Hamed, Belal Mohamed

Mediastinal radiation potentiates aortic stenosis and complicates its treatment. We compared the short and midterm-outcomes with transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in patients with prior mediastinal radiation. Electronic databases were searched from inception through December 2024. Dichotomous outcomes were pooled as risk ratios (RRs), and continuous outcomes were pooled as mean differences (MDs) with respective 95% confidence intervals (CIs). Six observational studies were identified, including 2458 TAVR patients and 1873 SAVR patients. In the short-term, TAVR was associated with lower rate of mortality (RR: 0.54; 95% CI: 0.34–0.88), atrial fibrillation (RR: 0.31; 95% CI: 0.15–0.65), acute kidney injury (RR: 0.75; 95% CI: 0.59–0.95), bleeding (RR: 0.37, 95% CI: 0.33–0.42), and shorter length of hospital stay (MD: −4.30; 95% CI: −5.45 to −3.15). One-year mortality was comparable between the 2 groups (RR: 1.04; 95% CI: 0.50–2.13). This meta-analysis of observational studies of patients with prior mediastinal radiation demonstrated that TAVR was associated with better short-term outcomes compared to SAVR. While 1-year mortality appeared similar between the 2 interventions, this finding should be interpreted with caution. However, randomized controlled trials are needed to validate these findings.

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.

ABSTRACT Background Right bundle branch block (RBBB) has a high prevalence among heart transplant recipients and could influence outcomes. Crucially, the predictors of RBBB development after heart transplantation are not well‐established. Our study aims to evaluate the preoperative predictors and outcomes of RBBB following heart transplantation. Methods PubMed, Scopus, Web of Science, and Cochrane Library were searched up to November 15, 2024, to identify studies comparing heart transplant recipients with RBBB and without RBBB. Random‐effects models were used to estimate the pooled mean difference (MD) and risk ratios (RRs) with 95% confidence intervals (95% CIs). Results Nine studies incorporating 1507 patients were included. Patients who developed RBBB had higher graft ischemia time [MD: 10.0; 95% CI: 2.00–17.91; p = 0.01] and pulmonary vascular resistance (PVR) (MD: 0.44; 95% CI: 0.21–0.68; p < 0.001). There was no significant difference between RBBB and non‐RBBB patients in terms of pulmonary artery pressure (MD: 1.83; 95% CI: ‐0.86–4.53; p = 0.18) or donor age (MD: 1.51; 95% CI: ‐0.30– 3.31; p = 0.10). There was no significant difference in the prognosis of RBBB patients in terms of acute rejection (RR: 1.06; 95% CI: 0.70–1.61; p = 0.78), chronic rejection (RR: 0.92; 95% CI: 0.60–1.41; p = 0.70), or mortality (RR: 1.87; 95% CI: 0.81–4.31; p = 0.14). Conclusion Despite the association of RBBB with graft ischemia time and PVR, post‐transplant RBBB had no significant impact on mortality or graft rejection. Further research focusing on the identification period and applied definition of RBBB is recommended.