VARGHESE, BEN

Background: Papillary Muscle (PM) related ventricular arrhythmia ablation is associated with lower acute success and suboptimal long-term outcomes due to complex anatomy, variable arrhythmogenic sites and dynamic exit points. Objective: To evaluate clinical and procedural outcomes of patients undergoing PM vs non-PM ablation. Methods: A retrospective analysis of adults (≥18 years) undergoing PVC ablation at Mayo Clinic (2019–2024) matched PM PVC ablations to controls (1:2) using propensity scoring based on age, sex, comorbidities and baseline LVEF. Chi-square and t-tests compared baseline and procedural characteristics. Logistic regression estimated odds ratios for immediate procedural success, PVC burden reduction and LVEF improvement at 3 months. Results: Of the 720 ablations, 392 cases were included after propensity matching: 132 PM and 260 non-PM. Patients in the PM group exhibited higher rates of complicated diabetes (9.8% vs 4.6%, p =0.045) and prior MI (18.2% vs 9.2%, p =0.011). Preprocedural ECG PVCs in the PM group showed a shorter intrinsicoid deflection (89.1 ± 35.0 msec vs 100.7 ± 24.3 msec, p <0.001) and longer coupling intervals (532.7 ± 100.3 vs 512.2 ± 81.4 msec, p =0.048).Moderate-to-severe MR was more prevalent in the PM group (17.4% vs 10.0%, p =0.036). Intraoperatively, the PM group had higher total energy delivery times (1939 ± 1336 sec vs 1227 ± 1033 sec, p <0.001) and more frequent cryoablation use (46.2% vs 7.3%, p <0.001). During post-ablation testing, non-clinical PVC was inducible in 39.5% of the cases in PM group compared to 25.7% in non-PM group ( p =0.005). More patients in the PM group were discharged on atleast one antiarrhythmic drug (AAD)(35.9% vs 18.5%, p <0.001) and AAD use persisted at 3 months (31.3% vs 18.4%, p =0.004). Outcomes were similar between groups, with no significant differences observed in immediate ablation success (aOR 0.64, p = 0.063, CI = 0.40-1.03), or >5% improvement in LVEF (aOR 0.76, p = 0.29) and PVC burden reduction (aOR 0.93, p = 0.81) at 3 months follow up. Conclusion: Patients undergoing PM ablation exhibited higher baseline rates of comorbidities. Intraoperatively they required greater energy delivery times, and an increased use of cryoablation. Postoperatively, a larger proportion of PM ablation patients required antiarrhythmic drug therapy. Despite these complexities, PM ablation showed no significant differences in PVC burden reduction, LVEF improvement, or procedural success compared to non-PM ablation.

Introduction: Older age and multimorbidity observed in individuals with dementia may impact both the care they receive and their outcomes in the setting of acute coronary syndrome (ACS). We conducted an analysis of ACS hospitalizations in the US to examine whether disparities exist between patients with and without dementia in percutaneous coronary intervention (PCI) use and ACS-related outcomes after accounting for age and comorbidities. Methods: We used the Nationwide Readmissions Database 2021 to identify adults hospitalized with a primary diagnosis of ACS, including STEMI and NSTEMI. Propensity scores for dementia were calculated using 33 baseline characteristics, including age, sex, insurance, income, hospital characteristics, Charlson comorbidity index, and other relevant comorbidities. We performed 1:1 nearest-neighbor matching with a caliper of 0.2 standard deviations. After matching, we compare the following outcomes of people with and without dementia: receipt of PCI, mechanical complications of ACS, cardiogenic shock, mechanical circulatory support, inpatient mortality, length of stay, and hospitalization cost, and reported odds ratios or mean difference, 95% confidence interval, p-value. Survey weights were applied to ensure national representativeness. Results: Among 295,396 patients hospitalized with ACS, 7,143 had dementia. After matching, 7,142 patients with and without dementia were identified for analysis ( Figure 1 ). Covariate balance was achieved (all standardized mean differences <.1). Patients with dementia were 28% less likely to undergo PCI (0.72 [0.67–0.77], p<.001) and 78% more likely to develop cardiogenic shock (1.76 [1.58–1.95], p<.001), 82% more likely to require mechanical circulatory support (1.82 [1.61–2.05], p<.001), and 16% more likely to die during hospitalization (1.16 [1.04–1.30], p<.01) ( Figure 2 ). No significant difference was observed in mechanical complications of ACS (0.89 [0.33–2.33], p=.81). Patients with dementia had longer hospital stays (9.27 vs. 5.89 days; mean difference 3.38 [3.06-3.7] days, p<.001) and higher hospitalization costs ($182,649 vs. $130,233; mean difference $52,416 [$44,618- $60,215], p<.001). Conclusion: In this analysis of US hospitalizations for ACS, dementia was independently associated with lower PCI rates and worse ACS-related outcomes despite accounting for age and comorbidities. Further research is needed to understand and address these inequities in ACS management in patients with dementia.