Acute myocardial infarction leads to myocardial inflammation and necroptosis, and is a major cause of heart failure, cardiovascular dysfunction, and mortality. Adverse remodeling and myocardial fibrosis following myocardial infarction are key pathophysiological processes contributing to poor prognosis. Licorice, a widely utilized herb and food, contains glabridin, a bioactive component that acts as a potent PPARγ agonist. Glabridin has demonstrated multiple beneficial biological effects, including antioxidative stress, anti-inflammation, anti-atherosclerosis, and tumor progression inhibition. However, its role in cardiovascular diseases remains understudied. Using C57BL/6 mice, a myocardial infarction model was established via left coronary artery ligation. Mice were treated with glabridin by oral gavage daily for 4 consecutive weeks post-surgery. Cardiac function and various indicators were assessed to evaluate the therapeutic effects. Additionally, primary cardiac fibroblasts were isolated from the mice for in vitro experiments to verify the effects of glabridin and further explore its mechanism of action. Glabridin treatment significantly improved cardiac fibrosis and alleviated cardiac dysfunction in mice. Mechanistically, glabridin activates PPARγ, thereby promoting the ubiquitination and degradation of EGFR, inhibiting the activation of the downstream PI3K/Akt signaling pathway, and mitigating myocardial fibrosis progression. Glabridin links the PI3K/Akt pathway and promote EGFR ubiquitination, offering insights into myocardial fibrosis mechanisms and potential therapeutic targets.

Background Conduction system pacing (CSP), including His bundle pacing (HBP) and left bundle branch area pacing (LBBAP), offers a physiological alternative to conventional pacing. However, current evidence is limited by small sample sizes, short follow-up, and inconsistent LBBAP definitions. Objective This study evaluated the long-term outcomes, safety, and lead performance of CSP in a large multicenter cohort, and provided a precise LBBAP classification for investigating its impact on clinical outcomes. Methods This prospective registry-based study included patients receiving CSP at 5 Chinese centers from 2019 to 2021. LBBAP was classified as left bundle branch pacing (LBBP), left ventricular septal pacing (LVSP), or unclassified LBBAP based on the presence, absence, or uncertainty of left bundle branch capture. Pacing and clinical outcomes were analyzed. Results Of 3,336 enrolled patients, 3,167 successfully received CSP (557 HBP, 2,610 LBBAP), with a mean follow-up of 41.3 ± 14.0 months. LBBAP comprised LBBP (84.2%), unclassified (12.5%), and LVSP (3.3%). In patients with LBBB and heart failure with reduced ejection fraction, LBBP and HBP achieved the greatest LVEF improvements (+20.7% and +21.9%), while LVSP showed the least (+12.1%). LVSP was associated with higher mortality or heart failure hospitalization (33.3%) compared with LBBP (8.6%) and unclassified LBBAP (15.4%). Threshold increases ≥1 V/0.5 ms occurred in 5.03% HBP vs 1.80% LBBAP (P < 0.001). Procedural complications (excluding threshold rise) occurred in 1.3% of both groups. Conclusions CSP demonstrated long-term safety and stability. Subclassification of LBBAP enhances clinical precision, with LBBP capture yielding a higher positive clinical outcomes and LVSP with inferior outcomes, especially in cardiac resynchronization therapy patients.

The development of flexible electronic devices necessitates materials with high piezoelectric performance. Poly(L-lactic acid) (PLLA) nanofiber-based piezoelectric membranes hold promise for self-powered health monitoring and tissue repair, yet their intrinsic piezoelectric performance remains insufficient for practical applications. Here, we develop a multi-path strategy to enhance the piezoelectric properties through crystallography and hierarchical design of PLLA fibers. We also demonstrate that incorporating high-aspect-ratio needle-like hydroxyapatite (HAp) into PLLA optimizes crystallinity and enhances piezoelectric output. Building upon this, we construct PLLA-HAp/PLLA composite fiber membranes with topological structures to further amplify the piezoelectric effect. Notably, low-concentration HAp dispersed within random PLLA fibers induces stress concentration at the interface with aligned PLLA fibers, resulting in satisfactory piezoelectric performance. In the impact mode and bending mode, the piezoelectric output is approximately 6 and 14 times that of pure PLLA fiber, respectively. The optimized fiber membranes demonstrated excellent potential for monitoring human physiological activities, as validated by subsequent experiments that successfully recorded porcine joint movements and heart rates. This piezoelectric enhancement strategy offers a new approach for next-generation high-performance piezoelectric devices, with broad applicability in health monitoring and tissue engineering.

Cardiac pacemakers are effective interventions for arrhythmias. However, conventional pacemakers lack the capability for real-time monitoring of hemodynamic parameters, which are crucial for diagnosing cardiovascular diseases and optimizing pacing parameters. Moreover, lead dislodgement, a common complication, can lead to serious consequences such as pacing failure. In this work, we developed a multi-functional passive fixation lead using force-electric conversion materials, enabling simultaneous continuous monitoring of intracardiac blood pressure and real-time evaluation of the lead's fixation status. In vitro and in vivo experiments demonstrated that the system allows for minimally invasive implantation, accurately captures blood pressure changes and can identify lead dislodgement. This study provides an integrated solution for precise diagnosis and treatment of cardiovascular diseases, offering significant potential for clinical application.

Background For patients with a high risk of sudden cardiac death, despite the benefits of an implantable cardioverter defibrillator (ICD), some patients are still at high risk of death.Aim The purpose of this study was to develop and validate a nomogram predicting all-cause mortality for patients with an ICD.Methods We retrospectively analysed the data of multicentre ICD registration study from 2010 to 2014 in China. A total of 617 ICD patients formed a development cohort. The physical activity monitored by ICD and clinical data was collected. Univariate and multivariate Cox regression analyses were used to screen mortality predictors and construct the nomogram. The performance of the nomogram was evaluated by the consistency index (C-index) and the calibration curve. Additionally, extensive subgroup and sensitivity analyses were conducted to evaluate the model’s robustness. A total of 196 ICD patients formed a validation cohort.Results In the development cohort, physical activity, diabetes and left ventricular end-diastolic diameter were selected as independent prognostic factors. The nomogram was constructed by these three factors. The C-index of the nomogram was 0.80 (95% CI 0.75 to 0.84). The calibration curve showed that the predicted survival probability of the nomogram was in good agreement with the actual survival probability. In the validation cohort, the C-index of the nomogram was 0.74 (95% CI 0.64 to 0.84), and the calibration curve still maintained good consistency. Crucially, the nomogram maintained stable and excellent discriminative capacity across primary and secondary prevention subgroups, as well as for predicting specific cardiac and sudden cardiac death.Conclusions Our study develops and validates a nomogram predicting all-cause mortality for patients with an ICD by integrating the physical activity monitored by ICD and clinical data. The nomogram performs well and can provide personalised death risk assessment for ICD patients.Trial registration number ChiCTR-ONRC-13003695.

Both obesity and oxidative stress are closely linked to leukocyte telomere length (LTL) shortening, yet the specific mediating role of total bilirubin in this association remains insufficiently explored. This study aimed to quantify the extent to which total bilirubin, a potent endogenous antioxidant, mediates the association between obesity and LTL. We analyzed data from 6,717 adults participating in the National Health and Nutrition Examination Survey 1999–2002. Causal mediation analysis with 1,000 bootstrap iterations was employed to investigate the mediating effect of serum total bilirubin on the association between body mass index (BMI) and LTL. In the fully adjusted model, BMI was significantly and inversely associated with LTL, with a total effect of -3.532 base pairs (bp) per 1-unit increase in BMI (95

BACKGROUND:Desmoglein 2 (DSG2)-associated cardiomyopathy represents a distinct subset of arrhythmogenic cardiomyopathy. A founder variant, NM_001943.5 (DSG2): c.T1592G (p.Phe531Cys), was identified with high frequency in China. OBJECTIVE:The study aimed to describe clinical features and outcomes of this founder variant. METHODS:Individuals with DSG2 c.T1592G (p.Phe531Cys) variants were recruited from 9 centers across China and categorized as single heterozygous, compound heterozygous (single variant plus rare variants of uncertain significance; abbreviated as compound), and homozygous. Clinical features and risk factors for malignant ventricular arrhythmias (MVAs), end-stage heart failure, and composite events of heart transplantation or cardiac death were analyzed. RESULTS:91 subjects were included: 21 (23.1%) single heterozygous, 21 (23.1%) compound, and 49 (53.8%) homozygous. Most subjects (74.7%) showed right ventricular dilatation, and nearly half (49.5%) had biventricular involvement. In patients with contrast-enhanced magnetic resonance imaging, 75.9% exhibited biventricular involvement. Compared with single heterozygous variant carriers, compound and homozygous variant carriers had a younger age at onset, more T-wave inversion, epsilon waves, and biventricular involvement (all pairwise P < .05). Homozygous variant carriers experienced significantly earlier MVA than compound (P = .013) and single heterozygous variant carriers (P < .001), with a trend toward earlier MVA in compound than single heterozygous variant carriers (P = .089). Compound and homozygous variant carriers exhibited significantly higher incidences of end-stage heart failure and composite events, whereas single heterozygous variant carriers remained event-free (all P < .05). CONCLUSION:DSG2 c.T1592G (p.Phe531Cys) founder variant defines a distinct arrhythmogenic cardiomyopathy subset with a high prevalence of biventricular involvement. Single heterozygous variant carriers held a less severe phenotype and relatively favorable prognosis, whereas compound and homozygous variant carriers held an advanced phenotype and poorer prognosis.

Lifelong pacing is one of the ultimate goals of cardiac pacemakers. However, meeting the critical energy condition for lifelong service is a tremendous challenge. Here we report a symbiotic transcatheter pacemaker that regenerates electric energy from heart motion via electromagnetic induction and surpasses the critical energy condition for lifelong service. The pacemaker can be closely integrated with the body owing to favourable biocompatibility and hemocompatibility, and its small size enables interventional delivery. To minimize energy loss and eliminate mechanical collision and friction, we propose a straightforward magnetic levitation energy cache structure. The energy regeneration module has a near-zero boot threshold, high kinetic energy conversion efficiency and intracardiac root mean square output power. We show the energy regeneration and therapeutic function of the symbiotic transcatheter pacemaker over a month-long autonomous operation in a porcine model of brady-arrhythmia. These advances may provide a potential path to extend the service life of pacemakers to the level of the natural heart. A self-powered symbiotic transcatheter pacemaker that regenerates energy via electromagnetic induction from the cardiac motion demonstrates a month-long operation in a porcine model of arrhythmia and surpasses the critical energy condition for lifelong service.

Background:Left bundle branch block (LBBB) on the surface electrocardiogram (ECG) is a key criterion for selecting patients suitable for cardiac resynchronization therapy. However, the diagnostic criteria for LBBB vary across guidelines, and their impact on the efficacy of left bundle branch area pacing (LBBAP) remains unclear. Objective:This study aimed to investigate the correlation among different LBBB-related ECG criteria, as well as ECG characteristics, on the efficacy of LBBAP in heart failure (HF). Methods:Consecutive patients with systolic HF with wide QRS complexes who successfully underwent LBBAP were enrolled. Preoperative standard 12-lead ECG was assessed. This included LBBB-related parameters, including time to notch/slur in lateral leads. The associations among different LBBB criteria (2009 American Heart Association guidelines, 2013 European Society of Cardiology guidelines, 2021 European Society of Cardiology guidelines, Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy, and Strauss criteria) were evaluated. The endpoints were post-LBBAP electrical synchronization, echocardiographic response, and clinical outcomes. Results:Among 149 patients included in the analyses (baseline left ventricular ejection fraction 32.6% ± 7.0%; QRS duration 170.8 ± 20.3 ms), substantial variability in LBBB classification was observed among different criteria. The Strauss criteria demonstrated the highest predictive accuracy for QRS narrowing (area under the curve 0.710) and showed favorable performance for identifying echocardiographic responders (area under the curve 0.631). Patients who met the Strauss LBBB criteria had a significantly lower risk of composite clinical endpoint than those without LBBB (adjusted hazard ratio 0.216; 95% confidence interval 0.057-0.810; P = .023). Combining the Strauss criteria with delayed time to notch/slur in lead V5/V6 (>60 ms) further improved the predictive value of ECG-based assessment. Conclusion:LBBAP provides the most clinical benefit among patients with HF with Strauss-defined LBBB. The combination of the Strauss criteria with delayed notch/slur in lead V5/V6 maximizes the predictive value of the ECG.

BACKGROUND AND AIMS:Left bundle branch pacing (LBBP) for cardiac resynchronization therapy is emerging as an alternative pacing strategy to biventricular pacing (BiVP) in dyssynchronous heart failure (DHF). This study aimed to explore the differences in treatment effects between the two pacing modalities using electrocardiographic, echocardiographic, and molecular measurements. METHODS:Adult canines underwent left bundle branch ablation, then either followed by 6 weeks of atrial tachypacing (DHF group, n = 8), or 3 weeks of atrial tachypacing followed by another 3 weeks of BiVP (n = 8) or LBBP (n = 8) tachypacing. Non-intervened canines constituted the control group (n = 7). Electrocardiographic, echocardiographic, and molecular features were compared between BiVP-treated and LBBP-treated DHF canines. RESULTS:BiVP- and LBBP-treated canines achieved equivalent reduction in QRS duration (32 ± 6 ms vs 35 ± 5 ms, P = .276). Both BiVP and LBBP increased left ventricular ejection fraction (9 ± 5% and 10 ± 4%, respectively; P = .390) while LBBP significantly outperformed BiVP in improving left ventricular global longitudinal strain (-3.7 ± 1.2% vs -2.3 ± 1.0%, P = .019). Both BiVP and LBBP reversed biomarkers of heart failure, while LBBP more significantly modulated cytoskeleton proteins, TGF-β signalling pathways and SERCA2a expression. Moreover, LBBP contributed to a more comprehensive improvement in myocardial energy metabolism compared to BiVP. CONCLUSIONS:This study in a DHF animal model indicates that LBBP results in electrocardiographic, echocardiographic, and molecular recovery at least as good as that during BiVP. The superiority of LBBP is especially reflected in more pronounced normalization of cardiac cytoskeleton, calcium handling and energy metabolism.

Background: The triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-c) has been linked to cardiovascular risk. However, its association with device-detected atrial high-rate episodes (AHRE) remains unclear. This study aimed to explore the relationships of TG/HDL-c with incident AHRE and mortality. Methods: This retrospective cohort study included patients implanted with pacemakers equipped with home-monitoring capability and without previous atrial fibrillation, atrial flutter, or atrial tachycardia. AHRE were defined as episodes with a burden exceeding 15 minutes during follow-up. The primary endpoint was AHRE, and the secondary endpoints were all-cause mortality and cardiovascular mortality. Findings: During a mean follow-up of 75.8±16.8 months, AHRE occurred in 303 of 1,463 patients (21.1%). Restricted cubic spline analysis revealed a significant U-shaped nonlinear association of TG/HDL-c ratio with AHRE, all-cause mortality and cardiovascular mortality (all P<0.001 for overall, all P<0.05 for nonlinearity). Multivariable Cox analysis showed that TG/HDL-c was independently and inversely associated with AHRE (hazard ratio [HR] 0.878, 95% confidence interval [CI] 0.771–0.999, P=0.049). As a category variable, compared with the low TG/HDL-c group, the moderate (HR 0.654, 95% CI 0.486–0.881, P=0.005) and high (HR 0.726, 95% CI 0.542–0.973, P=0.032) groups had significantly lower AHRE risk. Notably, the moderate group exhibited the lowest risk for all-cause and cardiovascular mortality. Interpretation: In pacemaker patients undergoing continuous home monitoring, lower TG/HDL-c was independently associated with a higher long-term risk of incident AHRE, and the association was non-linear. TG/HDL-c may serve as an accessible metabolic marker for AHRE risk stratification in this population. Further prospective studies are required to validate these findings and clarify the observed associations with mortality.

BACKGROUND:The trimethylamine N-oxide (TMAO) pathway has been associated with multiple cardiovascular diseases, yet its prognostic value for sudden cardiac arrest (SCA) survivors remains unknown. METHODS:Patients who survived SCA and received implantable cardioverter defibrillators (ICDs) were prospectively enrolled. We evaluated the associations between plasma concentrations of TMAO-related metabolites and long-term adverse clinical events, including recurrent lethal ventricular arrhythmia (VA). RESULTS:A total of 75 SCA survivors were included in the study. During a median follow-up of 1099 days, 34 (45.3 %) patients experienced adverse clinical events, including 24 (32.2 %) with life-threatening VA, 12 (16.0 %) with heart failure rehospitalization, and 5 (6.7 %) with cardiovascular death. Trimethylamine (TMA), carnitine, choline, and creatinine showed strong correlations with clinically significant parameters such as left ventricular ejection fraction (LVEF), New York Heart Association functional class, and N-terminal pro-brain natriuretic peptide (NT-proBNP). These four metabolites demonstrated positive associations with adverse clinical events, with higher median level of TMA associated with more than a threefold increased risk after adjusting for age, sex, LVEF, kidney function, and NT-proBNP levels (hazard ratio = 3.36, 95 % confidence interval [CI]: 1.18-9.59; P = 0.024). A scoring system, VT-C3, incorporating LVEF, TMA, and the weighted sum of TMA-related metabolites (Choline, Carnitine, Creatinine), showed significant predictive capacity for both adverse events (area under the curve [AUC]: 0.75, 95 % CI: 0.64-0.85) and recurrent lethal VA (AUC: 0.73, 95 % CI: 0.62-0.84). No significant prognostic values were observed for TMAO and betaine. CONCLUSIONS:Our findings suggest that plasma concentrations of TMA, choline, carnitine, and creatinine are associated with an increased risk of subsequent adverse clinical events among SCA survivors. A simple scoring system comprising LVEF and these biomarkers could enhance current risk stratification and improve secondary prevention strategies based on ICD implantation.

AIMS:To evaluate the effect of Life's Essential 8 (LE8), a comprehensive cardiovascular health (CVH) metric from the American Heart Association, on the risk of cardiac conduction disorders (CCD). METHODS AND RESULTS:We conducted a prospective cohort study of 112,160 adults from the UK Biobank, free of cardiovascular disease at baseline, to examine the association between LE8 scores and the risk of CCD. LE8 scores were categorized into low (0-49), moderate (50-79), and high (80-100) CVH groups. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for CCD incidence during a median follow-up of 11.6 years. A total of 2,760 CCD cases were identified. After adjustment for confounders, the high CVH group exhibited a significantly lower risk of CCD compared to the low CVH group (HR: 0.48, 95% CI: 0.40-0.56). Further analyses showed reduced risks for both severe conduction block (HR: 0.63, 95% CI: 0.52-0.78) and left bundle branch or fascicular block (HR: 0.35, 95% CI: 0.25-0.49) in the high CVH group. Restricted cubic spline regression revealed an L-shaped association between LE8 score and CCD risk. Among individual LE8 metrics, WQS analysis revealed that BMI and sleep health were the major contributors to reduced CCD risk. CONCLUSIONS:Higher LE8 scores were associated with a lower risk of CCD, including severe conduction block requiring pacemaker implantation and left bundle branch or fascicular block. Comprehensive strategies targeting optimal CVH, especially BMI and sleep health, may be beneficial for preventing CCD.

Electrocardiogram (ECG)-based QRS analysis provides non-invasive electrophysiological information and may be valuable for predicting ventricular arrhythmias (VAs). We aimed to evaluate whether QRS voltage and morphology predict VAs in patients after cardiac implantable electronic device (CIED) implantation. In this prospective study, patients underwent a five-minute ECG recording analyzed using Resting HyperQ, which automatically calculated the limb-to-chest QRS mean peak voltage ratio and the high-frequency morphology index (HFMI). The primary outcome was the occurrence of VAs, defined as sustained ventricular tachycardia, ventricular fibrillation, or appropriate implantable cardioverter-defibrillator therapy. Among 242 patients (mean age 56.3 ± 15.6 years; 70.2% male), 61 (25.2%) had ischemic cardiomyopathy (ICM). Over a median follow-up of 233 days, 13 (5.4%) experienced VAs. The limb-to-chest voltage ratio significantly predicted VAs (HR=1.97, 95% CI 1.03–3.79, P=0.041), and this association remained significant after adjusting for left ventricular ejection fraction (LVEF; HR=2.34, 95% CI 1.09–5.00, P=0.029). The ratio demonstrated moderate predictive value (C-statistic = 0.68, 95% CI 0.51–0.85), with an optimal threshold of 0.65. A linear relationship was observed between the limb-to-chest voltage ratio and VAs, with a higher ratio associated with significantly higher rate of VAs. In the ICM subgroup, HFMI in chest lead V2 independently predicted VAs (HR=1.25, 95% CI 1.04–1.51, P=0.017), and this association remained significant after adjusting for LVEF (HR=1.24, 95% CI 1.02–1.50, P=0.030). HFMI V2 also showed moderate predictive value (C-statistic = 0.72, 95% CI 0.50 –0.95), with an optimal threshold of 6.1. A linear relationship was observed between the HFMI V2 and VAs, with a higher ratio associated with significantly higher rate of VAs . ECG-based QRS voltage and morphology analysis, particularly the limb-to-chest voltage ratio and HFMI in chest lead V2, may serve as valuable non-invasive markers for identifying patients at risk for VAs.

BACKGROUND:The value of the triglyceride-glucose (TyG) index for predicting the prognosis in patients with hypertrophic cardiomyopathy (HCM) and heart failure with preserved ejection fraction (HFpEF) remains unexplored. METHODS:Patients from 15 centers were included. The primary outcome was all-cause mortality. The secondary outcomes were cardiovascular mortality and sudden cardiac death (SCD). Restricted cubic spline analyses, multivariate Cox regression analyses, competing risk models, subgroup and mediation analyses were used to assess the relationship between the TyG index and outcomes. RESULTS:A total of 1095 patients with HCM and HFpEF were included. During a median follow-up period of 69 months, 224 all-cause deaths, 142 cardiovascular deaths, and 56 SCDs occurred. Multivariable Cox regression showed that the highest TyG index quartile was associated with a lower incidence of all-cause (hazard ratio (HR) 0.74, 95% CI 0.56-0.99, P = .046) and cardiovascular mortality (HR 0.65, 95% CI 0.44-0.94, P = .024) compared to the lowest quartile. However, no significant association was found between the TyG index and SCD (HR 0.74, 95% CI 0.41-1.31, P = 0.300). The competing risk model confirmed a significant association between the TyG index and reduced cardiovascular mortality (HR, 0.56; 95%CI, 0.40-0.78, P = .001) but no significant association with SCD (HR, 0.69; 95% CI, 0.37-1.27, P = .230). Mediation analyses indicated N-terminal pro-B-type natriuretic peptide mediated the association between TyG index and cardiovascular survival, while serum creatinine had a suppression effect. CONCLUSION:A higher TyG index was associated with lower risks of all-cause and cardiovascular mortality but with no significant influence on SCD risk in patients with HCM and HFpEF.

To investigate the relationship between abdominal obesity and long-term prognosis in patients with a pacemaker. In the SUMMIT Study, patients were categorized by baseline waist circumference into obesity, normal, and lean groups. WC was measured at the midpoint between the last rib and hip bone after exhalation. Regular follow-ups were conducted, with all-cause mortality as the primary endpoint and cardiac death as the secondary endpoint. In total, 492 patients were included in the analysis. The average baseline waist circumference was 84.2 ± 12.7 cm, and abdominal obesity was observed in 37.6

Background: There is a shortage of patients with hypertrophic cardiomyopathy (HCM) with concurrent coronary artery disease (CAD), and the influence of CAD on the prognosis of patients with HCM is uncertain. This real-world cohort study was conducted to evaluate the prognosis of patients with patients with CAD. Methods: This cohort study of patients with HCM was conducted from May 2003 to September 2021. The total number of patients enrolled was 2167, and the mean follow-up period was 6.4 years (interquartile range 2.8–9.5 years). Sudden cardiac death (SCD), cardiovascular death, and all-cause mortality were assessed as outcomes. Using logistic regression, nine indicators were selected for 1:1 propensity score matching (PSM). Additionally, Kaplan–Meier survival curves and Cox proportional hazards regression analyses were used to assess the impact of CAD on the prognosis of patients with HCM. Results: During an average of 6.4 years of follow-up, of the 2167 patients enrolled, 446 (20.6%) died. The patients were classified into two groups: CAD (n = 480) and non-CAD (n = 1,687). After imputation of missing values using the mean and 1:1 propensity score matching, there was no difference in SCD (log-rank χ2 = 0.4, p = 0.540), cardiovascular death (log-rank χ2 = 0.1, p = 0.995) and all-cause mortality (log-rank χ2 = 0.1, p = 0.776) between the CAD and non-CAD groups. After imputation of missing values using the median and 1:1 propensity score matching, patients with and without CAD were not significantly different in terms of SCD (log-rank χ2 = 0.1, p = 0.948), cardiovascular death (log-rank χ2 = 0.1, p = 0.811), and all-cause mortality (log-rank χ2 = 0.5, p = 0.499). In the Cox analysis, CAD was not a significant independent predictor of SCD, cardiovascular death, or all-cause mortality in patients with HCM. Conclusions: In this study, it was observed that there was no statistically significant disparity in mortality rates between patients diagnosed with HCM who concurrently had CAD and those who did not exhibit CAD. This finding underscores the notion that the presence of CAD did not exert a notable influence on the incidence of SCD, cardiovascular death, or all-cause mortality, thereby emphasizing the complexity and multifaceted nature of mortality risk factors in HCM patients.

ABSTRACT Background There is limited data on long‐term safety and efficacy of subcutaneous implantable cardioverter defibrillator (S‐ICD) in Asian patients with a lower body mass index (BMI) due to smaller body build. Methods We performed a 2 year prospective study in 5 Asian cities from May 2017 to May 2018 to investigate the safety and feasibility of S‐ICD for primary or secondary prevention of sudden cardiac death in an Asian population. Results We enrolled 75 S‐ICD recipients (77% males; age 49.6 ± 16.8 years) with a mean BMI of 24.6 ± 5.0 (range 15.9–40.9) with 67% (50/75) with BMI ≤ 23. The indications of S‐ICD were primary and secondary prevention in 26 (35%) and 49 (65%) patients, respectively. Among them, 51 patients suffer from ischemic (30, 59%) or nonischemic (21, 41%) cardiomyopathy, and 25 patients have channelopathies. Their mean left ventricular ejection fraction was 44.4 ± 15.1%. All patients had successful S‐ICD implantation with a mean procedural duration of 75.5 ± 28.1 min using conscious sedation in majority of patients (65/75, 87%); and defibrillation testing was performed in 62 patients (83%). After 2 years of follow‐up, 8 patients developed serious adverse events, including 4 deaths (2 asystole, 1 sepsis, 1 myocardial infarction), 2 ventricular tachycardia storm, 1 pocket infection, and 1 lead failure requiring replacement. Both patients with ventricular tachycardia storm received appropriate shocks, and no patient developed inappropriate shocks. Conclusions S‐ICD implantation for both primary and secondary prevention of sudden cardiac death was found to be safe in an Asian population, including those with a low BMI, and was associated with a low rate of device‐related complications.

Abstract We described a patient opted for Micra™ leadless pacemaker implantation, which was successfully guided by transthoracic echocardiography (TTE) without use of fluoroscopy during the whole procedure. Chest X-ray on the second day confirmed an appropriate fixation, and the device parameters remained stable in 3-month follow-up.