Post-cardiac injury syndrome (PCIS) is an underrecognized inflammatory complication of atrial fibrillation ablation that can mimic acute coronary syndrome. We present a 72-year-old man who developed pleuritic chest pain and pleural effusions 3 days after radiofrequency ablation. Using the 2025 European Society of Cardiology diagnostic criteria, we identified pleural-predominant PCIS. Anti-inflammatory treatment led to rapid recovery.

Background:Central thyroid homeostasis may contribute to variation in heart rate even within the euthyroid range, but the relative contributions of endocrine and autonomic correlates remain uncertain. Objective:To examine the association between the TSH index (TSHI) and 24-hour mean heart rate and to explore whether this association could be statistically decomposed into components involving free triiodothyronine (FT3) and heart rate variability. Methods:This cross-sectional observational study was conducted as a secondary analysis of a previously described cohort. The cohort comprised 550 euthyroid adults who underwent 24-hour ambulatory electrocardiography and contemporaneous thyroid function testing. The present analysis focused specifically on the association between TSHI and 24-hour mean heart rate and its statistical decomposition involving FT3 and ln(SDNN). Multivariable linear regression and parallel mediation analysis, interpreted as statistical decomposition rather than causal mediation, were used after adjustment for demographic factors, body mass index, blood pressure, lifestyle factors, and major cardiometabolic comorbidities. Results:Higher TSHI was associated with lower mean heart rate (β -3.488 bpm per 1-unit increase; 95% CI -4.633 to -2.343; P < 0.001). Parallel mediation suggested opposite-direction indirect components: a positive association through FT3 (indirect estimate +0.251 bpm; 95% CI 0.052 to 0.520) and a negative indirect association through ln(SDNN) (indirect estimate -0.607 bpm; 95% CI -1.219 to -0.039). The net indirect association was not significant (-0.356 bpm; 95% CI -0.998 to 0.270), whereas the residual direct association remained predominant (c' -3.132 bpm; 95% CI -4.076 to -2.138). Conclusion:In euthyroid adults, the association between TSHI and 24-hour mean heart rate appears to comprise FT3 and heart rate variability components in opposite directions, while the residual direct association remains predominant. These findings should be interpreted as reflecting cross-sectional statistical decomposition, rather than providing evidence for causal mediation.

Background The Micra transcatheter pacing system provides a leadless alternative for patients requiring ventricular pacing. When a leadless device reaches end of service or fails prematurely, a second device is commonly implanted.Case summary We report a 91-year-old man with premature Micra AV battery depletion 28 months after implantation. During the second implantation, mechanically mediated device-device interaction caused intermittent oversensing. Oversensing was resolved by increasing the sensing threshold, which avoided device repositioning or retrieval.Discussion Suspected mechanically mediated interaction between sequential Micra devices may cause oversensing and pacing inhibition. In patients with clinically stable condition and adequate intrinsic R-wave amplitude, programming optimization may be considered before invasive revision; however, future management should account for cumulative right ventricular device burden.

Several studies have suggested that the application of left bundle branch area pacing (LBBAP) in cardiac resynchronization therapy (CRT) holds promise as a treatment modality for correcting left bundle branch block (LBBB) while concurrently enhancing left ventricular structure and function. However, it's noteworthy that current guidelines do not provide specific recommendations for the use of left bundle branch area pacing, underscoring the need for additional evidence regarding its safety and efficacy. In this context, we present a case report detailing the utilization of LBBAP-CRTD treatment in a patient with LBBB-induced cardiomyopathy. The investigation encompasses a thorough examination of the efficacy and safety of LBBAP-CRTD, with a particular emphasis on cardiac synchronization parameters. Written consent was obtained from the patient, and this case report adheres to the CARE guideline.

Background:Pericardial tamponade is a rare but life-threatening complication of catheter ablation for ventricular arrhythmias. While overt perforation-often steam-pop related-is classically implicated, alternative bleeding mechanisms are less well defined. Case:A 66-year-old man underwent left ventricular (LV) ablation for frequent idiopathic premature ventricular beats (34.3%). RF energy (30-40 W, ≤90 s) at the LV anterior wall markedly suppressed ectopy, followed by abrupt chest discomfort and hypotension. Fluoroscopy suggested pericardial effusion; emergent pericardiocentesis yielded 150 ml of bright red, arterialized blood with rapid hemodynamic recovery. Biventricular angiography showed no contrast extravasation, and serial echocardiography confirmed no recurrent effusion. The patient stabilized with indwelling drainage and was discharged uneventfully. Conclusion:Tamponade during LV ablation may occur without overt perforation. Prompt recognition and targeted drainage can be definitive when bleeding is self-limited.

Background::The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China.Methods::This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences.Results::Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [ n = 278] vs. 43.7% [ n = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs. 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. Conclusion::This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.

Background:The optimal endpoint for ablation in persistent atrial fibrillation (pers-AF) remains unclear. This study aimed to systematically evaluate the prognostic value of acute AF termination in predicting the recurrence of arrhythmias. Methods:A systematic search of the PubMed, Cochrane Library, Web of Science, and Embase databases was conducted from inception to July 2023. Only studies with reports of acute termination for pers-AF and its predictive role in arrhythmia recurrence were included. Subgroup analysis was performed to identify potential confounders for the effect of AF termination. Results:A total of 22 studies were included in the meta-analysis. The pooled analysis indicated that acute termination of AF is significantly associated with an increased long-term success rate (relative risk (RR), 1.53; 95% CI, 1.41-1.66; p < 0.001; I2 = 35.4%). Moreover, subgroup analysis revealed that patients with an AF duration >12 months (RR, 1.92; 95% CI, 1.57-2.35; p < 0.001), aged >60 years (RR, 1.92; 95% CI, 1.60-2.31; p < 0.001) may derive benefits from AF termination during ablation. Interestingly, a significant interaction was observed in the study design subgroup, where multi-center studies showed a success rate of RR, 1.31 (95% CI, 1.14-1.50; p < 0.001), while single-center studies exhibited a higher success rate of RR, 1.65 (95% CI, 1.49-1.82; p < 0.001), with an interaction p-value of 0.008. Importantly, acute termination of AF did not significantly increase procedural complications (RR, 1.19; 95% CI, 0.59-2.39; p = 0.627; I2 = 0.0%). Conclusions:Our study suggests that AF acute termination during ablation for pers-AF provides a better long-term clinical outcome. The PROSPERO Registration:CRD42023431015, https://www.crd.york.ac.uk/PROSPERO/view/CRD42023431015.

BACKGROUND:The association of thyroid hormone sensitivity with heart rate remains unclear. OBJECTIVE:This study aims to elucidate the relationship between impaired thyroid hormone sensitivity and lower heart rate in the euthyroid population. METHODS:A total of 550 participants were included. Heart rate and serum biochemicals were measured. Thyroid hormone sensitivity indices were calculated using the thyrotropin index (TSHI), thyrotropin thyroxine resistance index (TT4RI), thyroid feedback quantile-based index (TFQI), Chinese-referenced parametric TFQI (PTFQI), and the ratio of free triiodothyronine to free thyroxine (FT3/FT4 ratio). Logistic regression analyses were applied to explore the relationship between thyroid hormone sensitivity indices and heart rate. RESULTS:TSHI, TT4RI, TFQI, and PTFQI were higher, and FT3/FT4 ratio was lower in participants with heart rate ≤ 60 beats/min (P < .001 for all). Participants with increased TSHI, TT4RI, TFQI, and PTFQI and reduced FT3/FT4 ratio had lower heart rate (≤60 beats/min) (P for trend < .001 for all). Odds ratios (95% confidence intervals) for TSHI, TT4RI, TFQI, PTFQI, and FT3/FT4 ratio in the highest quartile were 2.090 (1.092-4.000), 2.240 (1.151-4.361), 2.014 (1.043-3.887), 2.163 (1.123-4.166), and 0.498, (0.249-0.996), respectively, as compared with the lowest quartile after adjusting for sex, age, body mass index, smoking, drinking, hypertension, diabetes, coronary artery disease, glycated hemoglobin, total cholesterol, low-density lipoprotein cholesterol, and triglycerides. CONCLUSION:Impaired sensitivity to thyroid hormones was associated with lower heart rate in euthyroid participants. Future large-scale studies are needed to confirm our findings.

Background Cancer and coronary artery disease (CAD) is reported to often co-exist in same individuals, however, whether cancer is directly associated with anatomical severity of CAD is rarely studied. The present study aimed to observe the relationship between newly diagnosed cancer and anatomical severity of CAD, moreover, to investigate effect of inflammation on the relationship of cancer with CAD. Methods 374 patients with newly diagnosed cancer who underwent coronary angiography (CAG) were enrolled. Through 1:3 propensity score matching (PSM) to cancer patients based on the age and gender among 51,106 non-cancer patients who underwent CAG, 1122 non-cancer patients were selected as control patients. Anatomical severity of CAD was assessed using SYNTAX score (SXscore) based on coronary angiographic image. SXscore ≤ 22 (highest quartile) was defined as SX-low, and SXscore > 22 as SX-high. The ratio of neutrophil to lymphocyte count (NLR) was used to describe inflammation level. Association between cancer and the anatomical severity of CAD was investigated using logistic regression. Results Univariate logistic regression analysis showed a correlation between cancer and anatomical severity of CAD (OR: 1.419, 95% CI: 1.083–1.859; P = 0.011). Cancer was associated with increased risk of SX-high after adjusted for common risk factors of CAD (OR: 1.598, 95% CI: 1.172–2.179, P = 0.003). Significant association between cancer and SX-high was revealed among patients with high inflammation (OR: 1.656, 95% CI: 1.099–2.497, P = 0.016), but not among patients with low inflammation (OR: 1.530, 95% CI: 0.973–2.498, P = 0.089). Conclusions Cancer was associated with severity of CAD, however, the association between the two diseases was significant among patients with high inflammation rather than among patients with low inflammation.

Background Stroke, which is mainly caused by thrombus formation in the left atrial appendage, represents the most prevalent complication of atrial fibrillation (AF). Both percutaneous left atrial appendage occlusion (p-LAAO) and surgical LAAO (s-LAAO) are used to treat AF and prevent stroke events. However, no head-to-head randomized controlled trials (RCTs) compared these strategies. Objective To examine the efficacy and safety of diverse strategies for reducing stroke risk using a network meta-analysis (NMA). Methods PubMed, EMBASE, and Cochrane repositories were explored to identify RCTs involving p-LAAO or s-LAAO, and five were included for NMA. This investigation adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-analyses. The NMA was pooled using the Bayesian random effect framework. All findings were expressed as odds ratios accompanied by a 95% confidence interval.The primary efficacy endpoint was any stroke (AS), and the secondary efficacy endpoint was combined AS and systematic embolism (AS/SE). The primary and secondary safety endpoints were major bleeding (MB) and all-cause death (ACD), respectively. Results Our meta-analysis incorporated 6,337 individuals diagnosed with AF. The NMA demonstrated a reducing trend in AS and AS/SE for s-LAAO versus p-LAAO, while p-LAAO showed a benefit in reducing MB and ACD. Conclusions and Relevance: s-LAAO could potentially benefit individuals at elevated risk for stroke, whereas p-LAAO may be linked to a reduced likelihood of bleeding.

Vascular calcification is a common complication of chronic kidney disease (CKD). The molecular mechanisms underlying this condition and the efficacy of potential treatments remain unclear. Bioinformatic methods were employed to analyze gene ontology (GO) annotations and pathway enrichments. Subsequently, an analysis of potential therapeutic agents for vascular calcification in CKD was performed. A total of 76 common genes, 181 enriched GO annotations-comprising 153 biological processes, 10 cellular components, and 18 molecular functions-41 KEGG pathways, 13 REACTOME pathways, and 3 BIOCARTA pathways were identified. Five key genes (PSMC5, TNFSF11, TNFRSF11A, TNFRSF12A, and ICAM1) were isolated. Most notably, the top five potential therapeutic drugs-ENAVATUZUMAB, DENOSUMAB, ALICAFORSEN, BI-505, and ENLIMOMAB PEGOL-were identified for vascular calcification in CKD. However, further molecular biological experiments are required to confirm these findings.

心脏淀粉样变性(CA)的患病率逐年升高,其常伴随着心房颤动的发生.近年,CA患者的生存期及生活质量虽得到了一定改善,但合并心房颤动的CA患者往往临床症状较重,药物耐受性差,且栓塞风险高.对此类患者的综合管理正在成为电生理医生们越来越关注的问题.

BACKGROUND:As left bundle branch pacing (LBBP) is more like physiological pacing, LBBP has emerged as a novel pacing strategy that uses the native conduction system to improve ventricular synchronization with stable pacing parameters. LBBP has been revealed associated with a significantly reduced risk of new-onset atrial fibrillation and heart failure compared with conventional permanent pacemaker implantation.CASE SUMMARY:A 64-year-old man was admitted with a 24-h history of chest distress and shortness of breath, which continued unabated. The patient had no symptoms of chest pain, dizziness, syncope, nausea nor vomiting. There were no abnormalities found in routine examinations after admission. Twelve-lead electrocardiogram presented a result of 2:1 atrioventricular block. Coronary angiography was performed the next day and no abnormality was found. Finally, the patient agreed to received LBBP and signed the informed consent. During the process of withdrawing the Medtronic Model 3830 lead into sheath, we found the lead helix was wrapped around the chordae tendineae of the septal valve of tricuspid. Attempts to rotate the 3830 lead failed to release the lead helix from the chordae tendineae, and ultimately we used radiofrequency ablation to ablate the wrapped chordae tendineae.CONCLUSION:Radiofrequency ablation effectively solved this problem without complications. It is an effective and reliable method to resolve lead winding chordae.

BackgroundAlthough there are many freezing protocols available, the optimal freezing dose is still not determined. We aimed to evaluate the effectiveness and safety of different freeze strategies of CBA in the treatment of AF.MethodsPubMed, Cochrane Library, Web of Science, and Embase were searched up to 1st December 2022. Studies comparing the outcomes between single-shot technique and standard technique of cryoablation were included. Subgroup analysis identified potential determinants for single-shot technique procedure.ResultsOur search resulted in 3407 records after deduplication. A total of 17 qualified studies met our inclusion criteria. Compared with standard technique, single-shot technique of cryoablation has a comparable rate of freedom from AF/AT(RR 1.00; P = 0.968), a trend for lower rate of procedure complications (RR 0.80; P = 0.069), a lower rate in transient phrenic paralysis (t-PNP) (RR 0.67; P = 0.038), a similar rate in persistent phrenic paralysis (per-PNP) (RR 1.15; P = 0.645), as well as a comparable procedure parameters. Importantly, potentially significant treatment covariable interactions in procedure complications were found in freeze strategy subgroup, male proportion subgroup and age subgroup, including single-shot freeze (RR 1.02; P = 0.915) and TTI-guided (RR 0.63; P = 0.007) with interaction P = 0.051, high male proportion (RR 0.54; P = 0.005) and a low male proportion (RR 0.94; P = 0.759) with interaction P = 0.074, as well as age ≥ 65 (RR0.91; P = 0.642) and age <65 (RR 0.54; P = 0.006),interaction P = 0.090. Meanwhile, only one significant treatment covariable interactions in procedure complications was found in the hypertension subgroup, including HT > 60% (RR 0.89; P = 0.549) and HT ≤ 60% (RR 0. 46; P < 0.01) with interaction P = 0.043.ConclusionsOur study suggested that single-shot technique of cryoablation has comparable effective and safety outcomes for AF ablation compared to standard technique.

Aims: Chemokines play important roles in the development and progression of atherosclerosis and coronary artery disease (CAD). The purpose of this study was to identify the relationship between CXCL5 and the risk of CAD and try to reveal the relative mechanisms. Methods: 395 CAD patientsand 403 controls were enrolled in this study. Using RT-PCR method to detected CXCL5 gene expression and Elisa method to determine CXCL5 plasma levels of were tested by in 160 CAD patients matched well with 160 controls. Established CXCL5 over expression, reduction and control EC lines; The chemotactic ability of THP-1 cells to ECs was evaluated by adhesion and transwell assay, and the signaling pathway expression was detected by Western blot. Results: Our study revealed CXCL5 gene expression and serum levels in CAD group were much higher than those in control group (P < 0.01, respectively). CXCL5 concentrations in CAD group (4.85 ± 0.19ng/mL) were significantly higher than that in control group (3.66 ± 0.14ng/mL) (P < 0.05). Logistic regression analysis indicated CXCL5 was a susceptibility factor of CAD and significantly correlated with CAD (P < 0.05). In adhesion and migration experiments, the numbers of THP-1 cells in CXCL5 overexpression groups (EO) were much higher than CXCL5 suppression groups (ES), lenti - MOCK infected groups (MOCK) and non - infected groups (EN) (P value < 0.05, respectively). Nevertheless, numbers of THP-1 cells in ES groups were significantly lower than other groups (P < 0.01, respectively). Conclusions: The evidence from our study indicated that CXCL5 might be a new biomarker in assessing the risk of CAD. Our study showed that CXCL5 overexpression facilitate the adhesion and migration of THP-1 to ECs.

Background:Obstructive sleep apnea (OSA) is an independent and modifiable risk factor in the initiation and maintenance of atrial fibrillation (AF). However, the effective of the continuous positive airway pressure (CPAP) on AF patients with OSA after ablation is elusive.Methods:Cochrane Library, PubMed, Embase, and Web of Science were systematically searched up to February 1, 2023. Studies comprising the AF recurrence rate between the CPAP therapy group and non-CPAP therapy group for the AF patients with OSA were included. Meanwhile, trial sequential analysis (TSA) was conducted to adjust the lower statistical power and random error in this study. Subgroup analysis identified the potential determinants for the AF recurrence rate with CPAP therapy.Results:A total of eight studies including 1,231 AF patients with OSA were eligible. Compared with non-CPAP treatment group, CPAP treatment group was statistically associated with a lower AF recurrence rate (risk ratio [RR], 0.58; p = 0.000). TSA indicated the firm evidence favoring CPAP group for AF recurrence risk. Three significant intervention-covariate interactions for AF recurrence was identified, including study design, non-paroxysmal AF (PAF) proportion, and CPAP treatment strategy.Conclusion:Our study suggests that CPAP therapy might be an effective strategy on reducing AF recurrence post-ablation for AF patients with OSA. The CPAP treatment strategy and the non-PAF proportion might be the possible determinants on AF recurrence for AF patients with OSA after ablation.Clinical trial registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023398588, identifier (CRD42023398588).

Background Observational studies have revealed a link between major depressive disorder (MDD) and a higher chance of developing atrial fibrillation (AF). It is still uncertain whether or not this correlation indicates a causal relationship. This research set out to evaluate the causal impact of MDD on AF. Methods To evaluate the causal relationship between MDD and AF, we employed a two-sample Mendelian randomization (MR) method. A new genome-wide association study (GWAS) with 500,199 participants was used to obtain an overview of the association of genetic variations with MDD. An additional GWAS incorporating 1,030,836 people provided data on the relationship between gene variants and AF. The inverse-variance weighted technique was utilized to assess the effect sizes. Sensitivity analysis included the use of other statistical approaches such as weighted median, Outlier, MR Pleiotropy Residual Sum, weighted mode, simple mode, and MR - Egger. Results By employing 47 single nucleotide polymorphisms (SNPs) as markers, MR analyses in random-effect inverse-variance weighted models found that genetically projected MDD was linked to an elevated incidence of AF (odds ratio [OR] = 1.098, 95% CI 1.000–1.206; P = 0.049). No gene pleiotropy was discovered as indicated by MR-Egger (intercept= -0.011, P = 0.169). Sensitivity analysis employing other MR techniques yielded reliable results. Conclusion This MR study established a causal relationship between genetically predicted MDD and an elevated risk of AF.

Aim: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) have been reported to manifest controversial relationships with cancer, and recent focus concerning the tumorigenic effect of ACEIs mainly falls on lung cancer. We compared ACEIs with ARBs for their impact on the risk and prognosis of lung cancer and non-lung cancers, respectively. Methods: A meta-analysis was performed to explore the impact of ACEIs on the risk of lung cancer and non-lung cancers, while a systematic review was performed to further analyze ACEIs’ influence on the prognosis of lung cancer. Terms concerning ACEIs and cancer were searched, and 10 cohort studies were included for risk analysis, while 5 cohort studies were included for analyzing the prognosis of lung cancer. Results: Initial pooled result revealed that ACEIs prescription is associated with an observed increase on the risk of lung cancer (RR 1.28, 95% CI 1.02-1.61), colorectal cancer (RR 1.46, 95% CI 1.13-1.87) and hepatic cancer (RR 2.00, 95% CI 1.01-3.94) when compared with ARBs, but further sensitivity analyses suggested the results unsolid, thus neither the development of lung cancer nor non-lung cancers could be proved associated with ACEIs prescription. However, systematic review suggested that ACEIs prescription is associated with an improved lung cancer prognosis. Conclusion: There has been no adequate evidence to demonstrate that ACEIs are associated with a higher incidence of lung cancer or non-lung cancers, but an improved prognosis of lung cancer was observed in patients taking ACEIs. Large-scale RCTs are needed and underlying mechanisms need further exploration.

患者男性,65岁,因胸闷、胸痛、憋气14年余,加重伴乏力10天入院.诊断慢性心功能不全急性加重,心脏超声提示左室射血分数0.35,心电图显示窦性心律,完全性左束支传导阻滞,优化药物治疗后患者仍有心力衰竭发作,心功能Ⅲ级.行心脏再同步化治疗,手术过程顺利,术后7天患者拆线,囊袋愈合良好,患者无发热,囊袋感染,无渗血血肿等情况.2周后患者因囊袋破溃渗液再次入院,入院后患者无发热,渗液涂片及培养结果均为阴性,考虑患者为无菌性炎症,予以负压闭式引流术保守治疗成功.