BACKGROUND: Data regarding catheter ablation of post-surgical atrial tachycardia occurring after mitral valve surgery are scarce. Through a search of the literature, this study aimed to assess the feasibility of catheter ablation and the characteristics of atrial arrhythmias ablated in these patients. METHODS: Studies assessing the main procedure parameters and the electrophysiologic findings of the investigated atrial tachycardia were selected. The electrophysiologic mechanism (focal vs. reentrant arrhythmias), site of arrhythmia origin (left atrium vs. right atrium) and their anatomic correlation with specific surgical access and/or prior Cox-Maze IV procedure were all addressed. RESULTS: Eleven studies including 206 patients undergoing catheter ablation of 297 post-surgical arrhythmia morphologies occurring after mitral valve surgery were considered. Major complications were observed in 2 patients only (0.9%). Restoration of sinus rhythm was achieved in 96% of patients. Macro-reentrant arrhythmia was mostly observed (90.4%) with a non-negligible proportion of focal arrhythmia (9.6%). Left-sided arrhythmia was common (54.4%,) but cavotricuspid isthmus-dependent arrhythmia was frequently reported (33%). Although specific atriotomies showed trends towards peculiar locations of the investigated arrhythmia, Cox-Maze IV procedure was the only independent predictor for left-sided arrhythmia (OR=17.3; 95% CI 7.2-41.2; p<0.0001). CONCLUSIONS: Catheter ablation of post-surgical arrhythmia occurring after mitral valve surgery is feasible, and, in this setting, the vast majority of the arrhythmia morphologies are based on macroreentry and in about one third of cases show cavotricuspid isthmus-dependent arrhythmia. Prior Cox-Maze-IV associated with mitral valve surgery is an independent predictor of left-sided arrhythmia possibly due to non-transmural surgical lesions.
BACKGROUND Long term efficacy and safety of either surgical or percutaneous treatment left main coronary artery disease treatment is lacking. METHODS We conducted a systematic review and meta-analysis of the most updated randomized clinical trials that compared the efficacy of coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) for the Left Main Coronary Artery (LMCA) disease. RESULTS We identified 6 studies, providing data on 5812 patients. The mean follow-up was 6.7 years. PCI was associated with an increased risk of major vascular events (MACE) (IRR 1.24, 95% confidence interval (CI) [1.03-1.67], p<0.01), and coronary revascularization (IRR 1.69, 95% CI [1.42-2.03], p<0.01) compared to CABG. Furthermore, all-cause death, MI and stroke events were not statistically different between the two therapeutic revascularization methodologies (IRR 1.06, 95% CI [0.90-1.24], p=0.47, IRR 1.35, 95% CI [0.84-2.16], p=0.03 and IRR 0.66, 95% CI [0.43-1.01], p=0.05, respectively). CONCLUSIONS LMCA PCI has an overall same survival compared to CABG in the long term follow up. Nevertheless, MACE and revascularization events were more frequent in PCI compared to CABG.
BACKGROUND: Takotsubo syndrome (TS) is an acute, reversible form of heart failure, often mimicking an acute coronary syndrome (ACS). Data regarding racial differences in TS are inconsistent. The aim is to assess clinical features associated with unfavorable in-hospital outcomes between African American (AA) and Caucasian (CAU) patients.METHODS: A retrospective electronic health record query identified 44 AA patients and 110 CAU patients with a diagnosis of TS. Our primary outcome was a composite of death, stroke, and cardiogenic shock during hospitalization. Variables associated with an increased risk of the primary composite outcomes were included in a logistic regression model.RESULTS: Compared to CAU patients, AA patients were a more comorbid population, and presented a higher prevalence of history of illicit drug use (27.3% vs 13.6% p=0.044). There were no significant differences regarding in-hospital complication rates between AA and CAU patients. In the logistic regression model, infection was associated with greater risk of developing the primary outcome in AA patients (OR=7.26 95% CI [1.22-43.17], p=0.029), whereas angina was a protective factor (OR=0.11 95% CI [0.02-0.65], p=0.015). In CAU patients, severely depressed ejection fraction and worse peak creatinine during hospitalization increased risk of developing the primary outcome (OR=5.88 95% CI [2.01-17.17], p<0.001 and OR=1.64 95% CI [1.15-2.58], p=0.031, respectively). Meanwhile, emotional stressors were protective (OR=0.16 95% CI [0.03-0.88], p=0.004).CONCLUSIONS: Despite experiencing the same rate of in-hospital complications, the clinical profiles of AA patients are distinct from CAU patients admitted for TS, and clinical variables correlated with worse in-hospital outcomes also differ by race.
