Citations

ABSTRACT Background Patients with cancer undergoing cardiac implantable electronic device (CIED) implantation face unique challenges. This study evaluates the outcomes and implications of CIED implantation in this population. Methods Using data from the National Readmission Database (NRD) from 2016 to 2019, we analyzed CIED implantations in patients aged ≥18 years, categorized by cancer status: no cancer, historical cancer, and active cancer. Multivariable logistic and linear regression models assessed associations with in‐hospital, 30‐day, and 90‐day outcomes, adjusting for various patient characteristics. Results A total of 748,957 CIED procedures were analyzed among which 13.3% were in patients with historical cancer and 3.8% with active cancer. Active cancer was linked to higher odds of pacemaker implantation but lower odds for ICD and CRT devices. Patients with active cancer experienced higher index hospitalization mortality (aOR 1.68; 1.50–1.89; p < 0.001), major adverse cardiovascular events (aOR 1.07; 1.02–1.14; p = 0.01), bleeding (aOR 1.36; 1.27–1.46; p < 0.01), and sepsis‐related (aOR 1.31; 1.19–1.44; p < 0.01) complications, with increased readmission rates at 30 (aOR 1.37; 1.30–1.44; p < 0.01) and 90 days (aOR 1.37; 1.31–1.44; p < 0.01) compared to those without cancer. Historical cancer was associated with better outcomes. Key predictors of adverse outcomes included chronic heart failure, kidney disease, cerebrovascular disease, and protein‐calorie malnutrition. Conclusions Patients with active cancer undergoing CIED implantation have an increased risk of in‐hospital complications and readmissions as compared to those without cancer.

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.

ABSTRACTBackgroundEsophageal‐pericardial fistula (EPF) is rare with an incidence of 0.016%–0.04%. With novel procedures involving intracardiac or esophageal instrumentation in the last few decades, including atrial fibrillation (AF) ablation, further understanding of this unique entity is warranted. In this systematic review, we summarize the etiology, diagnostic features, management, and outcomes of EPF.MethodsA librarian conducted a systematic literature review of case reports/series describing adults diagnosed with EPF through 7 major databases/registries from inception to 7/30/2024.ResultsOne hundred twenty patients from 115 papers met the inclusion criteria. Median age(IQR) was 57(44–67) years, with a male predominance (73.7%). The primary etiology of EPF shifted from benign esophageal diseases before 2000 to AF ablation on/after 2000. Median time(IQR) from AF ablation to EPF presentation/diagnosis was 17(13–23) days. Chest pain (70.8%) and pneumopericardium (90.0%) were, respectively, the most common presenting symptom and pericardial finding. Water‐soluble contrast esophagram (WSCE) had the highest diagnostic sensitivity (82.8%). Management included surgery (47.5%), stent placement (22.5%), combined surgery/stenting (19.2%), and conservative (10.8%). Overall mortality was 37.5%; median(IQR) time to death was 20(9–41) days. EPF from malignancy had poorer survival than those from benign esophageal causes (HR 2.65 [1.36–5.17]; p = 0.004) and cardiac ablation (HR 5.74 [2.41–13.65]; p < 0.0001). Patients who received any intervention (HR 0.28 [0.13‐0.57]; p = 0.0005) or had confirmed EPF resolution (HR 0.27 [0.12–0.59]; p = 0.0009) demonstrated better survival. There was no difference in survival between surgery and stenting alone (p = 0.91).ConclusionsAF ablation is now the leading etiology of EPF. Given its high mortality, a high degree of clinical suspicion is essential in those presenting with key signs/symptoms following AF ablation to enable urgent diagnosis and multi‐disciplinary management. WSCE may be the diagnostic modality to perform, given its high sensitivity. Future studies are warranted to investigate whether stenting should be the primary management given possible non‐inferiority to surgery.

ABSTRACT Background Transvenous lead removal (TLR) is a Class I indication for patients with cardiac implantable electronic device (CIED) infections. However, disparities in the utilization of TLR have not been fully explored, particularly concerning demographic and socioeconomic factors. Objectives This study aims to examine whether disparities exist among patients hospitalized for CIED infections with respect to the utilization of TLR, focusing on sex, race, and income characteristics. Methods We utilized the 2019 National Inpatient Sample (NIS) to assess patients hospitalized with CIED infections and identify those who underwent TLR. Multiple logistic regression was used to examine risk factors for TLR utilization, including age, sex, race/ethnicity, and socioeconomic characteristics. Results A total of 56 709 patients were hospitalized for CIED infection in the United States in 2019, of which 9867 (17.4%) underwent TLR. On an adjusted analysis, females and Black patients were found to have lower odds of undergoing TLR compared to males and White patients (OR: 0.62; 95% CI: 0.59–0.78; p < 0.01; and OR: 0.47; 95% CI: 0.39–0.57; p < 0.01, respectively). Hispanic patients also had reduced odds of TLR (OR: 0.73; 95% CI: 0.58–0.93; p = 0.01). No significant associations were observed between income or insurance status and the likelihood of receiving TLR after adjustment. Conclusions This study identified significant disparities in the utilization of TLR among patients hospitalized for CIED infections. Female, Black, and Hispanic patients were significantly less likely to receive TLR.

Background: The safety and cost of concomitant atrial fibrillation (AF) ablation and left atrial appendage occlusion (LAAO) procedure remain unknown. Objective: The study sought to determine real-world outcomes of AF patients who underwent LAAO with ablation. Methods: The National Inpatient Sample and International Classification of Diseases–Tenth Revision codes were used to identify patients who underwent LAAO with and without AF ablation during the years 2016-2022. The outcomes assessed included procedural complications and resource utilization. Results: LAAO with AF ablation was associated with a higher rate of overall complications (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.37-1.74), major complications (OR 1.38, 95% CI 1.18-1.60), non-home discharge (OR 1.55, 95% CI 1.23-1.96), prolonged length of stay >1 day (OR 3.21, 95% CI 2.92-3.52), and increased hospitalization costs as defined by median cost >$25,926 (OR 19.42, 95% CI 16.21-23.25) when compared to LAAO alone after adjustment for potential confounding variables. Patients who underwent LAAO with ablation were also more likely to receive pacemaker implantation (3.6 % vs 0.2%, P < 0.001) and experience acute kidney injury (3.9% vs 2.1%, P < 0.001) and non-ST elevation myocardial infarction (3.7% vs 1.5%, P < 0.001). Conclusion: In a large, contemporary, real-world study of LAAO procedures in the United States, concomitant AF ablation was associated with a higher rate of overall and major complications and an increased resource utilization.

ABSTRACT Background Cardiac implantable electronic device (CIED) infections are a serious complication associated with significant morbidity, mortality, and healthcare costs. Despite guideline recommendations for complete device removal, disparities in healthcare access and resource availability between urban and rural settings may influence patient outcomes. This study aims to evaluate rural–urban disparities in the management and outcomes of patients hospitalized with CIED infections. Methods A retrospective cohort analysis was conducted using the National Readmissions Database (NRD) from 2016 to 2021. Patients aged ≥ 18 years hospitalized with CIED infections were identified using ICD‐10 codes. Hospital location was categorized as urban or rural based on the Urban Influence Codes. Baseline characteristics, complications, and outcomes were compared using chi‐square and t ‐tests, and a multivariable logistic regression model was employed to assess the independent association of hospital settings with transvenous lead removal (TLR) utilization. Results A total of 288,402 patients were hospitalized for CIED infections, with 94.9% treated in urban hospitals and 5.1% in rural hospitals. Urban hospital patients had a higher prevalence of key comorbidities, including heart failure, valvular heart disease, atrial fibrillation and peripheral vascular disorders. In‐hospital mortality was significantly higher in urban hospitals (6.2% vs. 4.8%, p < 0.01) likely due to higher burden of comorbidities and higher rates of acute complications such as stroke (3.1% vs. 1.8%, p < 0.01) and systemic embolism (1.4% vs. 0.7%, p < 0.01). TLR was more frequently performed in urban hospitals (20.1% vs. 9.6%, p < 0.01), with rural hospitals exhibiting 59% lower odds of receiving TLR (OR: 0.41, 95% CI: 0.36–0.47, p < 0.01). TLR was associated with reduced in‐hospital mortality, 30‐day mortality, and 30‐day readmission rates across both hospital settings. Conclusion Our study highlights significant rural–urban disparities in CIED infection management. Despite rural hospitals admitting patients with a lower comorbidity burden, TLR utilization was significantly lower, potentially due to limited access to specialized expertise and procedural resources. Given TLR's association with improved survival and reduced readmissions, regardless of the hospital setting, targeted interventions are needed to enhance access to specialized care in rural settings. Further research is warranted to explore strategies for bridging these disparities and optimizing CIED infection outcomes nationwide.

Abstract Aims We aimed to perform a retrospective cohort study using the Centers for Disease Control and Prevention’s (CDC’s) Wide-Ranging Online Data for Epidemiologic Research (WONDER) database to analyse the trends in cardiovascular disease (CVD)–related mortality in patients with myeloproliferative neoplasms (MPNs) from 1999 to 2020. Methods and results We analysed the death certificate data from the CDC WONDER database from 1999 to 2020 for CVD with co-morbid myeloproliferative disorders in the US population. Age-adjusted mortality rates (AAMRs) and 95% confidence intervals (CIs) were computed per 1 million population by standardizing crude mortality rates to the 2000 US census population. To assess annual national mortality trends, we employed the Joinpoint regression model, calculating the annual per cent change in AAMR and corresponding 95% CIs. A total of 15 269 deaths related to CVD occurred in patients with co-morbid MPNs from 1999 to 2020. Overall, there was a decreasing trend in CVD-related AAMRs throughout these years. Males contributed to 51% of total deaths, and their AAMR was persistently higher than women throughout the study. Non-Hispanic (NH) Whites had the highest overall AAMR, followed by NH Blacks, NH American Indians or Alaska Natives, Hispanics or Latinos, and NH Asian or Pacific Islanders. Conclusion Our findings indicate a significant decline with notable gender, racial/ethnic, and regional differences in CVD-related mortality among patients with MPN over the past two decades. We emphasize the importance of a collaborative approach between oncologists and cardiologists in managing these patients, highlighting the potential benefits of integrating cardio-oncology services to enhance patient outcomes.