Selcuk Adabag

Background: The available risk prediction models are inadequate to identify a true low‐risk patient for developing new‐onset atrial fibrillation (AF) after typical atrial flutter (AFL) ablation. We aimed to determine whether adding markers of atrial myopathy to HATCH score ( h ypertension, a ge ≥75 years, t ransient ischemic attack/stroke, c hronic obstructive pulmonary disease, and h eart failure) can improve prediction of new‐onset AF after ablation of typical AFL. Methods: The study included 208 consecutive patients who underwent successful ablation of typical AFL at Minneapolis VA Medical Center and University of Minnesota Medical Center. Patients with history of AF prior to ablation were excluded. Results: Among the 208 patients, 76 (36.5%) developed new‐onset AF post AFL ablation. Mean follow‐up duration was 62 ± 31.8 months. HATCH score was not associated with new‐onset AF. When adding atrial myopathy (presence of at least one of the following: PTFV ₁ > 5000 µV*ms, interatrial block determined by biphasic inferior p wave with duration >120 ms, left atrium (LA) diameter ≥44 mm, or LA index ≥3 cm/m ² ) to HATCH score (HATCH‐A ₂ ), the combination was independently associated with new‐onset AF. The AF incidence between HATCH‐A ₂ score of 0–1 and ≥2 were 6.7% and 40.5%, respectively (Odds ratio 9.04, 95% confidence interval: 2.05–39.81, p = 0.004). Particularly, when HATCH‐A ₂ score was 0, none of the patients developed AF. Conclusions: Adding atrial myopathy to HATCH score improved predictability and could be used to delineate a true low‐risk patient of new‐onset AF after typical AFL ablation.

Background: Sudden cardiac death (SCD) is a significant global public health problem accounting for 15% to 20% of all deaths. A great majority of SCD is associated with coronary heart disease, which may first be detected at autopsy. The ankle–brachial index (ABI) is a simple, noninvasive measure of subclinical atherosclerosis. The purpose of this study was to examine the relationship between ABI and SCD in a middle‐aged biracial general population. Methods and Results: Participants of the ARIC (Atherosclerosis Risk in Communities) study with an ABI measurement between 1987 and 1989 were included. ABI was categorized as low (≤0.90), borderline (0.90–1.00), normal (1.00–1.40), and noncompressible (>1.40). SCD was defined as a sudden pulseless condition presumed to be caused by a ventricular tachyarrhythmia in a previously stable individual and was adjudicated by a committee of cardiac electrophysiologists, cardiologists, and internists. Cox proportional hazards models were used to evaluate the associations between baseline ABI and incident SCD. Of the 15 081 participants followed for a median of 23.5 years, 556 (3.7%) developed SCD (1.96 cases per 1000 person‐years). Low and borderline ABIs were associated with an increased risk of SCD (demographically adjusted hazard ratios [HRs], 2.27 [95% CI, 1.64–3.14] and 1.52 [95% CI, 1.17–1.96], respectively) compared with normal ABI. The association between low ABI and SCD remained significant after adjustment for traditional cardiovascular risk factors (HR, 1.63 [95% CI, 1.15–2.32]). Conclusions: Low ABI is independently associated with an increased risk of SCD in a middle‐aged biracial general population. ABI could be incorporated into future SCD risk prediction models.

Background: Balloon Tipped Temporary Pacemakers (BTTP) are the most used temporary pacemakers; however, they are associated with a risk of dislodgement and thromboembolism. Recently, Temporary Permanent Pacemakers (TPPM) have been increasingly used. Evidence of outcomes with TPPM compared to BTTP remains scarce.Methods: Retrospective, chart review study evaluating all patients who underwent temporary pacemaker placement between 2014 and 2022 (N = 126) in the cardiac catheterization laboratory (CCL) at a level 1 trauma center. Primary outcome of this study is to evaluate the safety profile of TPPM versus BTTP. Secondary objectives include patient ambulation and healthcare utilization in patients with temporary pacemakers.Results: Both groups had similar baseline characteristics distribution including gender, race, and age at temporary pacemaker insertion (p > .05). Subclavian vein was the most common site of access for the TPPM cohort (89.0%) versus the femoral vein in the BTTP group (65.1%). Ambulation was only possible in the TPPM group (55.6%, p < .001). Lead dislodgement, venous thromboembolism, local hematoma, and access site infections were less frequently encountered in the TPPM group (OR = 0.23 [95% CI (0.10-0.67), p < .001]). Within the subgroup of patients with TPPM, 36.6% of the patients were monitored outside the ICU setting. There was no significant difference in the pacemaker-related adverse events among patients with TPPM based on their in-hospital setting.Conclusion: TPPM is associated with a more favorable safety profile compared to BTTP. They are also associated with earlier patient ambulation and reduced healthcare utilization.

Background Balloon Tipped Temporary Pacemakers (BTTP) are the most used temporary pacemakers; however, they are associated with a risk of dislodgement and thromboembolism. Recently, Temporary Permanent Pacemakers (TPPM) have become increasingly used. Evidence of better outcomes with TPPM compared to BTTP is still scarce. Materials and methods Retrospective, chart review study evaluating all patients who underwent temporary pacemaker placement between 2014 and 2022 (N=126) in the cardiac catheterization laboratory (CCL) at a level 1 trauma center. Primary outcome of this study is to evaluate the safety profile of TPPM vs BTTP. Secondary objectives include patient ambulation and healthcare utilization in patients with temporary pacemakers. Results Both groups had similar baseline characteristics distribution including gender, race and age at temporary pacemaker insertion (p>0.05). Subclavian vein was the most common site of access for the TPPM cohort (89.0%) vs the femoral vein in the BTTP group (65.1%). Ambulation was only possible in the TPPM group (55.6%, pConclusion TPPM are associated with more favorable safety profile compared to BTTP. They are also associated with earlier patient ambulation and reduced healthcare utilization.

Background: Atrial fibrillation (AF) guidelines recommend amiodarone as the preferred antiarrhythmic medication (AAM) in patients with left ventricular hypertrophy (LVH), due to potential pro‐arrhythmic risk with other AAM. However, there are limited data to support this assertion.Methods: We retrospectively analyzed the records of 8204 patients who were prescribed AAM for AF and had transthoracic echocardiogram (TTE) at the multicenter, VA Midwest Health Care Network from 2000 to 2021. We excluded patients without LVH (septal or posterior wall dimension ≤1.4 cm). The primary outcome variable was all‐cause mortality during antiarrhythmic therapy or within 6 months after stopping it. Propensity‐stratified analyses were performed between amiodarone versus non‐amiodarone (Vaughan‐Williams Class I and III) AAM.Results: A total of 1277 patients with LVH (mean age 70.2 ± 9.5 years) were included in the analysis. Of these, 774 (60.6%) were prescribed amiodarone. Baseline characteristics of the two comparison groups were similar after propensity adjustment. After a median 1.40 years of follow‐up, 203 (15.9%) patients died. Incidence rates per 100 patient‐year follow‐up was 9.02 (7.58–10.66) for amiodarone and 4.98 (3.91–62.56) for non‐amiodarone. In propensity‐stratified analysis, amiodarone use was associated with 1.58 times higher risk of mortality (95% CI 1.03–2.44; p = .038). Sub‐group analysis in 336 (26.3%) patients with severe LVH showed no difference in mortality (HR 1.41, 95% CI 0.82–2.43, p = .21).Conclusion: Among patients with AF and LVH, amiodarone was associated with a significantly higher mortality risk than other AAM.