Search Results (130)

Background: Guidelines recommend patent foramen ovale (PFO) closure for secondary prevention after cryptogenic stroke in patients aged 18–65 years, but there is limited evidence to guide management of elderly adults. This research aims to assess the efficacy, safety and methodological quality of trials comparing secondary prevention PFO closure with medial therapy alone (MTA) in patients aged ≥ 60 years. Methods: A PubMed search identified four studies comparing PFO closure with MTA in elderly patients—PFOSK (South Korea), PT (Taiwan), DEFENSE (South Korea) and PFOG (Germany). Primary analyses evaluated study quality—patient selection, allocation, crossover and adherence. Secondary analyses compared recurrent cerebral ischaemia, mortality, new-onset atrial fibrillation (AF) and disability. Results: In 644 patients ≥ 60 years old, PFO closure was associated with a 45% (95% CI 0.35–0.86, p = 0.0091) reduction in recurrent cerebral ischaemia and an 85% (95% CI 0.05–0.49, p = 0.0016) reduction in mortality. Lower disability scores and increased incidence of new-onset AF (RR 2.15, 95% CI 1.07–4.32, p = 0.0306) was observed in closure groups. Study quality was limited by heterogeneity in medical regimens and closure protocols, crossover between treatment arms and imbalances in baseline characteristics, with closure groups generally younger and possessing larger shunt sizes. Conclusions: In patients aged ≥ 60 years, PFO closure appears to reduce the risk of the recurrence of ischaemic events and mortality, particularly in those with ‘high-risk’ PFO features. However, variability in study designs and low event rates limit certainty. Large, standardised trials are warranted to provide evidence for guideline recommendations in this population. Full article

Background/Objectives: New-onset atrial fibrillation (NOAF) frequently develops in patients with chronic coronary syndrome (CCS) and is associated with adverse cardiovascular outcomes. The C-reactive protein–to–albumin ratio (CAR) reflects systemic inflammation, whereas left atrial diameter (LAD) indicates structural cardiac remodeling. Their combined predictive role for NOAF in CCS remains uncertain. This study evaluated the predictive value of combined CAR and LAD for NOAF in CCS patients. Methods: We retrospectively analyzed 2431 CCS patients treated at the Third Affiliated Hospital of Sun Yat-sen University between 2012 and 2019. The primary endpoint was NOAF occurrence during follow-up. Receiver operating characteristic (ROC) analysis determined exploratory cutoff values for CAR (0.0429) and LAD (33.96 mm). Patients were categorized into four groups: Group 1 (low CAR–low LAD), Group 2 (high CAR–low LAD), Group 3 (low CAR–high LAD), and Group 4 (high CAR–high LAD). Cox proportional hazards, Kaplan-Meier, and subgroup analyses were conducted to evaluate associations with NOAF risk. Results: During a median follow-up of 4.96 years, 93 NOAF events were identified. Compared with the Group 1, patients with higher CAR and LAD showed significantly elevated NOAF risk (HR = 2.67, 95%CI 1.99–3.57, p < 0.001). The combined CAR–LAD model demonstrated superior predictive accuracy (AUC = 0.731, 95% CI = 0.654–0.765; p < 0.001) and consistent effects across most subgroups. Decision curve analysis confirmed greater net clinical benefit for the combined model. Conclusions: The integration of CAR and LAD serves as a simple, non-invasive, and effective tool for predicting NOAF in CCS patients. This dual-marker model facilitates early identification of high-risk individuals and support personalized preventive strategies in clinical practice. Full article

Background/Objectives: Cardiac resynchronization therapy with defibrillator (CRT-D) is a well-established therapy for patients with heart failure (HF) and intraventricular conduction delays, but a non-negligible risk of infection and of lead functionality loss overtime is related to intravascular hardware. The novel DX system enables atrial sensing through a floating dipole integrated into the ICD lead, reducing the intravascular burden. In this prospective non-randomized study, we aimed to evaluate the safety and efficacy of a two-lead DX-based CRT system compared to a conventional three-lead (3L) CRT-D system. Methods: A total of 210 patients meeting CRT indications and no signs of sick sinus syndrome (SSS) (baseline HR ≥ 45 bpm, or at least 85 bpm at 6 min walking test) were enrolled. Patients were assigned to either the CRT-DX or conventional 3L CRT-D group. The primary endpoint was a composite clinical response, defined as the freedom from cardiovascular death, HF hospitalization, or new-onset atrial fibrillation (AF). Results: After a mean follow-up of 46.5 ± 1.9 months, both groups had comparable clinical and instrumental outcomes. CRT-DX patients exhibited higher atrial sensing amplitudes and no significant differences in loss of lead function. Conclusions: In conclusion, the CRT-DX system provides equivalent clinical and echocardiographic benefits compared to conventional CRT-D in patients without an indication for atrial pacing. This supports the use of the DX system as a safe and effective alternative in the majority of CRT recipients. Full article

Background: Atrial high-rate episodes (AHREs) detected by pacemakers are linked to increased stroke risk. The predictive value of high-sensitivity cardiac troponin I (hs-cTnI) for AHREs in pacemaker patients remains uncertain. This study evaluated baseline hs-cTnI as a predictor for new-onset AHREs in this population. Methods: This prospective cohort study enrolled 272 patients undergoing permanent pacemaker implantation. We excluded 40 patients with pre-existing atrial fibrillation (AF), leaving a total of 232 patients (mean age 63.7 years; 53.4% male) in the at-risk cohort. Baseline hs-cTnI and NT-proBNP were measured. The primary endpoint was new-onset AHREs (>175 bpm), detected by device interrogation over a median follow-up of 12 months. Results: New-onset AHREs occurred in 65 (28.0%) patients. Contrary to our hypothesis, baseline hs-cTnI levels did not differ significantly between patients who developed AHREs and those who did not (median 16.5 vs. 15.7 pg/mL, p = 0.148). Multivariable Cox regression confirmed that neither hs-cTnI nor NT-proBNP were independent predictors. Instead, Sick Sinus Syndrome (HR 2.10, p < 0.001), heart failure (HR 1.78, p = 0.010), and Left Atrial Diameter (HR 1.15, p = 0.006) were significant independent predictors. Conclusions: In this high-risk pacemaker cohort, baseline hs-cTnI and NT-proBNP did not predict short-term new-onset AHREs. Established electrical and structural substrates appear to be the overwhelming drivers of arrhythmia in this specific population. Full article

Background/Objectives: Electrocardiographic (ECG) findings such as sinus tachycardia and right bundle branch block are commonly associated with acute pulmonary embolism (PE). This study aimed to investigate the prevalence of advanced interatrial block (IAB) in patients with acute PE and its association with atrial fibrillation (AF) and hemodynamic changes. Methods: This retrospective, single-center study included patients diagnosed with acute PE (42% female, 58% male) between January 2014 and September 2024 at University Hospital Münster. A control group of individuals without manifest heart disease (45% female, 55% male) served as a control group. All patients underwent clinical, laboratory, ECG, and echocardiographic evaluations. Results: A total of 351 patients with acute PE and 120 control patients were included. The PE group had a mean age of 62.5 years. Advanced IAB was detected in 35% of PE patients, significantly higher than in controls (2%). In contrast, typical ECG signs of PE such as sinus tachycardia (23%), right bundle branch block (8%), and S1Q3 pattern (20%) were less frequent. A subgroup analysis demonstrated that patients with IAB were older, had a higher CHA₂DS₂-VA score, and were more likely to have pre-existing and new-onset AF. IAB was not associated with right heart dysfunction on echocardiography. Conclusion: For the first time, this study revealed that advanced IAB was present in many patients with acute PE. IAB was associated with a higher risk of AF and greater thromboembolic risk but not with hemodynamic changes typical of PE. Detecting an advanced IAB at the initial presentation in the emergency department could provide an important indication of PE. Full article

The coronavirus disease 2019 (COVID-19) pandemic has revealed a close and multifaceted relationship between viral infection, systemic inflammation, and cardiovascular health. Among the cardiac complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), atrial fibrillation (AF)—especially new-onset atrial fibrillation (NOAF)—has emerged as a major determinant of disease severity and prognosis. Clinical studies and meta-analyses show that 5–10% of hospitalized COVID-19 patients develop AF, with markedly higher rates in critically ill individuals. Both pre-existing and NOAF are independently associated with increased risks of intensive care admission, mechanical ventilation, thromboembolic events, and mortality. The underlying mechanisms involve a combination of cytokine-mediated inflammation, endothelial dysfunction, microvascular injury, and dysregulation of the renin–angiotensin–aldosterone system (RAAS). Viral downregulation of angiotensin-converting enzyme 2 (ACE2) receptors contributes to myocardial fibrosis, while hypoxia, oxidative stress, and autonomic imbalance further promote electrical remodeling and arrhythmogenesis. Post-infectious studies indicate that atrial structural changes and autonomic dysfunction may persist for months, predisposing survivors to recurrent arrhythmias. Technological advances in telecardiology and digital medicine have provided new tools for early detection and long-term monitoring. Wearable electroencephalography (ECG) devices, implantable loop recorders (ILRs), and artificial intelligence (AI)-based diagnostic algorithms enable continuous rhythm surveillance and individualized management, improving outcomes in post-COVID patients. This review summarizes current evidence on the epidemiology, pathophysiology, clinical implications, and monitoring strategies of AF in COVID-19. It underscores the importance of integrating telemedicine and AI-assisted diagnostics into cardiovascular care to mitigate the long-term arrhythmic and systemic consequences of SARS-CoV-2 infection. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a chronic hepatic disease with a rising global prevalence (25–38% of the general population). As a new term, MASLD was introduced in 2023 to replace the previous nomenclature of non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD). This new term/definition introduced changes in the diagnostic criteria and underscores the direct link between cardio-metabolic risk and this prevalent liver disease. In this context, the present review examines the clinical and pathophysiological links between MASLD and cardiovascular disease (CVD), providing a robust evidence synthesis of primarily systematic review data on the association between MASLD and coronary artery disease (CAD), atrial fibrillation (AF), and heart failure (HF). This association appears to be not only synergistic, but also independent of other known CVD risk factors, highlighting MASLD as a key cardio-metabolic risk factor that merits prompt diagnosis and treatment. The development of MASLD-related cardiovascular morbidity increases with the severity of the underlying hepatic pathology, particularly with progression to steatohepatitis and fibrosis. Notably, growing evidence highlights the links between MASLD and CVD through cardiac structural, electrical, and functional alterations that can progress to CAD, AF, and new-onset HF. Recognizing these links in clinical practice underscores the importance of early detection and multi-disciplinary management of MASLD to prevent disease progression and CVD complications. Full article

Background: Pre-existing atrial fibrillation (AF) is common among patients undergoing transcatheter aortic valve replacement (TAVR). However, evidence regarding its impact on the risk of permanent pacemaker (PPM) implantation and other conduction disturbances (CDs) after TAVR remains inconsistent. The aim of this study was to assess the effect of baseline heart rhythm on the risk of conduction abnormalities following TAVR. Methods: This study included patients with severe AS who underwent TAVR using either balloon-expandable (BEVs) or self-expanding valves (SEVs). The primary endpoint was the incidence of PPM implantation and new or worsening left bundle branch block (LBBB) after TAVR according to baseline rhythm (sinus rhythm vs. AF). Secondary endpoints were predictors of PPM implantation, LBBB, the occurrence of periprocedural stroke, and in-hospital mortality. Results: A total of 5195 TAVR patients were included: 3560 with baseline sinus rhythm and 1635 with baseline AF. PPM implantation was more frequent in patients with AF than in those with sinus rhythm (17% vs. 15%, p = 0.033), whereas new or worsening LBBB was less common (11% vs. 14%, p = 0.026). After adjustment with multivariable logistic regression, these associations were no longer statistically significant (PPM implantation: OR 1.156, 95% CI 0.969–1.379, p = 0.108; new or worsening LBBB: OR 0.826, 95% CI 0.676–1.010, p = 0.062). Independent peri-procedural predictors of PPM implantation included baseline first-degree AV block, pre-procedural RBBB, the use of self-expandable valves, implantation of larger valve sizes (≥23 mm), and the need for valve repositioning. Conclusions: In this large cohort, baseline AF was not associated with an increased risk of PPM implantation or new onset LBBB compared with sinus rhythm. These findings suggest that baseline rhythm alone should not be considered an independent predictor of PPM implantation or CDs following TAVR. Full article

Background/Objectives: C-reactive protein (CRP) is widely used as a marker of perioperative inflammation, but its predictive value for cardiac surgical outcomes remains uncertain. Obstructive sleep apnea (OSA), a prevalent and underrecognized comorbidity, may independently contribute to postoperative complications through non-inflammatory mechanisms. This study aimed to reevaluate the prognostic role of CRP and determine the clinical impact of OSA severity on postoperative recovery, focusing on new-onset atrial fibrillation (AF), prolonged intubation time, and postoperative CPAP/AIRVO use as indicators of respiratory burden. Methods: In this prospective cohort of 142 elective cardiac surgery patients, preoperative polysomnography and serial CRP measurements were obtained. Multivariable regression, mediation analysis, and propensity score matching (PSM) were performed to evaluate associations between OSA severity, CRP, and perioperative outcomes (AF, intubation time, CPAP/AIRVO use). Results: OSA severity independently predicted prolonged intubation (β = 1.74, p = 0.0019) and new-onset AF (β = 0.85, p = 0.004), even after excluding patients with preexisting arrhythmia. CRP showed poor discriminatory power as a standalone biomarker (AUC for IOT > 14 h = 0.445) and did not mediate OSA–outcome associations. However, CRP > 2.1 mg/dL doubled the odds of moderate-to-severe OSA (OR = 2.05, p = 0.041). A composite score integrating AHI, BMI, and postoperative CRP strongly correlated with postoperative respiratory support (p < 0.0001). Conclusions: OSA exerts a stronger and more consistent influence on perioperative outcomes than CRP, challenging reliance on CRP for risk stratification. Incorporating objective OSA screening and spirometry into preoperative assessment may enhance perioperative risk prediction and guide personalized management strategies. Full article

Background and Clinical Significance: Early lead failure after dual-chamber pacemaker implantation is rare but clinically significant, particularly when associated with thromboembolic complications. Technical pitfalls at the time of implantation, such as suture fixation without protective sleeves, may be predisposed to premature lead damage and abrupt device malfunction. This case highlights the role of device interrogation in diagnosing arrhythmia-related stroke, the challenges of reimplantation in the setting of venous occlusion and anticoagulation, and the value of leadless pacing as a safe rescue strategy. Case Presentation: A 78-year-old man with a history of complete atrioventricular block underwent dual-chamber pacemaker implantation one year earlier. He presented to the emergency department with acute aphasia, right-sided hemiparesis, and facial asymmetry. Stroke was diagnosed, and new-onset atrial fibrillation was documented. Device interrogation revealed an abrupt fall in lead impedance followed by a sharp rise consistent with lead insulation failure and premature battery depletion. Fluoroscopy demonstrated multiple focal narrowings of the leads and complete left subclavian vein occlusion, making conventional transvenous reimplantation unfeasible, while extraction was judged high risk. Right-sided reimplantation was avoided due to hemorrhagic risk under anticoagulation. A leadless pacemaker was implanted successfully in the apico-septal region of the right ventricle via ultrasound-guided femoral access. Hemostasis was secured with a figure-of-8 suture fixed inside a 3-way tap, providing constant compression and preventing hematoma. At two-months follow-up, device function was stable and neurological recovery was favorable (mRS = 2). Conclusions: This case underscores how multiple adverse factors—stroke, arrhythmia detection, early device failure, venous occlusion, and anticoagulation—may converge in a single patient, and demonstrates leadless pacing as a safe and effective rescue strategy in such complex scenarios. Full article

New-onset postoperative atrial fibrillation (POAF) is common after cardiac and major noncardiac surgery and significantly associated with short- and long-term adverse events. Multiple management strategies have been described but the lack of evidence from large randomized controlled trials and the lack of consensus regarding best practices has led to major variations in practice patterns. Considering on the one hand its serious adverse effects and complex drug interactions, and on the other hand discrepancies among recent international guidelines, the indications of amiodarone to both prevent and treat POAF should be reserved to patients at high risk of POAF only, or patients with hemodynamic instability and/or severely reduced left ventricular ejection fraction. Perioperative optimization of oral and intravenous cardio-selective beta-blockers to prevent POAF, and control heart rate when POAF occurs with a rapid ventricular response is the recommended first-line strategy, simultaneously with the treatment of associated factors. Given their efficient and safe profile, ultra-short-acting intravenous beta-blockers like esmolol or landiolol could be preferentially used in acute care patients. Besides waiting for the results of ongoing RCTs in cardiac and noncardiac surgery, the use of oral anticoagulation in patients with POAF should take into account the individualized thromboembolic/hemorrhagic risk ratio. Full article

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, increasingly prevalent worldwide. Type 2 diabetes mellitus (T2DM) is a major chronic disorder and a significant risk factor for AF, contributing to high morbidity and mortality. Metformin monotherapy can contribute to the reduced occurrence of adverse cardiovascular outcomes in patients with T2DM, but its effects on AF are understudied. This meta-analysis evaluates the association of metformin with the risk of incident AF among patients with T2DM on metformin. Methods: Databases, including PubMed, Google Scholar, and EMBASE, were screened through November 2024 for studies evaluating the association between metformin and new-onset AF in patients with T2DM. Comprehensive Meta-Analysis (CMA) version 4, by Biostat, Inc., utilizing a random effects model, was used to pool hazard ratios (HR) and 95% confidence intervals (CI). A meta-regression analysis was also performed to identify factors that may have influenced the results. A p-value < 0.05 was considered statistically significant. Results: A total of seven studies, comprising 4,017,929 patients with T2DM, having a mean age of 62.82 years and 52.5% males, were included. Metformin was associated with a statistically significantly lower risk of new-onset AF among patients with T2DM compared to other hypoglycemic agents (aHR: 0.85; 95% CI 0.76–0.94; p = 0.002). Meta-regression analysis identified age as a significant moderator of the treatment effect (β = −3.15, p = 0.001). Conclusions: Metformin is associated with a lower risk of new-onset AF among patients with T2DM compared to other hypoglycemic agents. Furthermore, age-related attenuation of this association was observed, with older patients with T2DM showing a weaker association. Full article

Background: Atrial fibrillation (AF) is common complication of heart failure with preserved ejection fraction (HFpEF) that sufficiently intervenes in the prognosis. The aim of the study is a) to investigate the possible discriminative value of adropin for newly onset AF in patients with HFpEF without a previous history of AF and who are being treated in accordance with conventional guideline and b) to compare it with predictive potencies of conventionally used predictors. Methods: A total of 953 patients with HFpEF who had sinus rhythm on ECG were enrolled in the study. The course of the observation was 3 years. Echocardiography and assessment of conventional hematological, biochemical parameters and biomarker assay including N-terminal brain natriuretic pro-peptide (NT-proBNP), high-sensitivity cardiac troponin T, tumor necrosis factor-alpha, high-sensitivity C-reactive protein (hs-CRP), galectin-3, interleukin-6, soluble suppressor tumorigenisity-2 (sST2) and adropin, were performed at baseline. Results: Incident atrial fibrillation was found in 172 patients with HFpEF, whereas 781 had sinus rhythm. In unadjusted rough Cox regression model, age ≥ 75 years, type 2 diabetes mellitus, chronic kidney disease (CKD) stages 1–3, left atrial volume index (LAVI) ≥ 40 mL/m², NT-proBNP ≥ 1440 pmol/mL, hs-CRP ≥ 5.40 mg/L, adropin ≤ 2.95 ng/mL, sST2 ≥ 15.5 ng/mL were identified as the predictors for new onset AF in HFpEF patients. After adjusting for age ≥ 75 years, a presence of type 2 diabetes mellitus and CKD stages 1–3, the levels of NT-proBNP ≥ 1440 pmol/mL and adropin ≤ 2.95 ng/mL were independent predictors of new onset AF in patients HFpEF. We also found that discriminative value of adropin was superior to NT-proBNP, while adding adropin to NT-proBNP did not improve predictive information of adropin alone. Conclusions: adropin ≤ 2.95 ng/mL presented more predictive information than NT-proBNP ≥ 1440 pmol/mL alone for new cases of AF in symptomatic patients with HFpEF, whereas the combination of both biomarkers did not improve the predictive ability of adropin alone. Full article

Background and Objectives: The perioperative use of beta-blockers remains controversial due to conflicting evidence of their risks and benefits. The aim of this study was to evaluate the association between chronic beta-blocker (bb) therapy and perioperative cardiac events in non-cardiac surgeries using 24 h continuous Holter monitoring. Materials and Methods: A prospective observational study was conducted on patients undergoing elective or emergency non-cardiac surgery at a Romanian tertiary care hospital. The patients were divided into two groups: G1 (not receiving Bb) and G2 (on chronic Bb). The incidences of perioperative cardiac events, such as severe bradycardia (<40 b/min), new-onset atrial fibrillation (AF), extrasystolic arrhythmia (Ex), and sustained ventricular tachycardia (sVT) and arterial hypotension, were compared between the two groups using clinical, electrocardiography (ECG), and Holter ECG data. Beta-blocker indications, complications, and outcomes were analyzed using chi-squared tests and logistic regression. Results: A total of 100 consecutive patients (63% men, mean age of 53.7 years) were enrolled in the study. G2 included 30% (n = 30) of patients on chronic beta-blocker therapy. The indications included atrial fibrillation (46.7%, n = 14), arterial hypertension (36.7%, n = 11), extrasystolic arrhythmias (10%, n = 3), and chronic coronary syndrome (6.6%, n = 2). Beta-blocker use was significantly associated with severe bradycardia (n = 6; p < 0.001) in G2, whereas one patient in G1 had bradycardia, and 15 and 1 patients had hypotension (p < 0.001) in G1 and G2, respectively. The bradycardia and arterial hypotension cases were promptly treated and did not influence the patients’ prognoses. The 14 patients with AF in G2 had a 15-fold higher odds of requiring beta-blockers (p < 0.001, odds ratio (OR) = 15.145). No significant associations were found between beta-blocker use and the surgery duration (p = 0.155) or sustained ventricular tachycardia (p = 0.857). Ten patients developed paroxysmal postoperative atrial fibrillation (AF), which was related to longer surgery durations (165 (150–180) vs. 120 (90–150) minutes; p = 0.002) and postoperative anemia [hemoglobin (Hg): 10.4 (9.37–12.6) vs. 12.1 (11–13.2) g/dL; p = 0.041]. Conclusions: Patients under chronic beta-blocker therapy undergoing non-cardiac surgery have a higher risk of perioperative bradycardia and hypotension. Continuous Holter monitoring proved effective in detecting transient arrhythmic events, emphasizing the need for careful perioperative surveillance of these patients, especially the elderly, in order to prevent cardiovascular complications These findings emphasize the necessity of tailored perioperative beta-blocker strategies and support further large-scale investigations to optimize risk stratification and management protocols. Full article

While the interest and participation in general endurance training and recreational sports competitions have continuously increased in recent decades, the number of recreational master-level endurance athletes has additionally multiplied. Athletes, active men and women older than 40 years of age, who participate in competitive athletics are usually referred to by the term master athletes (MAs). Previous research revealed the significant benefits of regular moderate physical activity, i.e., its positive influence on cardiovascular risk factors and cardiovascular health; however, recent data have raised concerns that long-term endurance exercise participation is associated with cardiac remodeling and potential adverse cardiovascular outcomes. Previous research also indicated potential structural, functional, and electrical remodeling in MAs due to prolonged and repeated exposure to high-intensity endurance exercise—a condition known as athlete’s heart. In this review, we focus on the association between extreme levels of endurance exercise and potential cardiovascular controversies, such as arrhythmogenesis due to new-onset atrial fibrillation, accelerated coronary artery atherosclerosis, and exercise-induced cardiac remodeling. Additionally, the exercise-dependent modulation of immunological response, such as proteomic response and cytokine alterations, is discussed. Furthermore, we discuss the impact of nutritional supplements in MAs and their potential benefits and harmful interactions. We aim to provide sports medicine practitioners with knowledge of these contemporary longevity controversies in sports cardiology and to highlight the importance of shared decision making in situations of clinical uncertainty. Full article