Background: Modern implantable cardioverter-defibrillators (ICDs) utilize single-chamber (SC) or dual-chamber (DC) discrimination algorithms to differentiate between tachyarrhythmias and minimize the risk of inappropriate therapies. While modern SC algorithms, especially those with morphology detection, are considered comparable to DC algorithms, the available data are limited. We aimed to compare the efficacy of SC and DC discrimination algorithms in malignant tachyarrhythmias. Methods: We retrospectively analyzed data from all patients with ICDs from a single manufacturer (Biotronik, Berlin, Germany) who were remotely monitored and followed up at two tertiary centers. Patients were divided into SC and DC groups, based on the programmed discrimination algorithm. The primary outcome was the risk of inappropriate therapies comparing SC vs. DC discriminators. A sensitivity analysis was also conducted, including only a subgroup of SC patients with active morphology discrimination. Results: A total of 557 patients were included. The distribution of the implanted ICDs was as follows: 76 VVI; 226 VDD; 76 DDD; and 179 CRT-D devices. A total of 124 ICDs were programmed utilizing SC and 433 were programmed into the DC discriminators group. Among the SC group, 47 (39%) ICDs used active morphology discrimination. The incidence of inappropriate ICD therapies did not differ among the SC and DC discrimination groups (Hazard Ratio [HR] 1.165; 95% Confidence Interval [CI] 0.393-3.448; p = 0.783). The predefined sensitivity analysis did not reveal any significant difference regarding this outcome (HR 1.809; 95% CI 0.241-13.577; p = 0.564). Conclusions: In this bicentric, remote monitoring-based study, the risk of inappropriate therapy in the SC group was similar to that of the DC group. Based on our results, SC discrimination is a suitable option, even for patients with dual-chamber devices.

INTRODUCTION:Restoration and maintenance of sinus rhythm (SR) before pulmonary vein isolation (PVI) by antiarrhythmic drug (AAD) therapy can lead to a better outcome in persistent atrial fibrillation (AF). It is unknown, however if pharmacologic conversion by amiodarone loading itself, compared to the need for additional electrical cardioversion (ECV), predicts a better outcome of PVI. Furthermore, it remains controversial whether subsequent AF episodes occurring while on amiodarone before PVI, have any predictive value. Our aim was to assess whether amiodarone response before the procedure shows predictive value in patients with persistent AF undergoing PVI. METHODS AND RESULTS:We retrospectively collected data from consecutive patients with persistent AF who underwent PVI between 2013 and 2023, and who received temporary amiodarone therapy, with or without ECV to restore and maintain sinus rhythm before the intervention. A total of 353 patients (30% female, mean age: 63.76 ± 9.27 years) were included. Conversion to sinus rhythm was achieved solely by amiodarone therapy (AmioConv) in 96 patients (27%), while 257 patients (73%) required additional ECV as well. There were no differences between the two groups in terms of comorbidities, CHADS-VASc score (2.46 ± 1.43 vs. 2.26 ± 1.48, p = 0.27), or echocardiographic parameters, but the AmioConv group had a shorter history of AF (2.22 ± 2.96 years vs. 3.74 ± 4.64 years, p < 0.01). During a mean follow-up of 3.48 ± 2.32 years after PVI, patients in the AmioConv group less frequently experienced AF recurrences (41% vs. 56%, p = 0.016) and had significantly longer mean recurrence-free survival (5.21 ± 0.54 vs. 3.6 ± 0.35 years, p < 0.01), compared to the ECV group. The lack of pharmacologic conversion by amiodarone therapy (need for ECV) was found to be the only independent predictor of post PVI recurrences (adjusted HR 1.86, 95% CI 1.21-2.85, p < 0.01). On the contrary, breakthrough episodes of AF during amiodarone therapy, before ablation, were not predictive (adjusted HR 0.87, 95% CI 0.57-1.32, p = 0.51). CONCLUSION:In patients with persistent atrial fibrillation the outcome after PVI is predicted by pharmacologic conversion during amiodarone loading, but not the reoccurrence of the arrhythmia during continued pre-ablation AAD therapy.

An increasing number of studies suggest the role of the Purkinje network and Purkinje-myocardial junction in the development of malignant ventricular arrhythmias. Radiofrequency catheter ablation of the distal arborization of the left ventricular Purkinje network may influence the recurrence of ventricular fibrillation. In three patients (all male, age: 52 +/- 6.6 years), radiofrequency ablation of the distal left ventricular Purkinje network was performed due to recurrent ventricular fibrillation despite amiodarone treatment. One patient had hypertrophic cardiomyopathy, another had ischemic cardiomyopathy, and the third had idiopathic ventricular fibrillation. Target identification was achieved by mapping Purkinje-originated ventricular extrasystoles induced by isoproterenol infusion (in two patients) and by pace-mapping based on clinical ECG documentation and intracardiac defibrillator recordings (two patients). The radiofrequency ablation target included the area identified by Purkinje potentials along the left ventricular posterior fascicle and, in one case, also the distal arborization of the anterior fascicle. During a mean follow-up period of 17 +/- 11 months following the procedure, one patient experienced malignant ventricular arrhythmia, less frequently than before. In recurrent ventricular fibrillation of various origins, catheter ablation of the distal arborization of the left ventricular Purkinje network may reduce the recurrence of malignant ventricular arrhythmias. Orv Hetil. 2025; 166(8): 307-312.

Restoration and maintenance of sinus rhythm (SR) in the months before pulmonary vein isolation (PVI) by antiarrhythmic drug (AAD) therapy may lead to a better outcome in persistent atrial fibrillation (AF). Amiodarone is the only AAD that has been shown to be effective not only in achieving rhythm control, but also in reversing atrial remodeling. It is unknown, however if persistent AF patients who convert upon amiodarone loading exhibit better outcomes after ablation, compared to those that also need electrical cardioversion (ECV) to achieve SR. It is also controversial whether subsequent AF episodes before the PVI, while on amiodarone, portend a worse outcome after ablation. Our aim was to evaluate whether amiodarone response before the procedure has predictive value in patients with persistent AF undergoing PVI. We retrospectively collected data from patients with persistent AF who underwent PVI between 2013 and 2023, and who received temporary amiodarone therapy, with or without ECV to restore and maintain sinus rhythm prior to the intervention. A total of 371 patients (51% female, mean age: 63.76 ± 9.32 years) were included. Conversion to sinus rhythm was achieved solely by amiodarone therapy (AmioConv) in 104 patients (28%), while 267 patients (72%) required additional ECV as well. There were no differences between the two groups in terms of comorbidities and CHADS-VASc score (2.19±1.41 vs. 2.05±1.41; p=0,484), but the AmioConv group had smaller left atrial diameter (47 ± 6.6 mm vs. 49 ± 6.9 mm, p=0.034), higher left ventricular ejection fraction (57 ± 12.0% vs. 54 ± 13.3%, p=0.054) and a shorter history of AF (2.49 ± 3.0 years vs. 3.8 ± 4.67 years, p=0.01). During a mean follow-up of 2.47 ± 2.07 years after PVI, patients in the AmioConv group less frequently experienced AF recurrences (17% vs. 33%, p<0.01) and had longer mean recurrence-free survival (4.73±0.45 years vs. 3.9±0.29 years, p=0.02), compared to the ECV group. Conversion by amiodarone therapy was found to be an independent predictor of success of PVI (OR 2.03, 95% CI 1.20-3.43, p<0.01). On the contrary, AF episodes during amiodarone therapy, before ablation were not predictive of recurrences post PVI (p=0.32). In patients with persistent atrial fibrillation, the success of PVI is predicted by the spontaneous restoration, but not the maintenance of sinus rhythm during amiodarone pretreatment.

Egyre több vizsgálat eredménye utal a Purkinje-hálózat és a Purkinje-myocardium-junctio szerepére malignus kamrai arrhythmiák kiváltásában. A bal kamrai Purkinje-hálózat distalis arborizációjának rádiófrekvenciás katéterablatiója befolyásolhatja a kamrafibrilláció ismétlődését. Három beteg (mind férfi, életkor: 52 ± 6,6 év) esetében került sor amiodaron ellenére gyakran visszatérő kamrafibrilláció miatt a distalis bal kamrai Purkinje-hálózat ablatiójára. Egyikük hypertrophiás, egy másik ischaemiás cardiomyopathiában szenvedett, a harmadik esetében idiopathiás kamrafibrilláció volt a diagnózis. A célpont azonosítása izoproterenolinfúzióval indukálható, Purkinje-eredetű kamrai extrasystole térképezése (2 beteg esetében) és a klinikai EKG-dokumentáció, illetve a beültethető kardioverter-defibrillátor által rögzített regisztrátumok alapján végzett ’pace-map’ révén (2 beteg) történt. A rádiófrekvenciás ablatio célpontja a Purkinje-potenciálok által azonosított, bal kamrai posterior fasciculus mellett egy esetben magában foglalta az anterior fasciculus distalis arborizációjának területét is. A beavatkozást követő 17 ± 11 hónapos utánkövetés során egy beteg esetében jelentkezett – a korábbiaknál ritkábban – malignus kamrai arrhythmia. Különböző eredetű, visszatérő kamrafibrilláció esetén a bal kamrai Purkinje-hálózat distalis arborizációjának katéteres ablatiója csökkentheti a malignus kamrai arrhythmiák ismétlődését. Orv Hetil. 2025; 166(8): 307–312.

During the last decade, pulmonary vein isolation (PVI) has become the most effective treatment for patients with atrial fibrillation. However, success rates after the first interventions were less favourable, creating durable PV isolation proved to be a technological challenge, consequently, repeated (redo) interventions were often performed. Our objective was to examine how the proportions of redo PVIs and the PV reconnection rate have evolved in the practice of our institution in the light of the techological evolution of the past decade. We retrospectively analyzed the demographic and procedural data of patients undergoing first PVI, using point-by-point radiofrequency (RF) technology between 2013 and 2024 in terms of technology used at index PVI, outcome during follow-up and PV reconnections at redo procedures. The RF technology was categorized using a scoring system, where irrigated-RF catheter technology was the basis (0 point), and each additional technological improvement used (contact force sensing, steerable sheath, Ablation Index, high power-short duration RF) increased the score by 1, up to a maximum of 4 points. During the study period, 1580 patients underwent point-by-point RF PVI (60% male, age 62±10 years) and subsequently, 367 patients (23%) had redo interventions during the follow-up (25±26 months). The rate of first redo PVIs after index PVIs in ten years showed a significantly declining trend (53% in 2013, 6% in 2023, p<0.001). There was an inverse correlation between the technological points of the index procedures and the recurrence rate during follow-up (66%, 64%, 51%, 34%, 33%, in case of points 0 through 4, respectively, p<0.001). Lower technological score and persistent AF proved to be independent predictors of recurrence (p<0.001 and p=0.01, respectively). During the redo procedures, an inverse correlation was observed between the technology score of the index PVI and the rate of PV reconnection (88%, 99%, 74%, 59%, 46%, in case of points 0 through 4, respectively, p<0.001). Similarly, the number of reconnected PVs decreased with increasing score (a mean of 1.90, 2.0, 1.46, 1.23, 0.85 PVs, in case of points 0 through 4, respectively, p<0.001). In accordance with technological evolution, a significant increase was observed in the frequency of zero reconnection (0 points: 12%, 1 point: 11%, 2 points: 26%, 3 points: 41%, 4 points: 54%, p<0.001, Figure). Paralell with the evolution of applied RF technology, the rate of redo PVI interventions, the phenomenon and extent of PV reconnection during redos have shown a significantly declining trend. These observations may reevaluate long-term management strategies for arrhythmia recurrences after PVI.Figure

Background:Better outcome has been suggested for repeat procedures after atrial fibrillation (AF) ablation, when recurrence presented as organized atrial tachycardia (OAT) compared to recurrent AF. However, this contradicts the finding of more advanced atrial remodeling in patients with OAT recurrence and may be related to iatrogenesis by substrate modification during the index procedure. Therefore, we examined the prognostic significance of the type of recurrent arrhythmia after pulmonary vein isolation (PVI) without additional substrate modification. Methods:We included 185 patients (88 female, 64 ± 9 years) undergoing repeat ablation after index PVI for recurrent OAT (24%) or AF (76%). The recurrence rate, arrhythmia-free survival time, and the type of further recurrences were recorded. Results:There was no difference in the rate and mean time of arrhythmia-free survival between patients with OAT versus AF recurrence after the first (49% vs. 52%, p = .72 and 51.08 ± 6.66 vs. 53.37 ± 4.75 months, p = .54, respectively) and last (60% vs. 58%, p = .80 and 63.2 ± 7.04 vs. 61.2 ± 5.32 months, p = .23, respectively) redo procedure. AF occurred in the majority of subsequently recurring patients in both groups. No significant difference was found in the outcome of redo procedures between patients with typical flutter and atypical OAT, but a higher rate of successful rhythm control was observed in those with paroxysmal, as compared to persistent AF recurrence. Conclusion:After a PVI-only index procedure, recurrent OAT is not associated with a better outcome of redo procedures compared to recurrent AF. After repeat ablations, both groups experience AF as the dominant further recurrence.

Implantable cardioverter defibrillator (ICD) systems are available in both single-chamber (SC) and dual-chamber (DC) configurations, with discrimination functions varying accordingly. Although expert opinion generally suggests that modern SC discriminators equipped with morphology detection algorithms are equally effective to DC systems in tachyarrhythmia discrimination, only limited and contradictory data are available. In most previous reports the choice between SC or DC discrimination was determined by the number of the implanted leads. We aimed to assess the efficacy of SC vs. DC ICD discriminators in malignant tachyarrhythmias by performing a head-to-head comparison of devices from a single manufacturer, whose ICDs also include single-lead devices with a programmable option of SC or DC discriminators (VDD ICD). Data from ICD recipients followed up with the Home Monitoring system were retrospectively analysed. As primary outcome we compared the risk of inappropriate therapy between patients, whose ICD was programmed to SC (i.e. Stability/Onset/MorphMatch) vs. DC (i.e. SMART) discrimination algorithms. A sensitivity analysis was also conducted including only patients into the SC discrimination group with activated morphology discriminator. A total of 211 patients (mean age 64±12, male 75%, primary prophylaxis 33%) were included. All patients had been implanted with an ICD from the same manufacturer (VVI: 62, VDD: 94, DDD: 14, CRT-D: 41), and were remotely followed up. Among these, 71 ICDs were programmed to SC, while 98 were programmed to apply DC discriminators. In the remaining 42 cases, only VF zone was programmed, therefore these patients were excluded from further analysis. Of the SC discriminator group, 35 (49%) patients were programmed to utilize morphology discriminator. There was no significant difference between the SC and DC groups in atrial (6±3 vs. 4±3 mV; p=0.062) or ventricular sensing (15±6 vs. 14±7 mV; p=0.781) at the time of introduction to remote monitoring. We did not detect difference in the risk of inappropriate therapies between the SC and DC discriminator groups (HR 2.274; 95% CI 0.437-11.815; p=0.329), and we did not find difference in the predefined sensitivity analysis between the two groups (HR 2.177; 95% CI 0.254-18.664; p=0.478). Our data suggest that there is no significant difference in the performance of tachyarrhythmia discrimination between single- and dual-chamber discriminators. The findings of the present study support single-chamber discriminators as a viable alternative even for patients with implanted dual-chamber devices.

Importance Prescriptions for potentially inappropriate medications are common and, by definition, may carry risks that outweigh benefits. Objective To determine whether interventions to address potentially inappropriate prescribing for older primary care patients are associated with changes in the number of medications prescribed, drug-related harms, hospitalizations, and mortality. Data Sources MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to September 6, 2024. Study Selection Randomized clinical trials of interventions to address potentially inappropriate prescribing for older primary care patients (aged >= 65 years) residing in the community or in long-term care facilities, such as nursing homes or assisted-living facilities, were included. Data Extraction and Synthesis Two researchers independently screened the records and abstracted data using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Data were pooled using random-effects models. Main Outcomes and Measures The planned outcomes were the number of medications, nonserious adverse drug reactions, injurious falls, quality of life, medical visits, emergency department visits, hospitalizations, and all-cause mortality. Random-effects meta-analyses were performed using the inverse variance method for similar studies, reporting risk ratios (RRs) or standardized mean differences (SMDs). Heterogeneity was assessed with I2 values, and publication bias was assessed with funnel plots and the Egger regression test. Results Of the 14 649 records identified, 118 randomized clinical trials (comprising 417 412 patients) were included in this review. Interventions to address potentially inappropriate prescribing were associated with a reduction in the number of medications prescribed (SMD, -0.25 [95% CI, -0.38 to -0.13]), equivalent to approximately 0.5 fewer medications per patient. However, there were no substantial differences in the other outcomes, including nonserious adverse drug reactions (RR, 0.92 [95% CI, 0.58-1.46]), injurious falls (SMD, 0.01 [95% CI, -0.12 to 0.14]), quality of life (SMD, 0.09 [95% CI, -0.04 to 0.23]), medical visits (SMD, 0.02 [95% CI, -0.02 to 0.07]), emergency department admissions (RR, 1.02 [95% CI, 0.96-1.08]), hospitalizations (RR, 0.95 [95% CI, 0.89-1.02]), or all-cause mortality (RR, 0.94 [95% CI, 0.85-1.04]). Conclusions and Relevance In this systematic review and meta-analysis, interventions to address potentially inappropriate prescribing were associated with reductions in the number of medications prescribed, with no substantial change in other outcomes. These findings suggest that inappropriate prescribing interventions may be implemented to safely reduce the number of medications prescribed to older adults in the primary care setting. Future studies should continue to evaluate these interventions using standardized criteria and consistently report potential harms to support data synthesis and capture key outcomes such as quality of life, hospitalization, and mortality.

Background: An atrioventricular defibrillator system with a floating atrial dipole (VDD ICD) can provide atrial sensing by a single lead. Our aim was to compare the arrhythmia detection efficacy of VDD ICDs with conventional single- (VVI) and dual-chamber (DDD) defibrillators. Methods: Data from consecutive patients undergoing ICD implantation were retrospectively analyzed. The primary endpoint was the incidence of device-detected, new-onset atrial arrhythmias, while secondary endpoints were sensing parameters, complication rates, incidence of appropriate/inappropriate ICD therapy, arrhythmic/heart failure-related hospitalizations, and all-cause mortality. Results: A total of 256 patients (mean age 64 ± 12 years, male 75%, primary prophylaxis 28%, mean follow-up 3.7 ± 2.4 years) were included (VVI: 93, VDD: 94, DDD: 69). Atrial arrhythmia episodes were detected more frequently by VDD systems compared to VVI ICDs (aHR 7.087; 95% CI 2.371–21.183; p < 0.001), and at a rate similar to that of DDD ICDs (aHR 1.781; 95% CI 0.737–4.301; p = 0.200). The rate of inappropriate shocks was not different among the three ICD systems. Conclusion: VDD devices revealed an advantage in atrial arrhythmia detection compared to VVI ICDs and were non-inferior to DDD systems. Their main indication may be closer monitoring in high-risk patients with atrial arrhythmias to help therapy optimization and not the improvement of tachycardia discrimination.

Háttér: A pitvarfibrilláció (PF) miatt végzett pulmonálisvéna-izoláció (PVI) emelkedett trombembóliás rizikóval jár. A direkt orális antikoagulánsok (DOAK-ok) megjelenése jelentősen átalakította a perioperatív véralvadásgátlásra vonatkozó ajánlásokat. Vizsgálatunkban az antikoagulánsok megválasztásának időbeli trendjeit elemeztük katéterablációra felvett betegek körében. Módszerek: 2010-ben, 2015-ben és 2020-ban centrumunkban PF miatt katéterablációban részesülő betegek adatait elemeztük. A betegek demográfiai adatai mellett a trombembóliás és vérzéses rizikóra, valamint a véralvadásgátló-kezelésre vonatkozó információkat gyűjtöttük és hasonlítottuk össze. Eredmények: 2010-ben 55, 2015-ben 146, 2020-ban pedig 166 betegnél végeztünk PF miatt katéterablációt (átlagéletkor 62±11 év; férfi 54,7%). Az ablációra kerülő betegek életkora 2015-ben szignifikánsan magasabbnak bizonyult 2010-hez képest, ezt követően azonban nem emelkedett. Mind a nem figyelembevétele nélkül kalkulált CHA2DS2-VA score (1,6±1,3 ® 2,3±1,3 ® 2,6±1,5), mind a HAS-BLED score (0,53±0,7 ® 0,77±0,8 ® 1,06±1,0) folyamatosan nőtt az évek előrehaladtával. 2010-ben a kórházi felvételkor a betegek 78,2%-a részesült K-vitamin-antagonista (VKA) kezelésben, 5,5% LMWH-t kapott, 16,4%-a pedig nem volt antikoagulálva. 2015-ben a VKA-arány 66,4%-ra mérséklődött, 24,7%-ban megjelenetek a DOAK-ok, 3,4% továbbra is LMWH-t kapott, a betegek 5,5%-a továbbra sem részesült kezelésben. 2020-ra 65,1%-kal a DOAK-ok váltak a vezető antikoagulánsokká, a VKA-k aránya 28,9%-ra csökkent, LMWH 1,2%-ban, antikoaguláció nélküli beteg 4,8%-ban fordult elő. Konklúzió: Bár az elmúlt 10 évben az ajánlások alapján elsőként választandó DOAK-ok váltak a leggyakrabban alkalmazott véralvadásgátló készítményekké intézményünkben pitvarfibrilláció miatt katéterablációra kerülő betegek körében, a páciensek közel egyharmada 2020-ban még VKA-kezelésben részesült. A trombembóliás/vérzéses rizikó folyamatosan emelkedő tendenciája a PVI indikációs körének kibővülését jelezi.

Background Different guideline panels, and individuals, may make different decisions based in part by their preferences. This systematic review update examined the relative importance placed by patients aged ≥ 35 years on the potential outcomes of breast-cancer screening. Methods We updated our searches to June 19, 2023 in MEDLINE, PsycINFO, and CINAHL. We screened grey literature, submissions by stakeholders, and reference lists. We sought three types of preferences, directly through i) utilities of screening and curative treatment health states (measuring the impact of the outcome on one’s health-related quality of life), and ii) other preference-based data, such as outcome trade-offs, and indirectly through iii) the relative importance of benefits versus harms inferred from attitudes, intentions, and behaviors towards screening among informed patients. For screening we used machine learning as one of the reviewers after at least 50% of studies had been reviewed in duplicate by humans; full-text selection used independent review by two humans. Data extraction and risk of bias assessments used a single reviewer with verification. Our main analysis for utilities used data from utility-based health-related quality of life tools (e.g., EQ-5D) in patients. When suitable, we pooled utilities and explored heterogeneity. Disutilities were calculated for screening health states and between different treatment states. Non-utility data were grouped into categories and synthesized with creation of summary statements. Certainty assessments followed GRADE guidance. Findings Eighty-two studies (38 on utilities) were included. The estimated disutilities were 0.07 for a positive screening result (moderate certainty), 0.03-0.04 for a false positive (FP; “additional testing” resolved as negative for cancer) (low certainty), and 0.08 for untreated screen-detected cancer (moderate certainty) or (low certainty) an interval cancer. At ≤12 months, disutilities of mastectomy (vs. breast-conserving therapy), chemotherapy (vs. none) (low certainty), and radiation therapy (vs. none) (moderate certainty) were 0.02-0.03, 0.02-0.04, and little-to-none, respectively. Over the longer term, there was moderate certainty for little-to-no disutility from mastectomy versus breast-conserving surgery/lumpectomy with radiation and from radiation. There was moderate certainty that a majority (>50%) and possibly large majority (>75%) of women probably accept up to six cases of overdiagnosis to prevent one breast-cancer death.Low certainty evidence suggested that a large majority may accept that screening may reduce breast-cancer but not all-cause mortality, at least when presented with relatively high rates of breast-cancer mortality reductions (n=2; 2 and 5 fewer per 1000 screened), and at least a majority accept that to prevent one breast-cancer death at least a few hundred patients will receive a FP result and 10-15 will have a FP resolved through biopsy. When using data from studies assessing attitudes, intentions, and screening behaviors, across all age groups but most evident for women in their 40s, preferences reduced as the net benefit presented by study authors decreased in magnitude. In a relatively low net-benefit scenario, a majority of patients in their 40s may not weigh the benefits as greater than the harms from screening (low certainty evidence). A large majority of patients aged 70-71 years probably think the benefits outweigh the harms for continuing to screen. A majority of women in their mid-70s to early 80s may prefer to continue screening. Conclusions Evidence across a range of data sources on how informed patients value the potential outcomes from breast-cancer screening will be useful during decision-making for recommendations. Further, the evidence supports providing easily understandable information on possible magnitudes of effects to enable informed decision-making. Systematic review registration : Protocol available at Open Science Framework https://osf.io/xngsu/

Objective To compare the effects of aerobic training combined with muscle strength training (hereafter referred to as combined training) to aerobic training alone on cardiovascular disease risk indicators in patients with coronary artery disease (CAD). Design Systematic review with meta-analysis. Data sources MEDLINE, Embase, CINAHL, SPORTDiscus, Scopus, trial registries and grey literature sources were searched in February 2024. Eligibility criteria Randomised clinical trials comparing the effects of >= 4 weeks of combined training and aerobic training alone on at least one of the following outcomes: cardiorespiratory fitness (CRF), anthropometric and haemodynamic measures and cardiometabolic blood biomarkers in patients with CAD. Results Of 13 246 studies screened, 23 were included (N=916). Combined training was more effective in increasing CRF (standard mean difference (SMD) 0.26, 95% CI 0.02 to 0.49, p=0.03) and lean body mass (mean difference (MD) 0.78 kg, 95% CI 0.39 kg to 1.17 kg, p<0.001), and reducing per cent body fat (MD -2.2%, 95% CI -3.5% to -0.9%, p=0.001) compared with aerobic training alone. There were no differences in the cardiometabolic biomarkers between the groups. Our subgroup analyses showed that combined training increases CRF more than aerobic training alone when muscle strength training was added to aerobic training without compromising aerobic training volume (SMD 0.36, 95% CI 0.05 to 0.68, p=0.02). Conclusion Combined training had greater effects on CRF and body composition than aerobic training alone in patients with CAD. To promote an increase in CRF in patients with CAD, muscle strength training should be added to aerobic training without reducing aerobic exercise volume.

Background: Pulmonary vein isolation (PVI) for atrial fibrillation (AF) is associated with an increased risk of thromboembolism. The appearance of direct oral anticoagulants (DOACs) has significantly altered the recommendations for perioperative anticoagulation. In our study, we analyzed the current trends in anticoagulant choice among patients referred for catheter ablation. Methods: Data from consecutive patients undergoing catheter ablation for AF at our center in 2010, 2015, and 2020 were analyzed. In addition to patient demographics, thromboembolic and bleeding risk factors and information on anticoagulation therapy were collected and compared. Results: In 2010 55, in 2015 146, and in 2020 166 patients were admitted for catheter ablation of AF (mean age 62±11 years; male 54.7%). The mean age of patients undergoing ablation increased significantly in 2015 compared to 2010, but thereafter did not change. Both the CHA2DS2-VA score calculated without sex category (1.6±1.3 ® 2.3±1.3 ® 2.6±1.5) and the HAS-BLED score (0.53±0.7 ® 0.77±0.8 ® 1.06±1.0) increased continuously with the time. At admission in 2010, 78.2% of patients were taking vitamin K antagonist (VKA), 5.5% were on LMWH and 16,4% were not anticoagulated. In 2015, the VKA rate decreased to 66.4%, 24.7% had DOACs, 3.4% were still on LMWH and 5,5% were still not treated. By 2020, DOACs became the leading anticoagulants with 65.1%, VKAs decreased to 28.9%, LMWH was prescribed in 1.2%, and in 4.8% patients were referred without anticoagulation. Conclusion: Although the DOACs have become the first-line therapy in the last 10 years in patients undergoing catheter ablation at our clinic, nearly one third of patients still received VKA treatment in 2020. A continuous trend for increasing thromboembolic and bleeding risk indicates the expansion of the indication for PVI.

Purpose To inform updated recommendations by the Canadian Task Force on Preventive Health Care on screening in a primary care setting for hypertension in adults aged 18 years and older. This protocol outlines the scope and methods for a series of systematic reviews and one overview of reviews. Methods To evaluate the benefits and harms of screening for hypertension, the Task Force will rely on the relevant key questions from the 2021 United States Preventive Services Task Force systematic review. In addition, a series of reviews will be conducted to identify, appraise, and synthesize the evidence on (1) the association of blood pressure measurement methods and future cardiovascular (CVD)-related outcomes, (2) thresholds for discussions of treatment initiation, and (3) patient acceptability of hypertension screening methods. For the review of blood pressure measurement methods and future CVD-related outcomes, we will perform a de novo review and search MEDLINE, Embase, CENTRAL, and APA PsycInfo for randomized controlled trials, prospective or retrospective cohort studies, nested case–control studies, and within-arm analyses of intervention studies. For the thresholds for discussions of treatment initiation review, we will perform an overview of reviews and update results from a relevant 2019 UK NICE review. We will search MEDLINE, Embase, APA PsycInfo, and Epistemonikos for systematic reviews. For the acceptability review, we will perform a de novo systematic review and search MEDLINE, Embase, and APA PsycInfo for randomized controlled trials, controlled clinical trials, and observational studies with comparison groups. Websites of relevant organizations, gray literature sources, and the reference lists of included studies and reviews will be hand-searched. Title and abstract screening will be completed by two independent reviewers. Full-text screening, data extraction, risk-of-bias assessment, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) will be completed independently by two reviewers. Results from included studies will be synthesized narratively and pooled via meta-analysis when appropriate. The GRADE approach will be used to assess the certainty of evidence for outcomes. Discussion The results of the evidence reviews will be used to inform Canadian recommendations on screening for hypertension in adults aged 18 years and older. Systematic review registration This protocol is registered on PROSPERO and is available on the Open Science Framework (osf.io/8w4tz).

Összefoglaló közleményünkben részletesen áttekintjük a rádiófrekvenciás energiával végzett fokális, pontról pontra történő pulmonalisvéna-izoláció korszerű módszertanát, valamint a procedúra fejlődésének azon lépcsőfokait, amelyek meghatározó mértékben növelték a kezelés hatékonyságát. Célunk azon technikák alkalmazásával kapcsolatos tudományos evidenciák áttekintése volt, amelyek jelentősen hozzájárultak a pontról pontra történő pulmonalisvéna-izoláció, mint egységes és standardizálható procedúra felépítéséhez.

Electrical storm due to recurrent ventricular tachycardias (VTs) is a life-threatening arrhythmic emergency. The authors present a case report of a 69-year-old male patient with VT storm of non-ischemic etiology. Despite optimal medical treatment escalated by amiodarone antiarrhythmic drug therapy, the patient experienced multiple implantable cardioverter defibrillator (ICD) shocks. An electrophysiological study revealed an epicardial substrate; however, considering the patient’s extreme obesity and active anticoagulant effect, catheter ablation was deemed to be unfeasible. Subsequently, mexiletine was added to the patient’s drug regimen, resulting in successful control of arrhythmias during the following 6 months. Although the most recent European guidelines for the management of patients with ventricular arrhythmias mention mexiletine only for the treatment of LQT3 patients, its use for treatment-refractory VT storm seems to also be an important indication area.