Risultati per: Probiotici: in vivo vs in vitro

Circulation, Volume 150, Issue Suppl_1, Page A4147673-A4147673, November 12, 2024. Background:Cardiogenic shock (CS) affects up to 10% of hospitalized patients with acute myocardial infarction (AMI), leading to over 30% mortality despite treatment. In patients with AMI-CS refractory to vasopressors and inotropes, temporary mechanical circulatory support (MCS) devices have been used to provide hemodynamic support. Recently, Impella demonstrated significant mortality benefit in AMI-CS in the DanGer shock trial. However, it has not demonstrated such benefit over other devices, such as IABP and ECMO in other trials (ISAR-Shock, IMPRESS in Severe Shock, IMPELLA-STIC). Here we performed this network meta-analysis of all available studies including the DanGer shock trial comparing Impella with other MCS devices in AMI-CS patients.Method:We performed a Bayesian network meta-analysis to synthesize direct and indirect evidence from relevant studies published until April 2024 using PubMed, Embase, and Scopus databases comparing Impella with other strategies for treating AMI-CS patients. The primary outcome was a short-term mortality defined as in-hospital or 30-day mortality. This study is registered with PROSPERO, and data analysis was performed using the “BUGSnet” package in R.Result:Out of 7,211 studies, 17 were deemed eligible. These included five RCTs and 12 observational studies, encompassing 16,654 patients with AMI-CS assigned to 3 different MSC interventions: Impella, IABP, and ECMO in 9 different combinations or alone. Based on SUCRA value, IABP was the most effective strategy in regard to short-term mortality (73.46), long-term mortality (75.59), major bleeding (66.4), renal replacement therapy (73.02); Impella along with IABP for stroke (95.24), ischemic stroke (99.68), device-related bleeding (90.22), MI (94.38); ECMO for hemolysis (91.66); standard of care for peripheral ischemic complications (88.66), sepsis (78.71). In sub-analysis using the RCTs only, Impella was ranked best for short-term mortality (74.53).Conclusion:Based on the findings of this network meta-analysis, IABP could potentially provide both short-term and long-term mortality benefits, as well as reduce the risk of bleeding. Meanwhile, combining it with Impella could potentially reduce the risk of cerebral ischemia.

Circulation, Volume 150, Issue Suppl_1, Page A4142661-A4142661, November 12, 2024. Introduction:Although ECG devices with non-conventional form factors, such as wearable patches, offer enhanced convenience and comfort for users, they can introduce variability in signal characteristics, posing challenges for clinicians and ECG analysis software. To ensure accuracy and support informed decision-making, ECG software must process even the most difficult signals effectively.Aims:To compare the signal characteristics of a standard lead II configuration with those of a modified lead II (MLII) patch configuration and to evaluate the differential impact of these configurations on the performance of ECG processing software.Methods:Five-minute ECGs were recorded on 43 adult participants (63% male, mean age: 34.5 ± 9.1 years) using Bittium Faros cardiac monitors in two configurations: i) standard Einthoven lead II with electrodes placed across the chest cavity, and ii) a MLII patch configuration with electrodes 10 cm apart on the upper left chest. Average QRS amplitudes for both configurations were compared, using a paired T-test to determine statistical significance. ECG signals were processed with HeartKey software, and the accuracy of QRS beat detection was calculated against manual annotations. Heart rate (HR) detection accuracy was assessed using Bland-Altman analysis.Results:The average QRS amplitude was significantly lower in the MLII patch configuration compared to the standard lead II configuration (2.3 ± 1.0 mV vs. 1.2 ± 0.7 mV,p99.1% and a mean positive predictive value of >99.9% across both configurations. HR detection accuracy was high across both configurations, with an absolute mean HR difference of 0.4 bpm (95% CI: -0.5 bpm to 1.3 bpm) for the standard lead II and 0.24 bpm (95% CI: -1.4 bpm to 1.9 bpm) for the MLII patch configuration.Conclusion(s):Despite the notable decrease in QRS amplitude with the MLII patch configuration compared to the standard Lead II configuration, HeartKey software maintained high accuracy in detecting QRS beats and analysing heart rate.

Circulation, Volume 150, Issue Suppl_1, Page A4146376-A4146376, November 12, 2024. Background:Although observational studies have shown a higher rate of atrial arrhythmia recurrences in patients with atrial fibrillation (AF) undergoing delayed catheter ablation as compared with early ablation, a recent randomized controlled trial (RCT) did not show any such difference. We aimed to perform an updated meta-analysis of the available studies.Methods:Multiple online databases were searched for studies comparing early ablation (< 1 year) to delayed ablation ( > 1 year) in patients diagnosed with AF. The outcome of interest was atrial arrhythmia recurrence at the longest follow up available. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model.Results:A total of 8 studies (1 RCT and 7 observational) with 5,171 patients (early ablation n=1,636, delayed ablation n=3,535) were included. Around 70% patients were men, mean age was 61 years and mean duration of follow up was 28 months. Patients with AF undergoing early catheter ablation had a lower rate of atrial arrhythmia recurrence when compared with the delayed ablation group (OR 0.57, 95% CI 0.44 to 0.73, p < 0.0001). Substantial level of heterogeneity was present between the studies (I2 = 67%).Conclusion:Performing catheter ablation early (within 1 year of diagnosis) in patients with AF may lead to significant reduction in atrial arrhythmia recurrence as compared with delayed ablation. The results of this meta-analysis, however, are subject to potential bias and heterogeneity.

Circulation, Volume 150, Issue Suppl_1, Page A4144137-A4144137, November 12, 2024. Background:The optimal management of angiotensin-converting enzyme (ACE) inhibitors during elective surgeries remains uncertain. While some studies suggest that continuing ACE inhibitors increase the risk of perioperative hypotension, others argue that discontinuation may heighten the risk of significant clinical events. This meta-analysis aims to clarify the clinical outcomes associated with continuation compared to discontinuation of ACE inhibitors in surgical settings.Methods:We conducted a systematic search of MEDLINE, Cochrane, and Embase for clinical trials comparing the effects of continuing versus discontinuing ACE inhibitors during surgery. Outcomes evaluated included death, stroke, myocardial injury (MI), intraoperative hypotension, postoperative hypotension, and acute kidney injury (AKI). Data were synthesized using odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed with I2 statistics, and a random-effects model was applied. Statistical analyses were performed using R software version 4.3.2.Results:From 865 identified studies, 15 studies involving 11,519 patients met the inclusion criteria. Not all studies had outcomes available for comparison between them. The average age was 65.75 years, with 86.45% having hypertension and 13.13% with heart failure. Continuing ACE inhibitors was associated with a higher risk of intraoperative hypotension (OR 1.33; 95% CI 1.16-1.53). No significant differences were found between groups for mortality (OR 1.06; 95% CI 0.68-1.65), stroke (OR 0.99; 95% CI 0.47-2.09), MI (OR 0.98; 95% CI 0.72-1.31), postoperative hypotension (OR 1.27; 95% CI 0.74-2.17), and AKI (OR 0.88; 95% CI 0.66-1.16).Conclusion:Discontinuation of ACE inhibitors before non-cardiac surgery may lower the risk of intraoperative hypotension without significantly affecting mortality, stroke, MI, postoperative hypotension, or AKI. Further research with greater power and better design is needed to confirm these findings.

Circulation, Volume 150, Issue Suppl_1, Page A4143363-A4143363, November 12, 2024. Background:Various temporary mechanical circulatory support device (t-MCS) options are available for supporting patients in cardiogenic shock. While each device has a different physiological impact on the heart, limited studies compare genetic changes in the heart t-MCS. Here, we compare the impact of a percutaneous left ventricular assist device (pVAD) vs an Intra-aortic balloon pump (IABP) on miRNA expression of the left ventricle in patients being bridged to cardiac replacement.Hypothesis:Difference in genetic signature exists between patients treated with pVAD vs IABPMethods:Myocardial tissue was collected at the time of cardiac surgery from 4 patients bridged with a pVAD (Impella 5.5) and 4 bridged with IABP. Samples from each strategy of support were combined. Bulk sequencing was performed on an Illumina Hiseq 4000. Raw data was processed to identify unique sequences with lengths of 18-26 nucleotides and were mapped to miRBase to identify known and novel microRNAs (miRs).Results:The top upregulated (Fig. 1A) and downregulated (Fig. 1B) miRs had functionality related to endothelial pathology and cell transitions (miR 422,378 &92a, miR-653, miR-144). For example, miR 21 has been shown to represent a pathogenic state in cancer and cardiac disease and was found to be significantly lower in heart failure patients supported with pVAD when compared to patients supported with IABP. Gene set enrichment analysis of all the downregulated miRs was performed using miRNA enrichment analysis and annotation tool (miEAA). UpSet plots (Fig. 1C) of the downregulated miRs exhibited a regulatory role in inflammatory and cancer-based genes. KEGG enrichment analysis oftarget genesof the differentially expressed miRs exhibited that 1000 genes were associated with metabolic pathways (hsa01100), followed by 500 genes in cancer pathways (hsa05200) (Fig. 1D).Conclusion:Our results suggest that direct cardiac unloading using a p-VAD might have a better improvement of the pathological milieu of heart failure when compared to counter-pulsation unloading. The choice of t-MCS to support myocardial recovery might be important. Our future work will include a prospective study with temporal evaluation of patient’s blood for miRNA profiling.

Circulation, Volume 150, Issue Suppl_1, Page A4120469-A4120469, November 12, 2024. Introduction:Transcatheter cardiac interventions have emerged as a viable alternative to open heart surgery for specific congenital heart disease lesions. There is literature to support racial and ethnic disparities in medicine, indicating that patients from racially and ethnically marginalized populations are less likely to receive advanced less invasive procedures. This study seeks to delve into the existence of such inequities between transcatheter and surgical interventions, shedding light on potential inequalities in access and outcomes.Methods:We analyzed California and Florida’s State Inpatient and Ambulatory Surgery Databases from 2005 to 2017 to study patients under 18 admitted with diagnosis of atrial septal defect, pulmonary stenosis, aortic stenosis, and ventricular septal defects. Multivariable logistic regression, adjusted for patient characteristics, assessed race and ethnicity’s influence on procedure type and in-hospital mortality. We also used log-transformed linear regression to examine associations with length of stay, hospitalization cost, and cost per day.Results:We identified 13,771 records who had open surgeries, and 2,045 records who had CBI. Compared to non-Hispanic White patients, Black patients were significantly more likely to undergo open surgical procedures (adjusted Odds Ratio [aOR] 1.49, p < .001). Additionally, Black, Hispanic, and other race patients had higher risks of in-hospital death (aOR 1.92, p = 0.016 for Black; aOR 1.93, p < 0.01 for Hispanic; aOR 2.37, p < 0.01 for other races). Black and Hispanic patients also experienced longer lengths of stay (Adjusted Means Ratio [aMR] 1.34, p < 0.01 for Black; aMR 1.16, p < 0.01 for Hispanic), and higher costs (aMR 1.12, p = .01 for Black; aMR 1.11, p = .01 for Hispanic), but Black patients had a lower cost per day (aMR 0.96, p = .02).Conclusion:Racial and ethnic gaps persist in pediatric cardiac care, with Black patients facing reduced access to less invasive procedures, higher mortality rates, longer hospital stays, and increased costs compared to non-Hispanic whites. However, the higher costs are likely attributed to longer hospital stays rather than expensive interventions. It is imperative to tackle these disparities to prioritize patient-centered care and streamline resource allocation in healthcare.

Circulation, Volume 150, Issue Suppl_1, Page A4145168-A4145168, November 12, 2024. Introduction:Ebstein’s anomaly (EA) is associated with ECG signature of right bundle branch block (RBBB). Patients with EA also have high incidence of accessory pathways (AP) and it has been hypothesized that the absence of RBBB on ECG may be associated with a higher prevalence of AP. This study aims to assess the prevalence of RBBB in patients with EA and examine the correlation between its absence and the presence of AP.Methods:Adults (age >18 years) with EA, identified using the Mayo Adult Congenital Heart Disease registry, were divided into 3 groups based on the QRS morphology of their first ECG. Those with prior AP ablation were excluded. The demographic characteristics, baseline ECG data, echocardiographic parameters and EP study data were retrospectively collected and compared between the three groups using Chi-square or ANOVA test as appropriate.Results:Of 596 patients with EA, 358(60.06%) patients had a RBBB, bifascicular block or an incomplete RBBB (group1) ; 18 (3.02%) patients had either a LBBB , ventricular pre-excitation, isolated left anterior or posterior fascicular block (group 2); and 220 (36.92%) patients had normal QRS (group 3). The characteristics of these groups are compared in the table. Patients with RBBB had larger RV size, reduced RV systolic function and higher likelihood of tricuspid valve surgery. EP study was performed in 51 (14%), 3 (17%) and 51 (23%) patients in groups 1, 2,and 3 respectively. One or more APs were noted in 11/51 (22%) and 14/51 (30%) patients with RBBB and normal QRS respectively (p=0.18). Additionally, in patients who did not undergo an EP study, supraventricular tachycardia was documented in 39/307 (13%), 2/15(13%) and 13/169 patients (8%) in group 1,2 and 3 respectively during followup .Conclusion:In a large cohort of adults with EA in a tertiary referral center, greater than one-third of patients had a normal QRS complex without RBBB. However, EP study did not reveal a significant difference in the prevalence of accessory pathways between patients with and without RBBB. In EA, the absence of RBBB may not increase the risk of an underlying accessory pathway.

Circulation, Volume 150, Issue Suppl_1, Page A4146403-A4146403, November 12, 2024. Introduction:Anticoagulation therapy is crucial in enhancing perioperative outcomes, yet uncertainty persists regarding the optimal use of Direct Oral Anticoagulants (DOACs) and Vitamin K Antagonists (VKAs) in cardiovascular interventions. Key outcomes such as bleeding, thromboembolic events, and mortality are critical. Conducting a thorough review is essential to make well-informed decisions that improve patient quality of life and mitigate complications.Hypothesis:This meta-analysis aimed to investigate whether Direct Oral Anticoagulants (DOACs) reduce perioperative complications such as bleeding, thromboembolic events, and mortality compared to Vitamin K Antagonists (VKAs) in patients undergoing cardiovascular procedures.Methods:The present study was conducted in accordance with PRISMA guidelines. A systematic search was conducted in PubMed, MEDLINE, Scopus, Web of Science, Cochrane, and EMBASE databases on 05/14/2024. Data extraction was rigorously performed, and a random-effects model was used for data synthesis.Results:The review included 25 studies involving a total of 25,754 patients. For bleeding risk, the meta-analysis showed that DOACs are associated with a lower risk compared to VKAs, with a relative risk (RR) of 0.69 (95% CI: 0.51 to 0.94, p = 0.0457, I2= 60%). Thromboembolic events showed no significant difference between DOACs and VKAs (RR: 1.13, 95% CI: 0.74 to 1.73, p = 0.5313, I2= 15%). Mortality outcomes also showed no significant difference (RR: 0.53, 95% CI: 0.20 to 1.43, p = 0.1622, I2= 68%).Conclusion:The systematic review and meta-analysis demonstrate that DOACs are associated with a lower risk of bleeding compared to VKAs, with no significant difference in thromboembolic events and mortality. This evidence supports the substantial benefit of DOACs in cardiovascular interventions. Further research is needed to consolidate these findings and improve patient outcomes. PROSPERO registry— CRD42024547465

Circulation, Volume 150, Issue Suppl_1, Page A4137423-A4137423, November 12, 2024. Background:Elevated lipoprotein(a) [Lp(a)] is an inherited, currently non-modifiable risk marker that increases lifetime ASCVD risk. Guidance vary on Lp(a) levels at which risk increases; hence prevalence of “elevated” Lp(a) depends on putative thresholds e.g. >1.3 billion people globally have Lp(a)≥125 nmol/L. Lp(a) levels are >90% genetically determined and stable throughout life; hence measurement once in adulthood is recommended. Awareness of Lp(a) levels may change patient management with more intensive control of traditional risk factors. However, testing all adults is costly and the test is not universally available.Research Question:Can Machine Learning (ML) models reduce the number needed to screen (NNS) compared to population universal screening for identifying individuals with elevated Lp(a)?Aims&Objectives:To derive a model from ML to help prioritise individuals likely to have high levels for Lp(a) testing and compare its yield to universal screening at different Lp(a) cut-points. This approach could enable automatic screening of large databases like EHRs for Lp(a) testing.Method:We conducted a cross-sectional predictive analysis using UK Biobank, including individuals ≥40 years old with Lp(a) measurements, split into feature importance, derivation, and validation datasets. Eight ML classification algorithms were used for feature importance analysis and model derivation. Models’ performance was evaluated in the validation set using sensitivity and NNS in comparison with the discrimination ability of the following guidelines across different populations: The 2019’s Heart UK and European Atherosclerosis Society (EAS) and Society of Cardiology guidelines, the 2022 EAS Consensus Statement, and threshold used in clinical trial —respective cut-offs: 90,430,125,200nmol/L.Results:438,579 patients were included. The best ML models were neural networks with different weights. Regardless of the Lp(a) threshold used, ML models resulted in higher rates of high Lp(a) cases identified per million tests with lower NNS compared to universal screening (Table 1). Using higher Lp(a) thresholds (200-430nmol/L) increased models sensitivity with far fewer tests required to identify those with high Lp(a).Conclusion:ML models could reduce the number of tests needed to identify individuals with high Lp(a), increasing efficiency and potentially helping to prioritize Lp(a) testing, with a potentially scalable cost-effective option for health systems.Work supported by Novartis

Circulation, Volume 150, Issue Suppl_1, Page A4145901-A4145901, November 12, 2024. Introduction:Current guidelines recommend preprocedural fasting for at least 6 hours for solid food and 2 hours for clear liquids before cardiac transcatheter procedures. However, the supporting data are limited.Research Question:Does non-fasting impact (NF) patient safety and comfort compared to fasting (F) in transcatheter cardiac procedures?Aims:To compare the effects of fasting vs. non-fasting on patient outcomes in cardiac transcatheter procedures.Methods:We searched the Cochrane, Embase, and Medline databases for RCTs comparing fasting versus non-fasting states for cardiac transcatheter procedures. Risk ratios (RRs) and standardized mean difference (SMD) with 95% confidence intervals (CIs) were pooled for binary and continuous outcomes, respectively, using a random-effects model. Endpoints were hunger, thirst, incidence of aspiration, nausea/vomiting, acute kidney injury (AKI), length of stay, and patient satisfaction.Results:Our meta-analysis included 8 studies with 2,930 patients. Hunger sensation was significantly lower in the NF group (SMD -0.91; 95% CI: -1.71 to -0.11; P = 0.026; I2 = 96%; Figure 1A), with no difference in thirst. The incidence of aspiration (RR 2.20; 95% CI 0.29–17.02; P = 0.449; I2 = 0%; Figure 1B), nausea/vomiting (RR 1.09; 95% CI 0.67-1.78; P = 0.723; I2 = 0%), and AKI (RR 1.90; 95% CI 0.84–4.31; P = 0.126; I2 = 0%) were not significantly different between groups. Similarly, length of stay (MD -0.01 days; 95% CI -0.39 to 0.36; P = 0.940; I2 = 3%; Figure 2A), and patient satisfaction (SMD -0.74; 95% CI: -1.54 to -0.07; P = 0.073; I2 = 98%; Figure 2B) were also similar in both groups.Conclusions:Our study suggests a non-fasting strategy is a safe option before transcatheter cardiac procedures.

Circulation, Volume 150, Issue Suppl_1, Page A4141390-A4141390, November 12, 2024. Background:Appropriate direct oral anticoagulants (DOAC) dosing could improve their safety and effectiveness. To address this, we developed an intervention to improve on-label dosing using academic detailing and a quality improvement intervention.Methods:This was a cluster RCT with clusters at the site level. There were 2 arms, academic detailing (AD) and AD plus Learn. Engage. Act. Process. (AD/LEAP).Interventions:Primary care doctors and anticoagulation pharmacists from all participating sites were invited to participate in academic detailing, a 1:1 educational and motivational coaching program, about ways to improve DOAC prescribing safely.Intervention arm sites were also invited to participate in LEAP, a quality improvement program based on plan-do-study-act cycles.Sites:8 VA medical centersInclusion criteria:All patients on DOACs at participating sites.Analysis:Generalized Estimating Equations with logit links and clusters at the facility level using aggregated proportion data. Models were weighted by the size of the denominator within each facility and longitudinal measurements were modeled with an autoregressive working correlation matrix. For difference-in-difference modeling, the 6-month pre- and post-period data were included and entered into the model as a fixed effect plus an interaction with the treatment arm.Outcomes:The primary outcome was the percentage of DOAC prescribing that was off-label, including under- and over-dosing for that individual and using for inappropriate indications.Results:Over the full length of the study, there were 34,127 patients on DOACs across the 8 sites. The percentage of prescriptions that met the primary outcome increased from 5.65 to 6.43 in the AD arm and from 5.9 to 6.43 in the AD+LEAP arm, yielding a difference-in-difference of -0.25 (95% CI -1.57- 1.06). An as-treated analysis, which dropped the two sites that did not finish their LEAP programs, also found no effect, as did sub-groups of impacts on patients whose reason for using DOACs was atrial fibrillation vs. thromboembolism.Discussion:A quality improvement intervention did not improve safe DOAC prescribing when added to an academic detailing intervention. We hypothesize the primary reason was insufficient engagement with the intervention.

Circulation, Volume 150, Issue Suppl_1, Page ASa306-ASa306, November 12, 2024. Introduction:Manual pulse palpation during cardiopulmonary resuscitation has poor reliability in both hospital and prehospital settings. Recently, point-of-care ultrasonography (POCUS) of the carotid artery has been used for pulse determination in the in-hospital setting. However, this approach has not been evaluated for out-of-hospital cardiac arrest (OHCA) events where adequate views and prolonged pauses during pulse checks could be challenges. Our objective was to evaluate the potential use of POCUS for pulse determination by paramedics using carotid artery and subxiphoid cardiac views. We hypothesized that carotid POCUS views may be obtained more quickly and successfully in the prehospital setting than the traditional subxiphoid cardiac view.Methods:This was a retrospective analysis of carotid and subxiphoid POCUS use for pulse determination at a high-volume, ground-based EMS agency. Adult patients suffering from medical OHCA with POCUS attempted were included. Those under 18 years of age, protocol deviations, missing data, or uninterpretable data were excluded. Video was recorded throughout each CPR pause in which ultrasounds were conducted. EMS clinicians alternated carotid and subxiphoid views. Pause length and view adequacy were evaluated by two expert paramedic reviewers. Disagreements were adjudicated by an EMS physician. Statistical analysis: McNemar’s test was used to evaluate for differences between adequate view and compression pauses < 10 seconds between carotid and subxiphoid approaches. Generalized estimating equations were used to evaluate the association of adequate view and compression pauses < 10 seconds to POCUS approaches.Results:A total of 196 POCUS recordings from 94 patients were analyzed. Videos were evaluated by rates for adequate views with k=0.83 with 92% agreement. Overall, 73% (n=143) had a pause length < 10 seconds, and 62% (n=121) had an adequate view. Adequate views and compression pauses < 10 seconds were achieved more frequently using carotid POCUS (Figure). Adjusting for body mass index, carotid views had increased odds (AOR 9.3, 95% CI: 4.3-20.4) of combined adequate view and compression pause < 10 seconds as compared to subxiphoid imaging.Conclusion:Paramedic-obtained carotid POCUS demonstrated improved view adequacy and fewer extended CPR pauses. Limitations include the high level of POCUS training for paramedics and the single agency data source, making generalizability difficult to determine.

Circulation, Volume 150, Issue Suppl_1, Page A4142090-A4142090, November 12, 2024. Background:The persistently patent arterial duct accounts for ~12% of congenital heart lesions. Untreated, it may result in heart failure due to volume loading of the left heart, pulmonary hypertension, and infective endarteritis. Percutaneous device closure is the preferred occlusion technique, with the standard approach consisting of femoral artery access for angiography and venous access for device delivery (AA). A venous-only strategy (VA) for angiography and device delivery can also be employed.Hypothesis:We hypothesized that VA would eliminate arterial complications, and reduce procedure times and radiation exposure compared to standard AA.Methods:This retrospective cohort study reviewed isolated arterial duct device closures at the Hospital for Sick Children from January 1, 2011 through December 31, 2022. Exclusions included premature neonates, children requiring arterial access for monitoring and those who underwent other procedures. Children were categorized based upon initial access determined by operator preference, into VA or AA groups.Results:The cohort consisted of 405 children, 252 (62.2%) females, with a median age of 3.1 years (IQR1.30–5.84), median weight 13.2kg (IQR 9.0–19.5), and duct diameter of 2.9mm (IQR 2.0–3.5) with no significant differences between the groups. Type A ducts were more frequent in the AA group (90% vs. 72%). The VA group included 106 children, of which 14 (13.2%) required AA conversion for angiography due to complex anatomy, to assess device positon prior to release, but remained in the VA group for analysis.Children in the VA group had lower dose area product (DAP) (p

Circulation, Volume 150, Issue Suppl_1, Page A4146563-A4146563, November 12, 2024. Background:Secondary atrial fibrillation (AF) is triggered by acute illness and associated with adverse outcomes. Timely follow-up is recommended by the American Heart Association statement on acute AF.Hypotheses:Patients with secondary AF receive less follow-up and cardiac testing than those primarily hospitalized for AF (primary AF).Follow-up is lower for secondary AF patients hospitalized for noncardiac diagnoses.Methods:Population-based cohort study using linked administrative datasets of patients aged ≥66 yrs discharged alive after a new diagnosis of AF while hospitalized in Ontario between Apr 2013 – Mar 2019. Patients were classified as secondary or primary AF using a validated approach based on discharge diagnosis type and followed for 1yr. Outcomes included physician visits (family physicians [FP], internists, cardiologists), and cardiac testing (electrocardiograms [ECG], echocardiograms, ambulatory ECG monitoring). The cumulative incidence function was used to quantify the incidence of outcomes. Cause-specific hazards regression was used to estimate hazard ratios (HR) associated with hospitalization type in secondary AF patients. Regression analyses accounted for competing risks.Results:We studied 13,011 secondary AF (35.2% cardiac surgery, 9.6% cardiac medical, 17% noncardiac surgery, 38.1% noncardiac medical) and 11,065 primary AF patients. Secondary AF was associated with lower age, male sex, less heart failure, and greater prevalence of other comorbidities. Less than 50% of secondary AF patients had visits to internists, cardiologists, echocardiograms or ambulatory ECG monitoring (see Figure). The incidence of all outcomes was significantly lower for secondary than primary AF. Among secondary AF patients, specialist follow-up and cardiac testing rates were lowest after noncardiac diagnoses (see Table).Conclusion:Patients with secondary AF have less specialist follow-up and cardiac testing than primary AF, especially if hospitalized for noncardiac diagnoses.

Circulation, Volume 150, Issue Suppl_1, Page A4139940-A4139940, November 12, 2024. Background:There are two approved methods for transcatheter aortic valve replacement (TAVR) namely balloon-expandable valves (BEV) and self-expanding valves (SEV). While several randomized controlled trials (RCTs) have compared the efficacy of SEV and BEV, the generalizability of their findings is questioned. Therefore, to generate concrete evidence regarding the superiority between the two, we conducted this real-world meta-analysis to compare the clinical efficacy and safety outcomes of SEV vs BEV in patients undergoing TAVR for aortic stenosis (AS).Methods:MEDLINE, EMBASE, and Scopus were queried to shortlist studies including AS patients undergoing TAVR. Primary outcomes included 30-day and 1-year all-cause and cardiac mortality. Secondary outcomes were permanent pacemaker implantation (PPI), paravalvular leak (PVL), aortic regurgitation (AR), stroke, major vascular complications (MVC), major bleeding (MB), acute kidney injury (AKI), myocardial infarction (MI), length of stay (LOS), patient prosthesis mismatch (PPM), and atrial fibrillation (AF). A random effects meta-analysis was conducted to derive risk ratios and mean differences with corresponding 95% confidence intervals (CI).Results:Our meta-analysis included 38 real-world studies. No significant association was seen in 30-day (RR=1.13, P=0.15) and 1-year all-cause mortality (RR=1.04, P=0.55), and cardiac mortality (RR=1.28, P=0.12). SEV was associated with a higher risk of 30-day PPI (RR=1.61, 95% CI 1.28-2.02, I2 = 88%, P

Circulation, Volume 150, Issue Suppl_1, Page A4147894-A4147894, November 12, 2024. Background:Patients undergoing epicardial access for ventricular tachycardia (VT) have a higher rate of complications and VT recurrence post-procedure. Data regarding electrophysiological factors driving the outcomes are scant.Objective:To compare the factors and outcomes associated with epicardial vs endocardial VT ablation.Methods:A single-center, retrospective study of patients undergoing catheter ablation for scar-related VT was conducted. Data collected included demographics, comorbidities, medications, relevant laboratory abnormalities, electrocardiograms, echocardiograms, detailed procedural characteristics, and outcomes.Results:Our cohort of 554 patients had 89 (16.1%) epicardial and 465 (83.9%) endocardial VT ablations. Patients undergoing epicardial ablation had a greater frequency of NICM, and more patients had undergone sympathetic modulation for VT (p < 0.05) but had lesser frequency of valve surgery, and CABG. Epicardial ablation was associated with greater use of both short-term (6 months) anti-arrhythmic drugs (AAD) (p