Rivera, André

Background Tirzepatide is a dual agonist for glucose‐dependent insulinotropic polypeptide and glucagon‐like peptide‐1 receptors, with proven efficacy in weight loss and improvement in cardiovascular outcomes. However, the effects of tirzepatide on the incidence of atrial fibrillation in patients with overweight or obesity remain unclear. Methods PubMed, Embase, and Cochrane Library were searched for randomized controlled trials comparing tirzepatide versus placebo for individuals with overweight or obesity. Odds ratios (ORs) with 95% credible intervals (CrIs) were pooled using a Bayesian binomial‐normal hierarchical model, appropriate for rare‐event outcomes. Results Our meta‐analysis included 10 randomized controlled trials, including 6515 individuals, of whom 4491 (68.9%) were randomized to tirzepatide. The pooled OR was 2.20 (95% CrI, 0.81–6.75) for atrial fibrillation, 2.16 (95% CrI, 0.90–5.87) for atrial arrhythmia, and 1.84 (95% CrI, 1.04–3.90) for any arrhythmia. Conclusions Tirzepatide was not associated with atrial fibrillation or atrial arrhythmia. Although higher odds of overall arrhythmias were observed, event rates were low and the findings should be interpreted cautiously.

ABSTRACT Background The efficacy and safety of PolarX cryoballoon for pulmonary vein isolation (PVI) among patients with atrial fibrillation (AF) is unclear. Methods PubMed, Embase, Cochrane Central, and ClinicalTrials.gov were systematically searched for studies comparing the PolarX vs. standard cryoballoon (CB‐2/CB‐4). Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (95% CIs) were computed for binary and continuous outcomes, respectively. Results This systematic review and meta‐analysis included 2 randomized controlled trials and 18 observational studies with a total of 7107 patients, of whom 3.188 (44.8%) underwent ablation with PolarX. When compared to standard cryoablation, PolarX had similar incidence of atrial arrhythmias recurrence (OR 1.04; 95% CI 0.82–1.32; p = 0.73), acute PVI success (OR 0.91; 95% CI 0.31–2.68; p = 0.98), and procedural duration (MD 3.41; 95% CI ‐2.89 to 9.71; p = 0.29). However, PolarX was associated with higher persistent phrenic nerve palsy (OR 2.17; 95% CI 1.26–3.74; p = 0.005) and a lower nadir temperature in all veins. Additionally, in a subgroup analysis of randomized trials and propensity score matching studies, similar findings were noted for recurrence of atrial arrhythmias. Conclusion In patients with AF undergoing PVI, PolarX had similar acute PVI success, procedural duration, and recurrence of atrial arrhythmias as compared with standard cryoballoon technology, however, was associated with a lower nadir temperature, and higher rates of persistent nerve palsy.

Summary Introduction Postoperative delirium is a common complication following cardiac surgery. Despite its known impact on patient outcomes, effective preventative strategies remain elusive. We aimed to perform a comprehensive Bayesian network meta‐analysis of randomised controlled trials assessing the effect of pharmacological interventions on the incidence of postoperative delirium. Methods Databases were searched from inception to September 2024. Our search was updated in January 2025. Eligible studies included randomised controlled trials reporting the incidence of postoperative delirium in patients having cardiac surgery treated with pharmacological interventions. Bayesian models were used to estimate risk ratios (RR) and mean differences with 95%CrI through Markov chain Monte Carlo. Interventions were ranked using the surface under the cumulative ranking curve. Sensitivity analyses and grading of recommendations, assessment, development and evaluation assessment were conducted to evaluate the robustness and certainty of evidence. Results Seventy‐nine randomised controlled trials comprising 24,827 patients were included, with 29 pharmacological interventions compared. Dexmedetomidine combined with melatonin was the most effective intervention, reducing the incidence of postoperative delirium compared with placebo (risk ratio 0.31, 95%CrI 0.13–0.69; low certainty). Dexmedetomidine with melatonin also significantly decreased intensive care unit stay (2.4 days, 95%CrI ‐3.50–1.10) and hospital stay (1.32 days, 95%CrI ‐2.09 to ‐0.57). Other interventions, including ketamine and risperidone, showed potential efficacy but with low or very low certainty of evidence. Discussion We identified dexmedetomidine with melatonin as the most effective pharmacological strategy for preventing postoperative delirium following cardiac surgery. Whilst these findings highlight potential benefits, the low certainty of evidence underscores the need for more high‐quality primary evidence.

ABSTRACT Background High‐power short‐duration (HPSD) ablation has emerged as a promising alternative to conventional power delivery (CPD) for pulmonary vein isolation (PVI) among patients with atrial fibrillation (AF), though its efficacy, procedural efficiency, and safety profile remain uncertain. Aims To evaluate and compare the efficacy, procedural efficiency, and safety of HPSD versus CPD ablation strategies for PVI in patients with AF through a systematic review and meta‐analysis of randomized controlled trials (RCTs). Materials and Methods PubMed, Embase, Cochrane Library, and ClinicalTrials.Gov databases were systematically searched for RCTs comparing HPSD with CPD ablation for PVI in patients with AF. Random‐effects models were used to pool hazard ratios (HR) and risk ratios (RR) with 95% confidence intervals (CI). R version 4.4.2 was used for statistical analysis. Results Eight RCTs with 1094 patients (558 undergoing HPSD and 536 undergoing CPD ablation) were included. No significant differences were found in freedom from arrhythmia during the follow‐up period (HR: 0.77; 95% CI: 0.41–1.45; p = 0.424). AF recurrence did not differ (RR: 0.83; 95% CI: 0.59–1.16; p = 0.268) between groups. HPSD had a significantly shorter procedural (mean difference [MD]: −21.93 min; 95% CI: −31.34, −12.53; p < 0.001) and RF ablation times (MD: −13.87 min; 95% CI: −19.46, −8.27; p < 0.001). No differences were observed in fluoroscopy time and first‐pass isolation for right and left pulmonary veins. There was no difference in esophageal lesion rates, pericardial, or neurological complications, but there was a higher incidence of steam pops in HPSD (RR: 3.42; 95% CI: 1.45–8.09; p = 0.005). Discussion Although HPSD ablation did not significantly improve freedom from arrhythmia or reduce AF recurrence compared to CPD, it demonstrated enhanced procedural efficiency, with shorter procedure and RF ablation times. Despite the higher rate of steam pops, the overall safety profile was similar between both groups. Conclusion High‐power short‐duration ablation for pulmonary vein isolation in atrial fibrillation demonstrated comparable efficacy and safety to conventional power delivery, with the added benefit of shorter procedure and RF ablation times. However, HPSD ablation was associated with increased occurrence of steam pops.

Introduction: High-power short-duration (HPSD) ablation has emerged as a promising alternative to conventional power delivery (CPD) for pulmonary vein isolation (PVI) among patients with atrial fibrillation (AF). However, its efficacy, procedural efficiency, and safety profile remain uncertain. Methods: PubMed, Embase, Cochrane Library and ClinicalTrials.Gov databases were systematically searched for randomized controlled trials (RCTs) comparing HPSD with CPD ablation for PVI in patients with AF. Random-effects models were used to pool hazard ratios (HR) and risk ratios (RR) with 95% confidence intervals (CI). R version 4.4.2 was used for statistical analysis. Results: Seven RCTs with 1,006 patients (514 HPSD, 489 CPD) were included. No significant differences were found in freedom from arrhythmia during the follow-up period (HR 0.77; 95% CI 0.41–1.45; p=0.424). AF recurrence did not differ (RR 0.94; 95% CI 0.65–1.36; p=0.733) between groups. HPSD had a significantly shorter procedural (MD -22.61 min; 95% CI -33.18, -12.04; p<0.001) and RF ablation times (MD -15.70 min; 95% CI -20.86, -10.55; p<0.001). No differences were observed in fluoroscopy time and first-pass isolation for right and left pulmonary veins. There was no difference in esophageal lesion rates, pericardial, or neurological complications, but there was a higher incidence of steam pops in HPSD (RR 3.42; 95% CI 1.45–8.09; p=0.005). Conclusion: In patients with AF undergoing PVI, HPSD did not increase freedom from arrhythmia as compared with CPD ablation, however it was associated with shorter procedure and RF ablation times with a similar safety profile.