Shah, Siddharth

Heart failure with reduced ejection fraction is a major cause of morbidity and mortality. Cardiac resynchronization therapy (CRT) improves outcomes but faces challenges such as unsuccessful lead placement and suboptimal responses. The Wireless Stimulation Endocardially for CRT (WiSE-CRT) system, a novel leadless left ventricular (LV) pacing technology, uses ultrasonic energy to deliver electrical stimulation directly to the LV endocardium, potentially improving the response rates. A comprehensive literature search was performed across multiple databases from inception until August 2024. The outcomes of interest included the New York Heart Association (NYHA) functional score, LV ejection fraction (LVEF), LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and QRS duration. Statistical analysis involved pooling the mean differences (MDs) and their corresponding 95% confidence intervals (CIs) from each study using the inverse-variance random-effects model in RevMan version 5.4.1 software. Seven studies, including 468 patients with heart failure treated with the WiSE-CRT system, were included. The pooled analysis showed significant improvements in NYHA functional score (MD: −0.44; 95% CI: −0.67 to −0.21; P = 0.0002; I 2 = 77%), LVEF (MD: 5.71; 95% CI: 4.54 to 6.87; P < 0.001), LVEDV (MD: −24.49; 95% CI: −33.24 to −15.73; P < 0.001), and LVESV (MD: −24.47; 95% CI: −32.80 to −16.14; P < 0.001). The QRS duration also decreased significantly (MD: −38.62; 95% CI: −46.76 to −30.49; P < 0.001; I 2 = 60%). The WiSE-CRT system significantly improved NYHA functional score, LVEF, QRS duration, LVEDV, and LVESV in patients with heart failure. This leadless pacing technology offers a promising alternative for ineligible candidates or for those who do not respond to conventional CRT.

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity worldwide. Low-dose colchicine is a novel and nonstandard management approach for patients with CVDs who are at an increased risk of adverse events. However, few studies have reported the risk of stroke with colchicine, with controversial results. This meta-analysis aimed to compare the efficacy of colchicine and placebo for stroke prevention in patients with CVD. Major electronic databases were screened for randomized controlled trials (RCTs) comparing colchicine and placebo in patients with CVDs from inception to June 2024. Pooled estimates were calculated as risk ratios (RRs) with 95% confidence intervals (CIs) using an inverse-variance random-effects model. Statistical significance was set at P < 0.05. A total of 15 RCTs encompassing 25,116 patients with CVDs were included (12,568: colchicine and 12,548: placebo). The pooled analysis demonstrated a significant reduction in stroke [RR, 0.80 (95% CI, 0.64–0.99); P = 0.04] with colchicine compared with placebo. The risk of all-cause mortality [RR, 1.00 (95% CI, 0.77–1.28)] was comparable between the 2 groups. On subgroup analysis, low-dose colchicine (0.5 mg/day) demonstrated a significantly lower risk of stroke compared with high-dose (>0.5 mg/day) colchicine, which failed to achieve statistical significance. Based on this meta-analysis, colchicine significantly reduced stroke in patients with CVDs compared with placebo. This effect was most significant with low-dose colchicine at 0.5 mg/day. However, no differences were observed in all-cause mortality. Further long-term RCTs are warranted to investigate stroke prevention using colchicine in this population.