Barsoom, Ramez

ABSTRACT Background In patients with atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF), atrioventricular node ablation (AVNA) and permanent pacing are often pursued when rhythm control is not pursued. Biventricular pacing (BiVP) has demonstrated benefits over right ventricular pacing, while conduction system pacing (CSP) has emerged as an alternative. However, evidence directly comparing CSP with BiVP in this high‐risk population remains inconsistent. Objective To compare CSP versus BiVP in patients with AF and HFrEF undergoing AVNA, focusing on cardiac function, clinical outcomes, and procedural metrics. Methods Following PRISMA guidelines, we searched PubMed, Scopus, and Web of Science through February 2026 for studies comparing CSP and BiVP in adults with AF and HFrEF undergoing AVNA. Outcomes included all‐cause mortality, heart failure hospitalization (HFH), changes in left ventricular ejection fraction (LVEF), QRS duration, New York Heart Association (NYHA) class, pacing threshold, procedure duration, and fluoroscopy duration. A random‐effects model was used to pool mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals (CIs). Results Six studies (one randomized crossover trial and five observational studies; N = 766 patients: CSP = 356, BiVP = 410) were included. All‐cause mortality was significantly reduced in favor of CSP (RR 0.64 [CI: 0.44 to 0.94], p = 0.02, I 2 = 0%). There was also a trend towards lower HFH, but it marginally missed statistical significance (RR 0.77 [CI: 0.58 to 1.03], p = 0.08; I 2 = 0%). Additionally, CSP decreased NYHA class (MD ‐0.64 [CI: −1.18 to −0.10], p = 0.02; I 2 = 85%) and significantly reduced QRS duration (MD −33.56 ms [CI: −52.36 to −14.76], p = 0.0005; I 2 = 97%). LVEF improvement did not significantly differ between groups (MD 4.51% [95% CI: −1.50 to 10.52], p = 0.14; I 2 = 98%). Procedure duration and fluoroscopy times did not show statistically significant difference between the two groups (MD −11.54 min [CI: −50.05 to 26.97], p = 0.56, I 2 = 96%), and (MD −5.75 min [CI: −13.13 to 1.63], p = 0.13, I 2 = 88%), respectively. Overall pacing thresholds did not significantly differ between CSP and BiVP; however, modality‐specific subgroup analysis showed comparable thresholds between HBP and BiVP, whereas LBBP was associated with significantly lower pacing thresholds than BiVP. Conclusions Among patients with AF and HFrEF undergoing AVNA, CSP may offer symptomatic and electrocardiographic advantages over BiVP, with a possible signal toward improved major clinical outcomes that requires confirmation in larger randomized studies.

Abstract Background Obesity is a major public health concern and a leading contributor to premature mortality worldwide. While body mass index (BMI) has long been the standard measure for assessing obesity-related health risks, it fails to distinguish between fat and lean mass or capture the distribution of adiposity—key determinants of metabolic and cardiovascular (CV) health. The Body Roundness Index (BRI), a novel anthropometric measure incorporating waist circumference and height, offers a more precise assessment of body fat distribution and its associated health risks. Although prior studies have linked BRI to all-cause and CV mortality in general populations, its predictive value for premature mortality and potential disparities remain unexplored. Purpose To investigate the association between BRI and premature all-cause (primary outcome) and cardiovascular-specific mortality (secondary outcome) in U.S. adults younger than 65 years. Additionally, we examine whether these associations vary across sociodemographic subgroups. Methods We conducted a nationally representative cohort study using the National Health and Nutrition Examination Survey (NHANES) data (1999–2018) linked to mortality records through December 31, 2019. Adults younger than 65 years were included, excluding those with CV disease or missing covariates. BRI, derived from waist circumference and height, was categorized into quintiles (Q3 as reference). Premature mortality was defined as deaths before age 65. Multivariable Cox proportional hazards models, accounting for NHANES’ complex survey design, were used to assess associations and ensure nationally representative estimates. Nonlinear relationships were examined using restricted cubic splines. Results Among 29,016 (weighted N=1,349,437,788) adults (mean age 42 years; 50% female), 751 premature deaths occurred over a median follow-up of 10 yrs, including 163 attributed to CV causes. In fully adjusted models*, participants in the highest BRI quintile (Q5 vs. Q3) had a 47% higher risk of premature all-cause mortality (HR 1.47; 95% CI, 1.12–1.93; p=0.006) and a 96% higher risk of premature cardiovascular mortality (HR 1.96; 95% CI, 1.12–3.41; p=0.02; Fig.1). Subgroup analyses indicated that the association between high BRI and premature mortality was most pronounced among middle-aged adults (45-64 years: HR 1.80; p-interaction=0.004), males (HR 1.66; p=0.006), and Hispanics (HR 2.17; p=0.007). Similar patterns were observed for premature cardiovascular mortality (Fig.2). Conclusions High BRI is independently associated with increased risks of premature all-cause and cardiovascular mortality, with the strongest effects observed in middle-aged adults. These findings highlight the potential of BRI in risk stratification and underscore the need for targeted interventions to address disparities in premature mortality. Integrating BRI into preventive cardiology and public health strategies may help reduce early mortality.Figure 1 Figure 2

Abstract Aims Obesity, particularly visceral adiposity, is a key driver of cardiovascular mortality (CVM), yet conventional measures such as body mass index (BMI) inadequately capture fat distribution. The Body Roundness Index (BRI) is a novel anthropometric measure integrating waist circumference and height to better reflect body shape and visceral fat. This study examined the association between BRI and CVM in U.S. adults and across sociodemographic subgroups. Methods and results We analysed data from 31 351 adults (median age 43 yrs, 50% females) aged ≥20 years in NHANES 1999–2018, excluding those with prior cardiovascular disease or cancer. BRI was computed using a validated equation and categorized into quintiles (Q3 as reference). The primary outcome was CVM; secondary outcomes included all-cause, heart disease, and cerebrovascular mortality. Weighted Cox proportional hazards and restricted cubic spline (RCS) models evaluated associations after adjustment for demographic, behavioural, and clinical factors. Subgroup and sensitivity analyses tested consistency and effect modification. During a median follow-up of 10.1 years (IQR: 5.3–14.9 years), 883 cardiovascular deaths occurred. In fully adjusted models, participants in the highest BRI quintile had a 54% higher risk of CVM (HR, 1.54; 95% CI, 1.13–2.08; P = 0.006) vs. Q3. This risk remained high even among those with normal BMI. RCS analysis indicated a modest U-shaped association. Stronger effects were observed among middle-aged adults (45–64 years) and those with higher educational attainment. Conclusion Higher BRI is independently associated with increased cardiovascular mortality, particularly among middle aged adults and those with normal BMI, underscoring its potential as a practical, noninvasive tool for cardiovascular risk stratification. Incorporating BRI into clinical and public health assessment may improve identification of individuals at elevated risk.

Background: We conducted an updated meta-analysis of the routine use of cerebral embolic protection (CEP) devices in Transcathter Aortic Valve Replacement (TAVR). This analysis follows the recent BHF PROTECTED TAVI trial which is the largest randomized controlled trial to date. Methods: Electronic databases were searched through April 2025 for eligible randomized controlled trials (RCTs). The primary outcome was overall incidence of stroke, disabling stroke and non-disabling stroke all reported at 2-5 days and 30 days were primary outcomes for our analyses. Results: 8 RCTs with a total of 11,692 patients were included. No statistically significant difference was found between CEP group and the control group in overall stroke incidence at 2-5 days and 30 days as the following (RR=0.95, 95%CI: [0.75,1.19], p=0.64) and (RR=0.93, 95%CI: [0.57,1.53], p=0.79). Similarly, the pooled analysis revealed no statistically significant difference between the two groups in terms of disabling stroke at 2-5 days (RR=0.70, 95%CI: [0.41,1.18], p=0.18), and at 30 days (RR=1.18, 95%CI: [0.36,3.87], p=0.78). CEP group and control group didn’t show statistically significant difference in non- disabling stroke at 2-5 days and 30 days as the results showed: (RR=1.17, 95%CI: [0.84,1.63], p=0.36) and (RR=0.86, 95%CI: [0.49,1.51], P=0.61) respectively. Conclusion: Our meta-analysis found no statistically significant evidence that cerebral embolic protection (CEP) devices reduce the incidence of stroke—disabling or non-disabling in the 2-5 days following TAVR or after 30 days. Major bleeding, major vascular complication and AKI showed no statistically significant results indicating a neutral safety profile.

Background: Resistant hypertension (RH), defined as uncontrolled blood pressure (BP) despite ≥3 antihypertensive agents at maximally tolerated doses, remains a significant therapeutic challenge. Device-based renal denervation (RDN), using either radiofrequency (RF) or ultrasound (US) ablation, has shown promise in reducing BP. While both methods have demonstrated efficacy versus sham controls in randomized controlled trials (RCTs), direct comparisons remain limited. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of RF- and US-based RDN in patients with resistant hypertension. Methods: Following PRISMA guidelines, we searched PubMed, Scopus, and Web of Science through April 2025 for RCTs comparing RDN versus sham in RH. Eligible trials reported systolic or diastolic BP outcomes via ambulatory, office, or home measurements. Pooled mean differences (MD) and risk ratios (RR) were calculated using a random-effects model. Subgroup analyses were conducted by RDN modality and follow-up duration. Results: Seventeen RCTs met inclusion criteria. RDN significantly reduced ambulatory systolic BP (MD: −3.14 mmHg; 95% CI: −5.30 to −0.98; p=0.004) and diastolic BP (MD: −1.40 mmHg; 95% CI: −2.45 to −0.35; p=0.009) compared to sham. RF-based RDN showed consistent statistically significant reductions in both SBP and DBP across ambulatory and in-office measurements. In contrast, US-based RDN demonstrated variable efficacy, with only daytime DBP showing a marginal benefit (MD: −1.32 mmHg; p=0.04). Safety outcomes, including mortality, acute kidney injury, hypertensive crisis, and hypotension, were similar between groups. Conclusion: RDN offers a significant BP-lowering effect in resistant hypertension, with RF-based RDN yielding more consistent benefits across diverse measurement settings. US-based RDN showed limited but promising effects. Both techniques demonstrated acceptable safety profiles. Further head-to-head trials are needed to confirm long-term comparative effectiveness.