Ibrahim, Ramzi

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased morbidity, mortality, and healthcare expenses. Meanwhile, effective management of AF requires a comprehensive, patient-centered approach that includes risk factor modification, rate and rhythm control strategies, and prevention of thromboembolic events. Multidisciplinary AF clinics have emerged as a model for comprehensive management to improve patient outcomes and reduce healthcare burden. This review discusses the rationale, structure, benefits, challenges, and future directions of multidisciplinary AF clinics, emphasizing their role in optimizing AF management.

Introduction: Sex-based differences in outcomes among patients with heart failure with reduced ejection fraction (HFrEF) treated with sodium-glucose cotransporter 2 inhibitors (SGLT2is) remain underexplored. This study aimed to evaluate sex-specific differences in cardiovascular outcomes in patients with HFrEF receiving SGLT2 inhibitors alongside guidelinedirected medical therapy (GDMT). Methods: We conducted a retrospective cohort study using the TriNetX global research network. Adults with HFrEF treated with SGLT2is and GDMT were stratified by sex. Propensity score matching (PSM) was used to balance baseline demographics, comorbidities, medications, and laboratory data. Primary outcomes were all-cause mortality and acute heart failure (HF) events; secondary outcomes included hospitalizations, arrhythmias, renal outcomes, and advanced therapies. Results: After PSM, 17,408 male and 17,408 female patients were analyzed. Male patients had lower odds of acute HF events (aOR: 0.949; 95% CI: 0.909–0.991), all-cause hospitalizations (aOR: 0.933; 95% CI: 0.895–0.973), and renal failure (aOR: 0.915; 95% CI: 0.870–0.962). No significant differences were observed in all-cause mortality (aOR: 1.003; 95% CI: 0.926–1.087) or heart transplantation, although LVAD use was more frequent in males (aOR: 1.416; 95% CI: 1.053–1.905). Discussion: The findings highlighted potential sex-based disparities in outcomes for patients with HFrEF on SGLT2is. Differential prescribing patterns, comorbidity burden, or timing of therapy initiation may contribute to observed differences. Conclusion: Among HFrEF patients treated with SGLT2is, males experienced lower risks of HF events, hospitalizations, and renal failure compared to females, despite similar mortality. Further research is needed to understand and address sex-specific disparities in HFrEF management.

Chronic left bundle branch block (LBBB) has been associated with adverse cardiac remodeling and the development of cardiomyopathy. This retrospective cohort study evaluated the impact of angiotensin II receptor blocker (ARB) therapy on cardiovascular outcomes in adults with isolated LBBB with no known heart failure (HF), cardiomyopathy, or ischemic heart disease. Using the TriNetX global research network, patients were stratified by ARB use and followed for up to 5 years. Propensity score matching was performed to balance characteristics. Three thousand two hundred sixty-six patients were included in each group with comparable baseline characteristics. The ARB therapy was not associated with a reduction in new-onset acute HF events (4.9% vs 4.4%; hazard ratio (HR) 1.05 (95% CI 0.84–1.32)). Similarly, there were no significant differences in rates of all-cause hospitalizations, cardiac arrest, or ventricular tachycardia. However, ARB use was associated with a significantly lower, all-cause mortality rate (8.6% vs 12.1%; HR 0.67 (95% CI 0.57–0.77)). This is the first real-world study examining ARB use in a cohort with isolated LBBB, highlighting a potential mortality benefit, despite no difference in acute HF risk. While ARBs are not effective in preventing LBBB-induced cardiomyopathy based on these findings, the observed survival advantage warrants further investigation. Prospective studies are needed to elucidate mechanisms underlying this mortality benefit and to determine whether ARBs should be considered in the management of patients with isolated LBBB.

ABSTRACT Background Ventricular tachycardia (VT) is a major contributor to sudden cardiac death among patients with ischemic heart disease (IHD). While catheter ablation reduces the arrhythmic burden, the impact on long‐term outcomes remains uncertain. We assess the efficacy of catheter ablation in patients with IHD. Methods We performed a meta‐analysis by systematically searching electronic databases from inception to April 2025. Pairwise, reconstructed time‐to‐event data meta‐analyses and Trial Sequential analyses were conducted. Results A total of seven studies (1192 participants) were included. Among patients with IHD with ICD, VT ablation was associated with a significant reduction in ICD shocks (RR = 0.50, 95% CI = [0.34–0.74]), a trend toward reduced VT storm (RR = 0.64, 95% CI = [0.40–1.04], p = 0.07), and lower rates of cardiovascular hospitalization (RR = 0.73, 95% CI = [0.53–1.01], p = 0.06) compared to ICD alone. However, no significant differences were observed when compared to patients receiving ICD plus antiarrhythmic drugs (AADs). VT ablation showed no significant impact on mortality or VT/VF recurrence compared to either ICD alone or ICD with AADs. Reconstructed Kaplan–Meier analysis for all‐cause mortality showed no significant difference between VT ablation and AAD + ICD. Trial Sequential Analysis provided conclusive evidence for VT/VF recurrence, while further data is required for other outcomes. Conclusion Among patients with IHD with ICD, VT ablation reduces ICD shocks, VT storm, and cardiovascular hospitalizations compared to ICD‐only therapy, but offers no significant advantage over ICD combined with AADs. VT ablation does not impact overall mortality or the recurrence of VT/VF. Trial sequential analysis confirmed conclusive evidence for VT/VF recurrence, while additional data is needed for other outcomes.

Advances in plaque imaging have transformed cardiovascular diagnostics through detailed characterization of atherosclerotic plaques beyond traditional stenosis assessment. This review outlines the clinical applications of varying modalities, including dual-layer spectral CT, photon-counting CT, dual-energy CT, and CT-derived fractional flow reserve (CT-FFR). These technologies offer improved spatial resolution, tissue differentiation, and functional assessment of coronary lesions. Additionally, artificial intelligence has emerged as a powerful tool to automate plaque detection, quantify burden, and refine risk prediction. Collectively, these innovations provide a more comprehensive approach to coronary artery disease evaluation and support personalized management strategies.

Introduction: Amyloidosis complicated by heart failure (HF) poses significant mortality. We sought to identify trends in comorbid amyloidosis and HF mortality in the recent 22- year period. Methods: Mortality due to amyloid and HF as contributors of death were queried from death certificates using the CDC database from 1999 to 2020. Mortality rates and their 95% confidence intervals were adjusted for age (AAMR) through the Direct method and compared by demographic subpopulations. The Monte-Carlo permutation test was used to estimate the annual percentage change (APC). Log-linear regression models were utilized to assess temporal variation in mortality. Results: Age-adjusted mortality rates (AAMR) increased from 0.09 [0.08-0.10] in 1999 to 0.27 [0.25-0.29] in 2020. Mortality increased from 1999 to 2013 (APC +1.4, p=0.048) with an accelerating inflection point in 2013 to 2020 (APC +13.3, p<0.001). AAMR was higher among male populations (AAMR 0.20 [0.20-0.21]) compared to female populations (AAMR 0.07 [0.07- 0.07]). A significant inflection point in uprising mortality rates was observed for both male and female populations in 2013 (p<0.001). Mortality was highest among Black populations (AAMR 0.33), followed by White (AAMR 0.10), Asian/Pacific Islander (AAMR 0.06), and American Indian/Alaska Native populations (AAMR 0.04). Among Black populations, mortality remained consistent from 1999 to 2012 (APC +1.1, p=0.184), followed by an increase from 2012 to 2020 (APC +14.0, p<0.001). Among White populations, mortality remained stagnant from 1999 to 2013 (APC +0.7, p=0.302), followed by an increase starting in 2013 to 2020 (APC +13.5, p<0.001). Discussion: Our findings of a marked rise in HF-related mortality in patients with amyloidosis since 2013 highlighted the profound impact of enhanced diagnostic awareness, novel imaging techniques, and emerging therapeutics. Our analysis also showed mortality disparities between sexes, and geographic locations, races, and ethnicity that warrant targeted public health interventions. Conclusions: Amyloid and HF mortality increased in the recent 22-year period, primarily starting in 2013, emphasizing the urgent need for targeted intervention to address these disparities.

Abstract Background Inadvertent temporary transvenous pacing (TTVP) of left ventricle (LV) is rare and likely underreported, posing significant embolic risk. We present a case of TTVP with atypical trajectory identified on computed tomography (CT) imaging. Summary A 62-year-old male with metastatic renal cell carcinoma on chemotherapy and bifascicular block presented with symptomatic bradycardia and non–ST-elevation myocardial infarction (NSTEMI), raising concerns for complete heart block on ECG. Intermittent asystole occurred during TTVP placement with appropriate capture. Post-procedure, ECG showed ventricular-paced rhythm with pseudo-right bundle branch block, and chest X-ray suggested lead placement in right ventricle; however, suboptimal echocardiography limited lead visualization. Coronary angiography revealed non-obstructive coronary artery disease. Positron emission tomography–computed tomography (PET-CT), performed to evaluate immune checkpoint inhibitor myocarditis, incidentally noted TTVP wire entering right subclavian artery and traversing to LV. Patient underwent TTVP removal, endovascular repair, and pacemaker implantation; however, course was unfortunately complicated by embolic stroke and haemorrhagic conversion. Discussion Early detection and management of lead malposition remain critical to minimizing complications. Management strategies for inadvertent lead malposition (ILM) depend on duration of implantation, clinical presentation, and associated risks. This case highlights importance of recognizing this high-risk complication, preventive strategies, and evidence-based management. While existing data primarily focus on ILM in permanent devices, further research is needed to elucidate incidence, predictors, and outcomes of ILM in TTVP, particularly in resource-limited settings.