Jia-Feng Lin

BackgroundFor patients with rheumatic mitral stenosis (MS) undergoing percutaneous balloon mitral commissurotomy (PBMC) complicated with atrial fibrillation (AF), the clinical outcomes of radiofrequency catheter ablation (RFCA) remain unclear. This study aimed to investigate RFCA for AF in MS patients undergoing PBMC.MethodsWe retrospectively identified 3,895 patients who underwent AF ablation, including 50 MS patients who received PBMC simultaneously (combined group) and 3,845 general AF patients (control group). Propensity score matching was performed to balance baseline characteristics.ResultsAfter matching covariates, 43 well-balanced patient pairs were included. At 1 year, the rate of freedom from AF/AT was significantly higher in the combined group (79.1% vs. 51.2%; P = 0.0076). There were no significant differences in the incidence of major adverse cardiovascular and cerebrovascular events within 1 year (7.0% vs. 4.7%; P = 1.000) and the severity of mitral regurgitation. Both groups of patients free from AF/AT had significant postoperative reductions in left atrial size, with a more pronounced reduction observed in the control group. A subgroup analysis of 16 pairs of patients undergoing intraoperative left atrial voltage mapping revealed that with comparable left atrial volume index, the low-voltage area burden was significantly lower in the combined group.Conclusion sOur study, featuring the largest sample size of patients with MS undergoing PBMC combined with RFCA, is the first to reveal that RFCA for AF in this specific patient group demonstrates superior efficacy compared with general patients.

Background: Cardiometabolic multimorbidity (CMM) is increasingly common in older adults and is closely linked to insulin resistance (IR). However, whether IR surrogates perform similarly across heterogeneous obesity phenotypes remains unclear. Using the English Longitudinal Study of Ageing (ELSA), we examined the phenotype-specific associations of the triglyceride–glucose (TyG) index and the estimated glucose disposal rate (eGDR) with incident CMM and compared their predictive utility. Methods: We included 4,198 participants from the ELSA in our analysis. Cox proportional hazards models and restricted cubic splines were used to evaluate the association between IR markers (the TyG index and eGDR) and the risk of CMM, as well as to assess potential nonlinearity. We then quantified the IR–related disease burden across obesity phenotypes using the population attributable fraction (PAF) and compared the predictive importance of variables across obesity subgroups using Shapley additive explanations (SHAP) values derived from machine learning models. Results: Over a median follow-up of 6.8 years, there were 547 incident CMM events. The association between IR and CMM was strongest in the predominantly isolated central obesity group, surpassing those observed in the no obesity-risk and dual obesity-risk groups. In this subgroup, each 1-standard deviation (SD) increase in the TyG index was linked to a 60.8% higher risk of incident CMM, whereas each 1-SD increase in eGDR was linked to a 60.1% lower risk. Restricted cubic spline analyses revealed monotonic, linear associations for both TyG and eGDR across all three obesity phenotype groups. PAF analyses further showed that the predominantly isolated central obesity group had the highest attributable burden for both TyG and eGDR (37 and 65%, respectively). In internal validation, the machine learning models demonstrated promising discriminative ability, with areas under the curve of 0.827, 0.945, and 0.881. SHAP analyses identified eGDR and TyG as the leading contributors to model predictions. Conclusion: IR surrogates were associated with incident CMM and showed potential utility for CMM risk prediction, with the strongest gradients and greatest population impact observed in the predominantly isolated central obesity phenotype. eGDR may be particularly useful for phenotype-tailored CMM risk stratification.

Markers of insulin resistance, such as the triglyceride-glucose (TyG) index and estimated glucose disposal rate (eGDR), have been extensively linked to car

Introduction: The anterior interventricular vein (AIV) is an important and recognized source of ventricular arrhythmias (VAs) within the coronary venous system. However, no studies have specifically investigated the electrocardiographic (ECG) characteristics and ablation strategies for VAs originating from the AIV.Objective: This study aimed to investigate the ECG characteristics and optimal ablation strategies for VAs originating from the AIV.Methods: This study comprised 51 patients with VAs originating from AIV.Results: The 51 patients were divided into proximal (40 cases) and non‐proximal groups (11 cases) based on their target sites in AIV. Successful ablation was achieved in 82.5% (33/40) patients in the p‐AIV group and 72.7% (8/11) patients in the np‐AIV group. By ECG analysis, we found a deeper S‐wave in lead I and a lower R‐wave in lead V1 and V2, indicating a more distal origin in AIV. R_I/S_I < 0.10, R_V2 < 0.325 mV, and R_V2/S_V2 < 0.20 were excellent differential indices for predicting VAs originating from the np‐AIV, with the predictive value of 91.3%, 95.1%, and 95.8%, respectively. Ablation modalities, including conventional radiofrequency catheter ablation (RFCA) and guidewire ablation, have been applied in AIV VAs. Among successful cases, 87.8% of VAs were ablated by conventional RFCA and 12.2% by guidewire ablation. In the situation of an acute angle between the AIV and distal great cardiac vein (DGCV) or a thin AIV lumen, guidewire ablation should be prioritized over RFCA.Conclusion: There were significant differences in the ECG characteristics of VAs at different portions of AIV. Guidewire ablation could be considered an alternative approach for treating AIV‐originated VAs inaccessible to conventional ablation catheters.

To investigate the characteristics of bipolar intracardiac electrograms (bi-EGMs) in target sites of ventricular arrhythmias (VAs) originating from the distal great vein system (DGCVs). 169 patients undergoing first-time ablation for VAs originated from DGCVs were enrolled in present study. Successful ablation was achieved in 146 patients. Bi-EGMs on successful sites were recorded and analyzed. In the 146 cases, the DGCVs was subdivided into DGCV (100 cases), AIV (28cases), and summit-CV (18 cases) subgroup based on anatomic location of final target site. An A and V wave were consistently recorded in Bi-EGM of target sites. A total of 59 cases showed A/V ≥ 1 while 87 patients were < 1. The incidence of A/V ≥ 1 recorded in target sites was higher in the DGCV subgroup (52%, 52/100) compared to the AIV (10.71%, 3/28) and summit-CV (22.22%, 4/18) subgroups (all p < 0.05). In A/V > 1 cases, pacing-induced ventricle capture, atrium capture or alternate atrium and ventricle capture, and no chamber capture were 83.05%(49/59), 6.78%(4/59),10.19%(6/59), respectively, and they were 90.80%(79/87), 1.15%(1/87), 8.05%(7/87) (p > 0.05) in 87 cases of A/V < 1. A presystolic multicomponent fractionated potential was frequently observed in target sites of DGCVs VAs(102/146, 69.86%), with the DGCV subgroup being more frequent than the AIV and summit-CV subgroups (74/100, 74% vs. 19/28, 67.86% vs. 9/18, 50%). Catheter ablation of VAs arising from DGCV system is challenging. Different from traditional concept of atrioventricular annulus VAs, whose AV ratio of target sites should be less than 1, A/V ≥ 1 could be observed in VAs arising from DGCVs. In this region, target site identification should not be restrained by AV ratio. In addition, the presence of specific potentials in Bi-EGMs, can serve as an indicator for identifying target sites. Not applicable.

Background: Ischemic cardiomyopathy (ICM) is the end stage of ischemic heart disease, in which ventricular remodeling contributes to a fatal ventricular arrhythmia, worsens heart function and unfavorable outcomes, and is related to persistent chronic inflammation. Low‐intensity pulsed ultrasound (LIPUS) is an effective treatment modality for osteoarthropathy and has been illustrated to regulate the overactive inflammatory response in various diseases. Here, we aim to investigate whether LIPUS can perform cardiac protective effects in ICM and explore its possible mechanism. Methods: The left anterior descending artery of adult male Sprague–Dawley rats was ligated for 4 weeks to develop ICM and then treated with LIPUS. Vagotomy was applied to suppress the cholinergic anti‐inflammatory pathway. Cardiac‐specific Cav‐1 (caveolin‐1) overexpression in ICM on arrhythmias, excitation‐contraction coupling, and cardiac remodeling was investigated using the intramyocardial injection of an adeno‐associated virus serotype 9 system. Results: The results showed that LIPUS alleviated ventricular remodeling, improved cardiac electrophysiological function, and reduced the cardiac expression of collagens and inflammatory cytokines. Vagotomy suppressed the improvement of LIPUS. The overexpression of Cav‐1 reset the influence of vagotomy. Conclusions: We found that LIPUS had a direct effect on regional anti‐inflammation and antifibrosis, improved cardiac autonomic function and heart failure, protected the Cx43 (connexin‐43) protein, and reduced the risk of malignant arrhythmia during ICM. The cholinergic anti‐inflammatory pathway was one of the potential critical mechanisms involved, and Cav‐1 might play an important role downstream. Our study provided a new, promising, and noninvasive strategy for treating ICM.