Introduction: Atrial Fibrillation (AF) is the most prevalent chronic cardiac arrhythmia in adults, often leading to higher risk for further significant cardiac comorbidities. Atrial fibrillation is a disease with known disparities across racial groups, but repeat ablation outcomes are not well characterized currently. Objective: We aimed to retrospectively evaluate whether race was associated with discrete differences with repeat AF Ablation within 3 years after an index ablation, while also examining age- and gender- based differences. Method: We performed a multicenter retrospective cohort study with a population of adults over the age of 18, with AF Ablation between 1/1/2018, and 6/30/2020. We had over 23,558 encounters after excluding encounters that didn't belong within our parameters. Our primary outcome was to evaluate repeat ablation and readmission data with atrial fibrillation within 3 years. We elucidated statistics using chi-square plus multivariable adjusted analysis for age and sex based demographics, with pairwise racial subgroup comparisons. Results: The overall repeat ablation rate was 14.3% (N = 3368/23558). In the overall racial comparison, race was not significantly associated with repeat ablation rates (chi-square = 7.875, p = 0.1633; likelihood ratio = 8.3235, p = .1393). We also saw little statistical significance of white versus non-white patients, (chi-square = 2.1400, p = 0.1435). Pairwise subgroup comparisons did not demonstrate significant differences after multiple-comparison adjustment. In adjusted analyses, sex was not significantly associated with repeat ablation (p = 0.1611), whereas patients younger than 80 years had higher odds of repeat ablation compared with those aged 80 years and older, including ages 50–59 (OR 1.423), 60–69 (OR 1.433), 70–79 (OR 1.307), and < 50 (OR 1.344). Conclusion: In this multicenter retrospective cohort, race did not show an independent association with repeat AF ablation within 3 years of index ablation. However, these findings do not interpret itself as evidence of AF burden or treatment experience to be equivalent amongst racial groups. Furthermore, age-related differences in repeat ablation suggest that treatment prognostication varies amongst patient subgroups warranting further study in larger datasets.

Mitral valve prolapse (MVP) is a structural valvular abnormality increasingly correlated with sudden cardiac death (SCD). This case report describes a patient who presented with symptomatic arrhythmias and was found to have MVP with MAD. The patient’s clinical course emphasizes the importance of considering MAD as a source of arrhythmia and the significance of intervention and continued monitoring in these situations.

This study evaluated the clinical utility of the HEMOTAG™ recording device-A non-invasive, wearable system that measures cardiac time intervals (CTIs)-in managing patients with acutely decompensated heart failure (ADHF). The prospective, single-center study enrolled 105 patients, including those hospitalized with ADHF and a control group with non-HF-related conditions. Daily measurements of isovolumetric contraction time (IVCT), a key CTI marker, were collected using the HEMOTAG device and compared with NT-proBNP levels obtained on admission and day 3. Among ADHF patients, IVCT decreased in parallel with NT-proBNP levels, indicating volume status improvement with therapy. In contrast, the control group showed no significant change in IVCT or NT-proBNP. An IVCT ≥ 40 ms demonstrated strong sensitivity and specificity to detect ADHF (NT-proBNP ≥ 1800 pg/mL). These findings suggest that IVCT trends measured by HEMOTAG correlate with short-term treatment response in ADHF and could offer a non-invasive method to guide heart failure management. The technology demonstrated feasibility, safety, and clinical relevance, supporting its potential role in future remote management strategies.

Introduction: Cardiac Time Intervals (CTIs), derived from mechanical events of the cardiac cycle, offer valuable insights into myocardial performance and hemodynamics. With advancements in non-invasive technologies such as HEMOTAG, it is now possible to longitudinally monitor CTIs in real-world settings within minutes. However, the clinical implications of CTI variability in high-risk populations, such as diabetic patients, remain underexplored. Research Questions: To identify distinct CTI patterns using unsupervised clustering and evaluate their associations with biomarkers (NT-proBNP, N-terminal pro B-type natriuretic peptide), comorbidities, and medication profiles in a diabetic population. Our hypothesis was that diabetes patients with abnormal CTI patterns would demonstrate different clinical profiles and medication regimens compared to those with normal patterns, potentially informing targeted therapeutic approaches. Methods: Daily multi-channel recordings from the HEMOTAG device and electronic health records were analyzed for 56 diabetic patients. CTI features such as mitral valve closing (MC), aortic valve opening (AO), aortic valve closing (AC), mitral valve opening (MO), isovolumic contraction time (IVCT), and derived variability metrics, were extracted. K-means clustering identified patient groups based on CTI patterns. Associations with NT-proBNP, comorbidities, and medication use/dosages were assessed using appropriate statistical tests. Results: Two CTI-based clusters were identified: Stable and Abnormal. Patients in the Abnormal group showed higher NT-proBNP levels (p = 0.0139), also higher mean and variability in CTIs, during 30-day daily home management, suggesting increased cardiac stress. Medication analysis revealed that drugs such as lisinopril (p = 0.0012), losartan (p = 0.0268), and atorvastatin (p = 0.0061) differed both in frequency and dosage between groups, implicating potential pharmacologic influences on CTI dynamics. Notably, a higher proportion of patients in the Abnormal CTI group had undergone angioplasty. This trend may suggest a potential association between abnormal CTI patterns and underlying coronary pathology, warranting further investigation in larger cohorts. Conclusions: Abnormal CTI patterns are associated with elevated cardiac biomarkers and distinct medication profiles. CTI analysis may offer a non-invasive, physiologically grounded tool for risk stratification and personalized cardiovascular therapy in diabetic patients.

Introduction Atrial fibrillation (AF) stands as the most prevalent cardiac arrhythmia globally, and its incidence is increasing with ongoing advancements in cardiac monitoring devices. Managing AF involves diverse strategies, encompassing medications and various ablation procedures, with radiofrequency as the predominant catheter ablation method in the United States. Notably, studies indicate a gender-based impact on AF, with males exhibiting a higher incidence. In this retrospective study, our aim was to evaluate the recurrence of AF (Re-AF) post ablation and assess potential gender-related variations in this recurrence. Methods In our multi-center retrospective cohort study, we examined approximately 23,500 adults above the age of 18 years who underwent an index radiofrequency ablation for AF between January 1st 2018 and June 30th 2020. Additionally, we looked at the recurrence rate of AF within 3 years after index ablation. We used chi-square analyses to evaluate the association of racial disparities in Re-AF resulting in readmission within 3 years of the index ablation. Race was defined as Whites, African Americans (AA), Hispanics, and multiracial/others (includes Asians and Native Americans). Gender was defined as male and female. We used Chi-square analyses and Tukey-Kramer adjustment for pairwise comparisons to determine likelihood (LR) and odds ratios (OR). Results Among 23,558 patients, 14,951 were Male (63.46%) and 8,607 were female (36.54%). Rate of Re-AF was 44.4% (N = 10447/23558). Average age was 66 years, average length of stay was 1.5 days, and average BMI was 32. Chi-square analysis result for sex and Re-AF within three years was (= 17.6262, p<.0001). The risk Re-AF for females was 6.52% higher (RR=1.0652, 95% CI [1.0344,1.0968]) than the risk for males. When controlling for race, sex is significantly associated with the likelihood of Re-AF (= 17.4527, p<.0001) with females having 12.1% higher odds (OR=1.121, 95%CI [1.062, 1.182]) of Re-AF than males. Results of logistic regression show that sex is significantly associated with the likelihood of Re-AF when controlling for race and age group (=7.3426, p=.0067). The odds of Re-AF for females is 7.8% higher than (OR=1.078, 95% [1.021, 1.138]) the odds for males. Discussion Gender has been shown to impact various aspects of cardiac health. In cardiac arrythmias, such as AF, men exhibit a higher incidence of AF. In this retrospective analysis, we observed that a higher number of men with AF who underwent index ablation. When assessing for AF recurrence post-ablation, the results revealed a statistically significant higher recurrence in females, even after controlling for race, age, or both. We hypothesize that this gender difference may stem from advanced atrial remodeling, detectable through high-density electroanatomic mapping in women. These findings underline the need for further research to explore potential gender variations in response to different treatments and their impact on procedural choices. Conclusions The risk of recurrence of atrial fibrillation within 3 years of treatment with index radiofrequency ablation was higher in Females compared to Males.

AF is the most common type of cardiac arrhythmia, and its prevalence has been increasing worldwide. Current data shows that AF is more common in white males compared to blacks. Interestingly, despite multiple cardiovascular comorbidities, data suggests that blacks are less prone to development of AF. There is paucity of data showing the recurrence of AF re-ablation after index ablation specifically as it pertains to race, gender, and age. We sought to explore the rates of recurrent AF re-ablation in this retrospective cohort analysis. Using a multi-center database, we examined 23,558 encounters and 10,530 of had readmission records i.e. readmitted within 3 years. The encounters looked at adults (18+) who had an ablation procedure for atrial fibrillation between 1/1/2018-06/30/2020. We used binary logistic regression models to analyze pairwise comparisons among different subgroups of race, sex, and age group. The primary endpoint was recurrence of repeat ablation. Secondary endpoints included non-fatal stroke and myocardial infarction. Our sample size was 23,558 patients, 20,276 were white patients (86%) and 3,282 were non-white patients (14%). The average age was 66.29 years (SD 10.43) and average age at the time of repeat ablation was 65.97 years. The average BMI was 21.55. Out of the 23,558 patients, 14.30% (N= 3368) had re-ablation within 3 years of the index ablation. The odds ratio of re-ablation for patients in their 50s is 1.4229 (95% CI [1.1172, 1.8122]) times the odds for the patients in their 80s. Similarly, the odds ratio is 1.4330 (95% CI [1.1466, 1.7909]) for the 60s, 1.3075 (95%CI [1.0458, 1.6346]) for the 70s and 1.3443 (95% CI [1.0088, 1.7914]) for patients below 50 when comparing with patients over 80. The LR for re-ablation was 0.8438 (p=0.3583) in females when compared to males. The incidence of non-fatal stroke was 0.27% (N= 63) and non-fatal MI was 0.19% (N= 45). The average length of time to re-ablation was 415.5 days. There were 1649 patients with HF and 45% had recurrence of AF and 13.3% had repeat ablation therapy. When controlling for age group and sex, race was not significantly associated with an increased likelihood of repeat ablation. When controlling for race and age group, sex was not significantly associated with an increased likelihood of repeat ablation. When controlling for race only, females were not at a higher risk of re-ablation. However, when controlling for race and sex, patients in their 50s are 42.3% more likely to have re-ablation when compared to patients in their 80s. In contrast, pairwise comparison tests also found that as the age of patients at their first ablation increases and there appears to be a rising trend indicating a higher likelihood of AFIB recurrence within three years when controlling for race and sex. The incidence of repeat AF ablation is not higher in racial minorities when compared to whites. Interestingly, there appears to be a decreasing rate of AF re-ablation in older patients despite a higher rate of AF recurrence as age increases possibly owing to medical management. Heart failure patients with recurrent AF do undergo repeat ablation after recurrence of AF.

Introduction Left ventricular assist devices (LVADs) are indicated for patients with Stage D heart failure with reduced ejection fraction (HFrEF). Furthermore, stage D HFrEF is associated with increased hospital admissions. Racial and ethnic disparities in the access LVADs have been described in the past, revealing significant gaps in care. However, it remains to be seen if current efforts to mitigate health disparities have improved access to LVADs in underrepresented populations. Therefore, we aim to clarify existing practices in the United States to examine if there have been any changes in racial disparities in the access to LVADs and use this critical knowledge to direct additional steps to mitigate health disparities. Hypothesis Racial disparities exist in the access to LVADs in the US. Methods The National Inpatient Sample (NIS) was queried from 2016 to 2019 to identify all adult admissions with HFrEF who underwent LVAD placement using the International Classification of Diseases Tenth Revision (ICD-10) codes. We stratified the sample into 3 study groups: Black, Hispanic, and White. We explored baseline characteristics, LVAD utilization (defined as the number of LVADs per 100,000 admissions with a history of HFrEF) and completed a multivariate regression analysis to assess the association of race and ethnicity with LVAD placement and clinically meaningful outcomes. Results A total of 7,674,108 admissions with HFrEF were included study, and 14,665 (0.2%) underwent LVAD placement. Seventy-seven percent of patients who received an LVAD were male. Black patients were likelier to be of lower socioeconomic status and be enrolled in Medicaid than Hispanic and White patients. LVAD utilization was higher in Black patients compared to White and Hispanic patients (256 vs. 175 vs. 175, respectively, p<0.001). Compared to White race, Black race had higher odds of receiving an LVAD (OR=1.60, 95% CI 1.41-1.80, p<0.001), receiving a blood transfusion (OR=1.40, 95% CI 1.05-1.84, p=0.02), and non-routine discharge (OR=1.35, 95% CI 1.09-1.67, p=0.006). Hispanic race was associated with lower odds of survival free of stroke (OR=0.68, 0.47-0.98, p=0.038) compared to White race. However, there was no difference in mortality between the study groups. Conclusion Black race was associated with higher odds of LVAD utilization after adjusting for multiple confounders. Compared to previous studies, inequalities in outcomes remain while an apparent disparity in the access to LVADs in Black patients is not evident in this study which might be related to potential confounders or other factors. Further studies evaluating both outcomes are needed to clarify the reasons behind these findings.

Abstract Introduction Atrial fibrillation (AF) is the most common type of cardiac arrhythmia, and its prevalence has been increasing worldwide. Current data shows that AF is more common in white males compared to blacks despite blacks having multiple cardiovascular comorbidities. There is paucity of data showing the recurrence of AF re-ablation after index ablation specifically as it pertains to race, gender, and age. We sought to explore the rates of recurrent AF re-ablation in this retrospective cohort analysis. Methods Using a multi-center database, we examined 23,558 encounters and 10,530 had readmission records i.e. readmitted within 3 years. The encounters included adults (18+) who had an ablation procedure for atrial fibrillation between 1/1/2018-06/30/2020. We used binary logistic regression models and Tukey-Kramer procedure to analyze pairwise comparisons among different subgroups of race, sex, and age group. The primary endpoint was recurrence of repeat ablation. Secondary endpoints included non-fatal stroke and myocardial infarction. Results Our sample size was 23,558 patients, 20,276 were white patients (86%) and 3,282 were non-white patients (14%). The average age was 66.29 years (SD 10.43) and average age at the time of repeat ablation was 65.97 years. The average BMI was 21.55. Out of the 23,558 patients, 14.30% (N= 3368) had re-ablation within 3 years of the index ablation. The odds ratio of re-ablation for patients in their 50s is 1.4229 (95% CI [1.1172, 1.8122]) compared to patients in their 80s. Similarly, the odds ratio is 1.4330 (95% CI [1.1466, 1.7909]) for the 60-69 group, 1.3075 (95%CI [1.0458, 1.6346]) for the 70-79 group and 1.3443 (95% CI [1.0088, 1.7914]) for patients below 50 compared to over 80 group. The LR for re-ablation was 0.8438 (p=0.3583) in females. The incidence of non-fatal stroke and MI were 0.27% (N= 63) and 0.19% (N= 45). Average length of time to re-ablation was 415.5 days. Discussion When controlling for age group and sex, race was not significantly associated with an increased likelihood of repeat ablation. When controlling for race and age group, sex was not significantly associated with an increased likelihood of repeat ablation. When controlling for race only, females were not at a higher risk of re-ablation. However, when controlling for race and sex, patients in their 50s are 42.3% more likely to have re-ablation when compared to patients in their 80s. In contrast, the age of patients at their first ablation increased, there appeared to be a rising trend indicating a higher chance of AF recurrence within 3 years when controlling for race and sex. Conclusion The incidence of repeat AF ablation is not higher in racial minorities when compared to whites. Interestingly, there appears to be an decreasing rate of AF re-ablation in older patients despite a higher rate of AF recurrence as age increases possibly owing to more conservative therapeutic approach such as medical management.

Introduction A key part of the management of atrial fibrillation is anticoagulation to reduce the risk of stroke1. Chronic kidney disease (CKD) is known to promote atrial fibrillation, possibly through an inflammatory pathway2. While anticoagulation for atrial fibrillation has traditionally been done with warfarin, a vitamin K antagonist, it can also be accomplished via a direct oral anticoagulant (DOAC), including the factor Xa inhibitor apixaban. Recent studies have shown that a DOAC is noninferior to warfarin3. However, most studies have excluded people with advanced CKD. This retrospective observational study is, to our knowledge, the largest yet to compare effects of apixaban and warfarin use in patients with atrial fibrillation and advanced chronic kidney disease. Methods Admission encounters from a comprehensive, multi-institutional database were examined for patients diagnosed with atrial fibrillation and advanced CKD, defined as chronic kidney disease stage 3, 4, or 5, as well as end-stage renal disease. These patients were separated into cohorts taking either apixaban or warfarin. The rate of endpoint diagnoses, identified by International Classification of Diseases (ICD) codes, were compared between the two groups. Results The records of 14998 patients were collected people with a mean age of 76.9, including 11177 (74.5%) patients using apixaban and 3821 (25.4%) using warfarin. The two groups were not identical; the warfarin group was more likely to be in stage 3 chronic kidney disease compared to the apixaban group, which was more likely to be in end stage renal disease. The primary endpoint was the rate of stroke, and the secondary endpoints were rate of GI bleed, ocular hemorrhage, and intracranial hemorrhage. The apixaban cohort was associated with a higher rate of stroke (odds ratio 1.25, 95% confidence interval 1.05 - 1.4) than the warfarin group. Meanwhile, the warfarin cohort was more likely to develop a GI bleed compared to apixaban, as well as having a higher rate of all-cause mortality. Both groups were equally likely to develop intracranial or ocular hemorrhage. Conclusions In patients with chronic kidney disease who received warfarin instead of apixaban for atrial fibrillation, the risk of stroke was found to be lower but that of GI bleed to be higher. This may be in part because warfarin is renally excreted, while apixaban is excreted both by the kidney and hepatobiliary route. The higher likelihood of GI bleed and all cause mortality is concerning, possibly caused by the narrow therapeutic window of warfarin. These findings suggest that warfarin and apixaban have key differences in their risk profiles, and that treatment in patients with chronic kidney disease should be personalized. Patients with additional risk factors for stroke may consider warfarin. This is especially relevant because of the morbid nature of stroke relative to GI bleed. Further research should be done to determine if other stroke risk factors may be comorbid with CKD and be better treated by warfarin.

BACKGROUND:There is a paucity of data regarding the impact of cardiac conduction disease (CD) on clinical outcomes in patients with cardiac amyloidosis (CA). METHODS:The National Inpatient Sample (NIS) was queried to identify all CA admissions and those with CD using ICD-10 codes from 2016 to 2019. We explored baseline characteristics and used multivariate logistic regression to assess the association between CD and several clinical outcomes during index admission; a p-value of <0.05 was significant. Propensity score matching (PSM) was performed to validate our results. RESULTS:A total of 12,185 patients with CA were identified. Of these, 920 (7.6 %) had CD. The median age of the sample was 72 years (IQR: 64-80). After multivariate adjustment and PSM, the presence of CD in CA was associated with higher odds of ventricular arrhythmias (VA) (aOR = 2.97, 95 % CI 1.78-4.96, p < 0.001), syncope (aOR = 3.44, 95 % CI 1.51-7.83, p = 0.003), and cardiovascular implantable electronic device (CIED) implantation (aOR = 12.86, 95 % CI 5.50-30.04, p < 0.001) but not with sudden cardiac arrest (p = 0.092), acute heart failure (p = 0.060), all-cause in-hospital mortality (p = 0.384), and non-routine discharge in patients admitted for CA (p = 0.271). CONCLUSIONS:Although CD was not associated with all-cause in-hospital mortality, there was a significant association with VAs and syncope. Syncope is associated with worse survival in patients with CA. Further studies that prospectively follow patients are needed to determine the true effect of cardiac CD on mortality in patients with CA.

Patients with severe mitral valve regurgitation (MVR) and coincidental aortic or tricuspid valve disease represent a management challenge. Traditionally, if an interdisciplinary heart team decides to perform open-heart surgery to replace the mitral valve, aortic stenosis or regurgitation is usually corrected simultaneously. However, patients at high surgical or prohibitive risks are typically referred to a less invasive alternative such as transcatheter edge-to-edge mitral valve repair (TEER) for severe mitral valve regurgitation. We decided to observe the outcomes of the patients who underwent TEER for severe mitral valve regurgitation associated with aortic or tricuspid valve disease. In this retrospective cohort study, 170 patients participated that underwent TEER. Patients only with severe MVR 73/170 (42.9%) were compared to patients who had associated either moderate to severe aortic stenosis or regurgitation or tricuspid insufficiency 97/170 (57.1%). The patients had similar basic characteristics in terms of gender, prior diseases such as stroke, peripheral arterial disease, diabetes, heart failure, chronic lung disease, KCCQ12 score, MR severity, and ejection fraction. We assessed the impact of coincidental aortic or tricuspid valve disease on post-TEER outcomes such as MR reduction, total-in-hospital stay, and mortality. Post-TEER, no difference was found in reducing the severity of MR (p=0.91.), total-in-hospital stay (p=0.77), and survival between patients with only MVR and patients with MVR associated with either aortic stenosis or regurgitation or tricuspid insufficiency. Both groups exhibited a reduction in the severity of MR, average total in-hospital stay of 6.33∼ 6.73 (mean 6.53), and survival of 100% compared to another group with good outcomes. There was no difference in feasibility and short-term outcomes of TEER in patients only with MVR compared to patients with MVR and associated aortic or tricuspid valve disease. In the era of minimally invasive procedures such as TEER, when performed in patients with concomitant and very often complicated valve pathology, we need large-scale trials to follow up on these patients' short- and long-term outcomes.

Background: Despite a large amount of evidence evaluating elevated troponin I levels and adverse clinical outcomes, little is known about the role of a normal (negative) troponin I during the first 24 h of admission for risk stratification in patients with Coronavirus Disease 2019 (COVID-19). This study aims to evaluate the utility and negative predictive value of a serum troponin I level to predict in-hospital mortality.Methods: We retrospectively analyzed all adult patients (>18 years of age) with COVID-19 admitted to an HCA Healthcare facility between March 2020 and March 2021 who had a troponin I level drawn at admission. Patients were initially stratified into two groups based on their cardiac troponin I value in the first 24 h of admission (elevated vs negative).Results: A total of 65,580 patients were included in the final analysis. A negative troponin I value was associated with lesser odds of death during admission (OR = 0.32, 95 % CI 0.31-0.34, p < 0.01) and cardiac complications (OR = 0.38, 95 % CI 0.37-0.40, p < 0.01). The negative predictive value of a negative troponin value for allcause in-hospital mortality was 85.7 %.Conclusions: Our study found a significant association between a negative troponin I value in the first 24 h of admission and decreased odds of death during admission in patients with confirmed COVID-19 infection, in addition to decreased odds of cardiac complications but no significant difference in hospital length of stay. Therefore, the authors suggest that the absence of troponin I elevation may serve as an indicator of a more benign hospital course.