CPAP) and recurrent AF after catheter ablation with pulmonary vein isolation (PVI) remain unclear. We conducted this systematic review and meta-analysis to evaluate the effect of CPAP treatment in OSA patients after atrial fibrillation ablation. Methods: We searched MEDLINE and Embase databases from inception to September 2023 to identify studies that assess the effect of CPAP in OSA patients on the recurrence of AF after PVI. Data from each study were combined using the random effects model. Results: Eight studies (one randomized controlled trial and seven cohort studies) with 1487 OSA patients (660 in the CPAP group and 827 in the control group) were included. The use of CPAP in OSA patients was associated with significantly lower AF recurrence after PVI (odds ratio (OR) = 0.36, 95% conference interval (CI) 0.25–0.53, p < 0.001). The results of sensitivity analysis remain the same as the main analysis. Conclusions: Our meta-analysis demonstrated that CPAP treatment was associated with lower rates of AF recurrence after PVI.

Background: Iron deficiency in patients with systolic heart failure (HF) was found to be associated with poorer exercise capacity and quality of life. We conducted this systematic review and meta-analysis to assess whether iron supplementation in patients with systolic HF can improve exercise capacity and quality of life. Methods: We searched MEDLINE, and Embase databases from inception to May 2022 to identify the studies that reported the impact of iron therapy including oral and intravenous (IV) iron forms in systolic HF patients with iron deficiency. Outcomes of interest included 1) six minute walk test (6MWT) and 2) Quality of life (QoL) assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ). Data from each study were combined using the random-effects model to calculate weight mean difference (WMD) and 95% confidence interval (CI) Results: Five studies (4 randomized controlled trials and 1 nonrandomized open-label study) with a total of 1,075 patients (610 in the intervention group and 465 in the control group) were included. In the intervention group, 474 patients received IV iron and 136 patients received oral iron therapy. Iron therapy was associated with significant improvement of 6MWT (WMD =22.81, 95% CI 0.47-45.14, p < 0.001) and KCCQ (WMD =4.68, 95%CI 0.43-8.93, p< 0.001). Interestingly, subgroup analysis showed that the main results were driven by IV iron therapy in both 6MWT (WMD =34.68, 95%CI 25.13-44.24, p< 0.001) and KCCQ (WMD =6.78, 95%CI 3.81-9.75, p< 0.001) as there was no significant improvement after oral iron therapy in 6MWT (WMD =0.15, 95% CI -23.86-24.16, p =0.99) and KCCQ (WMD =2.71, 95% CI-1.35-6.78, p =0.19). As shown in Figure 1. Conclusions: Intravenous iron therapy, but not oral iron therapy is associated with improved exercise capacity and QoL in patients with systolic HF.

AbstractBackgroundTransvenous lead extraction (TLE) is increasingly considered in cardiac implantable electronic device management. Heart failure (HF) might be associated with mortality risks after the TLE procedure. This study aims to assess mortality risk in HF patients undergoing TLE.MethodWe searched MEDLINE and Embase databases from inception to June 2022 to identify articles that included patients with and without HF who underwent TLE, which reported mortality in both groups. The pooled effect size was calculated with a random‐effects model and 95% CI to compare post‐TLE mortality between the two groups.ResultsEleven studies were included in the analysis. Each left ventricular ejection fraction (LVEF) increased by 1% was associated with reduced mortality by 2% (HR = 0.98, 95% CI: 0.97–0.99, I2 = 74.9%, p < .01). The presence of HF compared to those without HF was associated with higher mortality rates (OR: 3.04, 95% CI: 2.56–3.61, I2 = 0.0%, p < .531). There was a significant increase in the mortality rates in patients with New York Heart Association (NYHA) function class III (OR: 2.29, 95% CI: 1.29–4.06, I2 = 0.0%, p = .498) and NYHA IV (OR: 8.5, 95% CI: 2.98–24.3, I2 = 0.0%, p = .997).ConclusionsOur study found that post‐TLE mortality decreases by 2% as LVEF increases by 1%, also mortality is higher in patients with NYHA III and IV.

AbstractBackgroundThe impact of chronic kidney disease (CKD) or end‐stage renal disease (ESRD) on patients receiving transvenous lead extraction (TLE) is not well‐established. We performed a systematic review and meta‐analysis to explore the association between CKD and all‐cause mortality in TLE.MethodsWe searched the databases of PubMed and EMBASE from inception to April 2022. Included studies were published TLE studies that compared the risk of mortality in CKD patients compared to control patients. Data from each study were combined using the random‐effects model.ResultsEight studies (5,013 patients) were included. Compared with controls, CKD patients had a significantly higher risk of overall all‐cause mortality (hazard ratio [HR] = 2.14, 95% confidence interval [CI]: 1.65–2.77, I2 = 51.1%, p < .001). The risk of overall all‐cause mortality increased with the severity of CKD for nonspecific CKD (HR = 2.01, 95% CI: 1.49–2.69, I2 = 53.4, p < .001) and ESRD (HR = 2.79, 95% CI: 1.85–4.23, I2 = 0%, p < .001). The risk of all‐cause mortality in CKD is double at follow‐up ≤1 year (HR = 1.99, 95% CI: 1.29–3.09, I2 = 50.9%, p = .002) and higher at follow‐up >1 year (HR = 2.36, 95% CI: 1.63–3.42, I2 = 59.7%, p < .001).ConclusionsOur meta‐analysis demonstrates a significantly increased risk of overall all‐cause mortality in patients with CKD who underwent TLE compared to controls.

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.

AbstractBackgroundQRS area, a three‐dimensional QRS complex, is a novel vectorcardiography method of measuring the magnitude of electrical forces in the heart. Hypothetically, a greater QRS area denotes higher dyssynchrony and indicates potential benefits from cardiac resynchronization therapy (CRT). Previous studies suggest a positive correlation between QRS area and the degree of response to CRT, but its clinical use remains unclear. We performed a meta‐analysis of the relationship between QRS area and survival benefit following CRT.MethodsWe comprehensively searched the MEDLINE, EMBASE, and Cochrane databases from inception to August 2021. We included studies with prospective and retrospective cohort designs that reported QRS area before CRT and total mortality. Data from each study were analyzed using a random‐effects model. The results were reported as a hazard ratio (HR) and 95% confidence intervals.ResultsFive observational studies including 4931 patients were identified. The cut‐off values between large and small QRS areas ranged from 102 to 116 μVs. Our analysis showed a larger QRS area was statistically associated with increased 5‐year survival in patients implanted with CRT (HR pooled 0.48, 95% CI 0.46–0.51, I2 = 54%, p < .0001). Greater QRS area reduction (pre‐ and post‐implantation) were associated with a lower total mortality rate (HR pooled 0.45, 95% CI 0.38–0.52, I2 = 0%, p < .0001).ConclusionLarger pre‐implantation QRS area was associated with increased survival after CRT. QRS area reduction following CRT implantation was also associated with lower mortality. QRS area may potentially become an additional selection criterion for CRT implantations.

Although most patients with hepatitis E virus (HEV) infection are asymptomatic or have mild symptoms, its infection is generally underdiagnosed and overlooked. In immunocompromised patients, HEV infection can lead to acute liver failure and death. However, the clinical evidence of HEV infection in hematopoietic stem cell transplant (HSCT) recipients is scarce; thus, we conducted this systematic review and meta-analysis to assess the prevalence of HEV infection in this population. We searched MEDLINE, EMBASE, and the Cochrane Library databases from inception through October 2020 to identify studies that reported the prevalence of HEV infection among HSCT recipients. HEV infections were confirmed by HEV-IgG/IgM or HEV-RNA assay. A total of 1977 patients from nine studies with a follow-up time up to 40 months were included in the final analysis. The pooled prevalence of positive HEV-RNA was 3.0% (95% CI 2.3% to 4.0%). The pooled prevalence of positive HEV-IgG was 10.3% (95% CI 4.5% to 21.8%). The pooled prevalence of de novo HEV infection was 2.9% (95% CI 1.8% to 4.5%). Age and male gender were not associated with HEV-RNA or HEV-IgG positivity in the meta-regression analysis. In conclusion, the prevalence of HEV-IgG in HSCT recipients was about 10%, while the prevalence of HEV-RNA was only 3%. However, further studies that focus on the clinical outcomes in this population are warranted.

Abstract Background QRS area, three-dimensional QRS complex, is among novel vectorcardiographical methods of measuring the magnitude of electrical forces generated by the heart. Hypothetically, greater QRS area portrayed higher dyssynchronous electrical activation, possibly deriving significant cardiac resynchronization therapy (CRT) benefit. Previous studies suggested a positive correlation between QRS areas and the degree of CRT responses. Nevertheless, its clinical use has remained premature. We hence performed a systematic review and meta-analysis of QRS area in predicting survival benefit following CRT. Method We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane database from inception to March 2021. Included studies with prospective and retrospective cohort design. Studies those report QRS area before implantation of CRT and outcome of total mortality. Data of each study were combined with random effects model. The results were reported in hazard ration (HR) with 95% confidence intervals. Result Four observational studies, including 4,931 patients, were identified. The cut-off values between large and small QRS areas ranged from 102–116 μVs. Our analysis showed larger QRS area was statistically associated with survival benefit in patients implanted with CRT with follow up time up to 5 years (Pooled hazard ratio 0.46, 95% confident interval 0.38–0.55, I2=42%). More QRS areas changes (pre and post implantation) were associated with lower total mortality rate (Pooled hazard ratio 0.45, 95% confident interval 0.38–0.52, I2=0%). Conclusion Patients with pre-implantation larger QRS area were strongly associated with survival benefit after CRT implantation. QRS area may potentially become additional selection criteria for CRT implantation. Funding Acknowledgement Type of funding sources: None. Figure 1. Forest plot of pooled hazard ratioTable 1. Study characteristics