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Open AccessArticle

The Predictors of New-Onset Atrial Fibrillation in End-Stage Renal Disease Patients: A Multi-Center Retrospective Observational Study

by Ahmed A. Zayed, Mohamad Bahij Moumneh, Bahy Abofrekha, Hadi Itani, Omar Khayat, Abdelrahman Abouelnas and Martin M. Amor

J. Clin. Med. 2026, 15(8), 2879; https://doi.org/10.3390/jcm15082879 - 10 Apr 2026

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Abstract

Background/Objectives: Atrial fibrillation (AF) is a significant and prevalent cardiovascular complication in end-stage renal disease (ESRD) patients, yet its specific predictors within this population are not well understood. This study aimed to identify the predictors of new-onset AF in ESRD patients undergoing [...] Read more.

Background/Objectives: Atrial fibrillation (AF) is a significant and prevalent cardiovascular complication in end-stage renal disease (ESRD) patients, yet its specific predictors within this population are not well understood. This study aimed to identify the predictors of new-onset AF in ESRD patients undergoing dialysis. Methods: We conducted a retrospective multicenter cohort study within the Northwell Health System, analyzing data from 5326 ESRD patients on dialysis between 2017 and 2019. The mean age was 64.2 ± 13.1 years, with 48.3% females. Multivariable-adjusted logistic regression was used to identify predictors of new-onset AF, the primary outcome. Adjusted odds ratios (ORs) were calculated for potential risk factors. Results: Of the 5326 patients, 1564 (29.4%) developed new-onset AF. Significant predictors included increasing age (OR 1.038 per year, 95% CI 1.032–1.044, p < 0.0001), obesity (BMI > 30 vs. BMI 20–25: OR 1.208, 95% CI 1.026–1.422, p = 0.023), and coronary artery disease (OR 1.678, 95% CI 1.466–1.920, p < 0.0001). African American patients had lower odds of developing AF compared to White patients (OR 0.578, 95% CI 0.494–0.676, p < 0.0001). Hypertension, sex, diabetes, and tobacco use were not significantly associated with AF risk. Conclusions: Age, obesity, and coronary artery disease are significant predictors of new-onset AF in ESRD patients on dialysis. Notable racial disparities exist, with African American patients having a lower risk. These findings may inform targeted prevention strategies and guide future research into the mechanisms underlying AF in ESRD patients. Full article

(This article belongs to the Special Issue Advances in Arrhythmia Diagnosis and Management)

22 pages, 2476 KB

Open AccessArticle

Expanding the Role of Implantable Loop Recorders: Diagnostic and Therapeutic Yields Across Seven Clinical Indications in 388 Real-World Patients

by Carlos Plappert, Philipp Lacour, Abdul S Parwani, Leif-Hendrik Boldt, Felix Bähr, Doreen Schöppenthau, Anna Feuerstein, Leonie H Wieland, Emanuel Heil, Felix Hohendanner, Nikolaos Dagres, Gerhard Hindricks, Ingo Hilgendorf and Florian Blaschke

J. Clin. Med. 2026, 15(5), 1977; https://doi.org/10.3390/jcm15051977 - 5 Mar 2026

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Abstract

Background/Objectives: Implantable loop recorders (ILRs) enable long-term electrocadiographic monitoring and are established diagnostic tools for syncope and atrial fibrillation (AF). However, their diagnostic yield and therapeutic impact in other clinical settings remain less well defined. We aimed to evaluate the diagnostic yield [...] Read more.

Background/Objectives: Implantable loop recorders (ILRs) enable long-term electrocadiographic monitoring and are established diagnostic tools for syncope and atrial fibrillation (AF). However, their diagnostic yield and therapeutic impact in other clinical settings remain less well defined. We aimed to evaluate the diagnostic yield and clinical impact of ILR implantation across contemporary clinical indications. Methods: In this retrospective single-center study, 388 patients who underwent ILR implantation between 2011 and 2018 were included. Indications were categorized into seven groups: unexplained syncope, presyncope, cryptogenic stroke or transient ischemic attack (TIA), AF detection, AF recurrence after atrial flutter (AFL) ablation, risk stratification in structural or inherited heart disease, and palpitations. Results: Among 388 patients (median age 63 [51.8–71.8] years, 57.5% male; median follow-up 17.0 [IQR 6.4–32.4] months), ILRs were most frequently implanted for syncope (44.6%), AF (20.4%), and stroke/TIA (12.9%). ILR-detected arrhythmias occurred in 241 patients (62.1%), with the highest detection rates in AF (83.5%) and AFL (73.7%). Indication-fulfilling diagnoses were established in 155 patients (39.9%), most frequently in AF (73.4%) and AFL (71.1%), after a median of 4.4 months (IQR 2.4–12.5). Nearly three quarters (72.9%) of diagnoses were made within the first year. ILR findings prompted therapeutic interventions in 156 patients (40.2%), including pacemaker implantation in syncope and rhythm- or anticoagulation-based therapies in AF. AF and AFL independently predicted higher diagnostic yield, while diagnostic yield and AF history predicted ILR-triggered therapy. AF, AFL, stroke/TIA, and AF history were associated with shorter time to first arrhythmia detection. Arrhythmia-free survival differed significantly across indication groups (p < 0.0001) and was lowest in AF and AFL, which demonstrated the highest cumulative incidence of indication-fulfilling arrhythmias. Conclusions: ILRs provide substantial diagnostic and therapeutic value across a broad range of indications. Beyond established uses in syncope and AF, clinically relevant yields were observed in presyncope, risk stratification, and AFL post-ablation, supporting broader consideration of ILRs and optimized patient selection. Full article

(This article belongs to the Special Issue Advances in Arrhythmia Diagnosis and Management)

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14 pages, 524 KB

Open AccessArticle

Conduction System Pacing Improved Cardiac Functions, Myocardial Work and Functional Capacity in Heart Failure with Reduced Ejection Fraction and Right Bundle Branch Block

by Anna Zsófia Tóth, László Nagy, Csaba Jenei, Arnold Péter Ráduly, Gábor Sándorfi, Krisztina Mária Szabó, Alexandra Kiss, László Tibor Nagy, Gergő István Szilágyi and Zoltán Csanádi

J. Clin. Med. 2026, 15(1), 232; https://doi.org/10.3390/jcm15010232 - 27 Dec 2025

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Abstract

Background/Objectives: Conduction system pacing (CSP) is a potential alternative to biventricular pacing (BVP) in heart failure with reduced ejection fraction (HFrEF) and left bundle branch block (LBBB) or non-LBBB. Available data also suggest that unlike BVP, CSP may improve clinical outcome in patients [...] Read more.

Background/Objectives: Conduction system pacing (CSP) is a potential alternative to biventricular pacing (BVP) in heart failure with reduced ejection fraction (HFrEF) and left bundle branch block (LBBB) or non-LBBB. Available data also suggest that unlike BVP, CSP may improve clinical outcome in patients with right bundle branch block (RBBB), although its effects on cardiac mechanics and energetics are ill-defined. Herein, we report on echocardiographic and clinical outcomes of CSP in this patient cohort. Methods: CSP either with His bundle pacing or LBB area pacing was attempted as a primary strategy in patients with RBBB, QRS duration ≥ 130 ms, LVEF < 35% and NYHA II-IV symptoms after optimized medical therapy for 6 months. Data on functional status, NT-proBNP and echocardiographic parameters were collected at baseline and 6 months after CSP. Results: CSP performed in 16 patients reduced QRS duration from 155.3 ± 12.8 ms to 130 ± 16.5 ms (p < 0.001), increased LVEF from 27 ± 7% to 33 ± 9% (p = 0.01), improved LV global longitudinal strain from −7 ± 3% to −10 ± 4% (p = 0.004) and improved LV peak strain dispersion from 126 ± 28 ms to 96 ± 23 ms (p = 0.004). Global myocardial work index increased from 582 ± 277 mmHg% to 840 ± 306 mmHg% (p = 0.003), as did global constructive work (900 ± 374 mmHg% to 1203 ± 393 mmHg%; p = 0.006) and global work efficiency (from 71 ± 7% to 77 ± 8%; p = 0.004). NYHA class (12.5% with NYHA II, 87.5% with NYHA III before vs. 25% with NYHA I, 50% with NYHA II and 25% with NYHA III at 6 months; p = 0.002) and 6 min walk distance (from 354 ± 88 m to 411 ± 95 m; p = 0.003) improved, while NT-proBNP decreased (from 4093 ± 7215 ng/L to 2087 ± 2872 ng/L, p = 0.003). Conclusions: CSP improved functional capacity and echocardiographic parameters related to cardiac functions and myocardial work in HFrEF patients with RBBB. Nevertheless, these results await further confirmation by large-scale, multi-center randomized trials. Full article

(This article belongs to the Special Issue Advances in Arrhythmia Diagnosis and Management)

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14 pages, 815 KB

Open AccessArticle

Comparing Conduction System Pacing to Biventricular Upgrade in Pacemaker-Induced Cardiomyopathy: A Retrospective Observational Study

by Bernadett Miriam Dobai, Balázs Polgár, Márk Gémesi, Manuella Bogdan, Nikolett Vigh, Mirjam Turáni, Gábor Zoltán Duray and Péter Bógyi

J. Clin. Med. 2025, 14(21), 7745; https://doi.org/10.3390/jcm14217745 - 31 Oct 2025

Cited by 2 | Viewed by 1328

Abstract

Background/Objectives: Pacemaker-induced cardiomyopathy (PICM) develops in up to 30% of patients with chronic right ventricular pacing. While biventricular (BIV) upgrade is the conventional strategy, conduction system pacing (CSP) offers a physiologic alternative recently endorsed by the 2025 ESC/EHRA Consensus Statement. However, comparative [...] Read more.

Background/Objectives: Pacemaker-induced cardiomyopathy (PICM) develops in up to 30% of patients with chronic right ventricular pacing. While biventricular (BIV) upgrade is the conventional strategy, conduction system pacing (CSP) offers a physiologic alternative recently endorsed by the 2025 ESC/EHRA Consensus Statement. However, comparative evidence in PICM is limited. Therefore, we aimed to compare outcomes of PICM patients undergoing CSP versus BIV upgrade. Methods: This retrospective analysis included consecutive PICM patients who were upgraded to CSP or BIV between 2022 and 2024 at a single, experienced center. Follow-up averaged >19 months. Clinical outcomes, lead performance, echocardiographic parameters, complications, and quality of life (QoL) were evaluated. Results: Sixty-three patients were included (CSP: 26; BIV: 37). Mean age and sex distribution were similar; both groups had wide paced QRS complexes and a high ventricular pacing burden. Baseline left ventricular ejection fraction (LVEF) was lower in BIV patients (29 ± 7% vs. 35 ± 6%, p = 0.01). Procedure duration was comparable, but fluoroscopy was shorter with CSP. QRS duration narrowed significantly in both groups (CSP: 163 ± 28→132 ± 12 ms; BIV: 171 ± 23→140 ± 18 ms; both p < 0.05). During follow-up, LVEF improved (CSP: 41 ± 8%; p = 0.008; BIV: 39 ± 8%, p = 0.0001), as did NYHA class, with no significant intergroup differences. The rates of heart failure hospitalization, all-cause mortality, and QoL were similar. Notably, 34.6% of CSP patients retained their existing generator, suggesting procedural and economic benefits. Conclusions: CSP is a feasible and potentially cost-efficient alternative to BIV upgrade in PICM, with comparable improvements in ventricular function, symptoms, and clinical outcomes. Larger prospective trials are warranted. Full article

(This article belongs to the Special Issue Advances in Arrhythmia Diagnosis and Management)

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12 pages, 559 KB

Open AccessArticle

Pharmacological Cardioversion Versus Electrical Cardioversion in the Acute Treatment of Atrial Fibrillation in the Emergency Department: The Recufa-Hula Register

by Juan Jose López-Díaz, Alejandro Manuel López-Pena, Juliana Elices-Teja, Charigan Abou Johk-Casas, Andrea López-López, Tania Seoane-García, Ramón Ríos-Vázquez and Carlos González-Juanatey

J. Clin. Med. 2025, 14(19), 6845; https://doi.org/10.3390/jcm14196845 - 27 Sep 2025

Cited by 2 | Viewed by 2140

Abstract

Background: Strategies to restore sinus rhythm in hemodynamically stable patients with atrial fibrillation (AF) admitted to the emergency department (ED) are the focus of debate. The present study was carried out to compare pharmacological cardioversion (PC) and electrical cardioversion (EC) in terms of [...] Read more.

Background: Strategies to restore sinus rhythm in hemodynamically stable patients with atrial fibrillation (AF) admitted to the emergency department (ED) are the focus of debate. The present study was carried out to compare pharmacological cardioversion (PC) and electrical cardioversion (EC) in terms of their efficacy in converting to sinus rhythm. Methods: A retrospective, analytical observational study was carried out in patients seen in the ED over four consecutive years with episodes of uncomplicated AF. Two rhythm control strategies were evaluated: PC (followed or not by EC) and EC. Demographic and clinical variables were also compiled for both groups. Results: A total of 401 cardioversion procedures in 284 patients were analyzed. The mean patient age was 62.81 years (standard deviation [SD] 12.07), and 67.4% were male. PC was carried out in 160 subjects (56.3%), with a success rate of 76.8%, and EC was performed in 98 patients (34.5%), with a success rate of 94.9%. Significant differences between the two strategies were found for the primary objective (cardioversion to sinus rhythm), with the EC group presenting the best results (p = 0.0001). Conclusions: EC is safe and more effective in converting to sinus rhythm. The efficacy of PC alone is limited, and additional procedures for rhythm control are often required. Full article

(This article belongs to the Special Issue Advances in Arrhythmia Diagnosis and Management)

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11 pages, 1378 KB

Open AccessArticle

Sequential AI-ECG Diagnostic Protocol for Opportunistic Atrial Fibrillation Screening: A Retrospective Single-Center Study

by Ji-Hoon Choi, Sung-Hee Song, Jongwoo Kim, JaeHu Jeon, KyungChang Woo, Soo Jin Cho, Seung-Jung Park, Young Keun On, Ju Youn Kim and Kyoung-Min Park

J. Clin. Med. 2025, 14(18), 6675; https://doi.org/10.3390/jcm14186675 - 22 Sep 2025

Cited by 1 | Viewed by 1449

Abstract

Background/Objectives: Atrial fibrillation (AF) often occurs in episodes that are sudden and go unnoticed, reducing the chances of anticoagulation. We evaluated a two-stage AI ECG screening protocol that uses a single ECG model at initial screening and, if necessary, a serial ECG [...] Read more.

Background/Objectives: Atrial fibrillation (AF) often occurs in episodes that are sudden and go unnoticed, reducing the chances of anticoagulation. We evaluated a two-stage AI ECG screening protocol that uses a single ECG model at initial screening and, if necessary, a serial ECG model after short interval follow-up to enhance accuracy while saving monitoring resources. Methods: We analyzed 248,612 12-lead ECGs from 164,793 adults (AF, n = 10,735) for model development and assessed the protocol in 11,349 eligible patients with longitudinal ECGs. The proposed algorithm first applied a single-ECG AI model at the initial visit, followed by a serial-ECG AI model three months later if AF was not initially detected. The model’s performance was evaluated using several metrics, including the area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, accuracy, and F1 score. Results: The protocol achieved an AUROC of 0.908 with a sensitivity of 88.1%, specificity of 78.7%, positive predictive value (PPV) of 30.2%, negative predictive value (NPV) of 98.4%, accuracy of 79.6%, and an F1 score of 0.450. Among patients with a history of stroke (n = 551), 84.9% were correctly identified as AF-positive under the protocol. Conclusions: A sequential AI ECG strategy maintains high NPV at entry and improves PPV with longitudinal confirmation. This approach can prioritize ambulatory monitoring for those most likely to benefit and merits prospective, multi-center validation and cost-effectiveness assessment. Full article

(This article belongs to the Special Issue Advances in Arrhythmia Diagnosis and Management)

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16 pages, 1982 KB

Open AccessArticle

Head-to-Head Comparison of Single- Versus Dual-Chamber ICD Discriminators for Tachyarrhythmia Detection: A Single-Manufacturer, Remote Monitoring-Based Bicentric Study

by Flora Diana Gausz, Daniel Fodor, Mirjam Turani, Marton Miklos, Attila Benak, Dora Kranyak, Attila Makai, Gabor Bencsik, Peter Bogyi, Robert Pap, Laszlo Saghy, Attila Nemes, Tamas Szili-Torok, Gabor Zoltan Duray and Mate Vamos

J. Clin. Med. 2025, 14(16), 5859; https://doi.org/10.3390/jcm14165859 - 19 Aug 2025

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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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Advances in Arrhythmia Diagnosis and Management)

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12 pages, 382 KB

Open AccessArticle

Association Between Psychosocial Stress and Premature Ventricular Contractions During the Recovery Phase Following Treadmill Testing in Asymptomatic Individuals

by João Paulo de Almeida Dourado, Luan Morais Azevêdo, Larissa de Almeida Dourado, Jaciara Gomes de Oliveira, Bianca Barros de Faria, Karolyne de Oliveira Matos, Leonardo Roever, Paulo Magno Martins Dourado and Pedro Gabriel Senger Braga

J. Clin. Med. 2025, 14(13), 4637; https://doi.org/10.3390/jcm14134637 - 30 Jun 2025

Cited by 1 | Viewed by 3296

Abstract

Introduction: Ventricular arrhythmias may lead to sudden cardiac death and, when occurring during the recovery phase after exercise testing, are associated with increased cardiovascular risk. Aim: To investigate the association between psychosocial stress and the risk of premature ventricular contractions (PVCs) during [...] Read more.

Introduction: Ventricular arrhythmias may lead to sudden cardiac death and, when occurring during the recovery phase after exercise testing, are associated with increased cardiovascular risk. Aim: To investigate the association between psychosocial stress and the risk of premature ventricular contractions (PVCs) during the recovery phase after treadmill testing in asymptomatic individuals. Methods: A total of 282 asymptomatic adults underwent treadmill testing. Participants were categorized into a stress-present group (+S, n = 176) or a stress-absent group (−S, n = 106) based on their self-reported psychosocial stress levels. Inclusion criteria included exercising for at least 6 min and reaching at least 85% of the age-predicted maximum heart rate. Exclusion criteria comprised pre-exercise VAs, unreadable ECGs, chronic medication use, systolic blood pressure ≥180 mmHg, and diastolic blood pressure ≥110 mmHg. This study was registered on ClinicalTrials.gov (NCT05987891). Results: Compared to the −S group, the +S group had a higher body mass index (BMI) (p = 0.0025); 26.5 (23.9; 29.0) and larger waist circumference (p = 0.0001); 95 (86; 103), and reported lower physical activity levels (p = 0.0004). Notably, only psychosocial stress and BMI were statistically associated with PVCs during the recovery phase, immediately following the stress test. For each 1 kg/m² increase in BMI, the risk of PVCs decreased by 9%. Participants reporting psychosocial stress had a 9.03-fold higher risk of PVCs compared to those who did not report stress. Conclusions: Self-reported psychosocial stress significantly increases the risk of PVC occurrence during the recovery phase of treadmill exercise testing in asymptomatic individuals. These findings may support the development of improved PVC detection strategies and enhance cardiovascular risk assessment in clinical settings. Full article

(This article belongs to the Special Issue Advances in Arrhythmia Diagnosis and Management)

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18 pages, 1822 KB

Open AccessSystematic Review

Enhancing Heart Failure Management: A Systematic Review and Meta-Analysis of Continuous Remote Telemedical Management vs. In-Person Visit in Patients with Cardiac Implantable Electronic Devices

by Boglarka Veres, Boldizsar Kiss, Peter Fehervari, Marie Anne Engh, Peter Hegyi, Endre Zima, Bela Merkely and Annamaria Kosztin

J. Clin. Med. 2025, 14(12), 4278; https://doi.org/10.3390/jcm14124278 - 16 Jun 2025

Cited by 2 | Viewed by 3588

Abstract

Background/Objectives: Remote telemedical management (RTM) in heart failure (HF) patients with cardiac implantable electronic devices (CIED) is a reliable approach to follow device-specific and heart failure-related parameters. However, while some positive outcome data is available, results are inconclusive. We aimed to assess the [...] Read more.

Background/Objectives: Remote telemedical management (RTM) in heart failure (HF) patients with cardiac implantable electronic devices (CIED) is a reliable approach to follow device-specific and heart failure-related parameters. However, while some positive outcome data is available, results are inconclusive. We aimed to assess the benefits of continuous remote telemonitoring (RTM) compared to the in-person visit (IPV) in reducing all-cause mortality, heart failure hospitalizations (HFH), cardiovascular (CV) deaths, and the occurrence of inappropriate therapy. Methods: The study comprised a systematic review and meta-analysis of randomized controlled trials (RCTs) testing RTM (device-related or other non-invasive telemonitoring systems) vs. IPV for the management of HF patients. The main endpoints were all-cause and CV mortality. Risk of bias and level of evidence were assessed. Hazard ratios (HRs), odds ratios (ORs) and 95% confidence intervals (CI) were calculated. CENTRAL, EMBASE and MEDLINE were searched, and only randomized controlled studies were included. Results: Sixteen RCTs were identified, comprising a total of 11,232 enrolled patients. Seven studies evaluated all-cause mortality, resulting in an OR 0.83 (95% CI 0.72 to 0.96). When CV mortality was assessed, the RTM group showed a significant benefit compared to the IPV group (OR 0.81, 95% CI 0.67 to 0.97). The risk of bias ranged from “low” to “some concerns” for most outcomes, and the certainty was low to moderate depending on the specific outcomes. Conclusions: RTM proved to be superior in reducing all-cause and CV mortality compared to IPV; however, there is a clear need to have standardized alert actions to achieve the mortality benefit. Full article

(This article belongs to the Special Issue Advances in Arrhythmia Diagnosis and Management)

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12 pages, 1508 KB

Open AccessSystematic Review

Efficacy and Safety of Intranasal Etripamil for Paroxysmal Supraventricular Tachycardia: Meta-Analysis of Randomized Controlled Trials

by Mayank Jha, David Song, Andrew Kung, Sam Lo, Alexander Sacher, Song P. Ang, Aasim Akthar, Hritvik Jain, Raheel Ahmed, Matthew Bates, Sang Lee and Seth Goldbarg

J. Clin. Med. 2025, 14(11), 3720; https://doi.org/10.3390/jcm14113720 - 26 May 2025

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Abstract

Background: Patients with arrhythmias, particularly paroxysmal supraventricular tachycardia (PSVT), face an increased risk of cardiac complications. Currently, non-parenteral medications for rapid PSVT cessation are lacking. Etripamil, a novel intranasal, short-acting calcium channel blocker, offers a rapid onset and the potential for unsupervised PSVT [...] Read more.

Background: Patients with arrhythmias, particularly paroxysmal supraventricular tachycardia (PSVT), face an increased risk of cardiac complications. Currently, non-parenteral medications for rapid PSVT cessation are lacking. Etripamil, a novel intranasal, short-acting calcium channel blocker, offers a rapid onset and the potential for unsupervised PSVT management. However, data on its use in arrhythmia management remain limited. Aims: We aimed to assess the efficacy and safety of 70 mg of etripamil compared with placebo in the treatment of PSVT. Methods: We systematically searched PubMed, Embase, Web of Science, Scopus, and the Cochrane Library for randomized controlled trials (RCTs) from inception to April 2025. We calculated pooled risk ratios (RRs) with 95% confidence intervals (CIs) using random or common effects models, depending on the heterogeneity. Results: Four RCTs including 540 patients were analyzed. Etripamil demonstrated higher conversion rates to the sinus rhythm at 15 min (RR 1.84 [95% CI: 1.32–2.48]), 30 min (RR 1.80 [95% CI: 1.38–2.35]), and 60 min (RR 1.24 [95% CI: 1.04–1.48]). PSVT recurrence rates were similar between groups (RR 0.52 [95% CI: 0.20–1.34]). Adverse events (AEs) and severe AEs were comparable between etripamil and the placebo. Etripamil was associated with higher rates of nasal discomfort, nasal congestion, rhinorrhea, and epistaxis but not with increased bradyarrhythmia, atrial fibrillation, or non-sustained ventricular tachycardia. Conclusions: Etripamil appears to be a promising treatment for cardiac arrhythmias. Larger long-term RCTs are needed to confirm its safety and efficacy in clinical practice. Full article

(This article belongs to the Special Issue Advances in Arrhythmia Diagnosis and Management)

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