Ronpichai Chokesuwattanaskul

Background: Atrial fibrillation (AF) is prevalent in cardiac amyloidosis (CA) and is associated with adverse clinical outcomes. Catheter ablation is increasingly used for rhythm control in this population, yet its clinical outcomes remain uncertain. We performed a systematic review and meta‐analysis to evaluate arrhythmia recurrence and clinical outcomes following catheter ablation compared with medical therapy in patients with CA. Methods: We systematically searched MEDLINE, Embase, and Scopus from inception through December 2025 for studies evaluating catheter ablation of atrial arrhythmias in CA. Cohort studies reporting arrhythmia recurrence and/or clinical outcomes were included. The primary outcome was freedom from atrial arrhythmia (AA) following ablation. Secondary outcomes included all‐cause mortality, heart failure hospitalization, and stroke. Random‐effects models were used to pool event rates and odds ratios (ORs). Results: Thirteen observational studies comprising 797 patients with CA and AF were included. The pooled rate of freedom from AA following catheter ablation was approximately 50% (95% CI 37%–63%; I ² = 71.7%). The all‐cause mortality analysis included 4 observational studies comprising 616 patients. Catheter ablation was associated with lower odds of all‐cause mortality (OR 0.26, 95% CI 0.11–0.60; I ² = 18.4%); however, this association should be interpreted with caution given the retrospective design and risk of bias. No statistically significant differences were observed for heart failure hospitalization or stroke. Conclusions: In patients with CA, catheter ablation was associated with modest arrhythmia‐free survival and lower odds of all‐cause mortality. However, all contributing studies were observational cohorts. Randomized studies are needed to confirm these findings.

Background: Right ventricular apical (RVA) pacing often leads to interventricular dyssynchrony and pacing-induced cardiomyopathy. Conduction system pacing (CSP), particularly Left Bundle Branch Area Pacing, provides a physiologic alternative. In Limited Resource Countries (LRCs) like Thailand, Cardiac Resynchronization Therapy (CRT) under-penetration persists due to high costs and a shortage of operators skilled in coronary venous anatomy. Objective: To share the experience and provide clinical update of CSP as a sustainable, cost-effective physiological pacing strategy to improve access to advanced arrhythmia management in resource-constrained environments. Methods: This review explores the implementation of minimalist protocols and CSP-based CRT. Scalability strategies include specialized training programs, device reprocessing, and the establishment of regional longitudinal registries to bridge infrastructure gaps. Results: CSP-based CRT can reduce device costs by nearly 50% compared with traditional triple-lead systems. This modality effectively mitigates the hemodynamic risks of RVA pacing while bypassing the technical and financial barriers of conventional CRT. Discussion: Despite its advantages, CSP adoption requires overcoming infrastructure challenges, specifically the lack of automated remote monitoring. Optimizing clinical outcomes in LRCs necessitates standardized training, robust data collection, and innovative resource management to ensure equitable access to life-saving technology.

Background: The implantable cardioverter‐defibrillator (ICD) is an intervention for patients with cardiac abnormalities, serving as both a primary and secondary prevention of sudden cardiac death. However, reduced quality of life and adverse psychological effects have been reported. This qualitative study aims to gain further insights into the perspectives and psychological impacts of living with an ICD. Findings and Conclusion: A comprehensive interview was conducted with 15 participants who were selected from a follow‐up clinic. The interviews were subjected to qualitative descriptive analysis, and verbatim transcripts were coded and analyzed using a thematic analysis approach. Through this process, five main themes emerged from the data: (i) Shock experiences and concerns regarding receiving shock, (ii) lack of concern about receiving shock, (iii) changes in health and quality of life after implantation, (iv) expectations from implantation, and (v) follow‐up program as a concern reliever. Overall, this qualitative study provided valuable insights into the experiences, perspectives, and psychological effects of living with an ICD. Remarkably, the majority of participants demonstrate a lack of concern about getting shocked from an ICD. The investigation revealed additional concerns associated with the device, highlighting that these concerns can vary among individuals. Additionally, the follow‐up program for individuals with ICDs should prioritize enhancing quality of life and supporting mental well‐being, rather than focusing solely on the function of the device. General questions to screen for anxiety and depression triggered by device implantation should be conducted in every setting.

Background Evening exercise may elevate arousal levels and enhance insulin sensitivity, potentially influencing sleep hygiene and metabolic profiles. To gain a clearer understanding of these effects, we conducted a meta-analysis to compare the impact of morning versus evening exercise on anthropometric indices, metabolic markers, and sleep health. Methods A systematic search of the MEDLINE, EMBASE, and Cochrane databases was conducted from inception through March 2023. Exercise is defined as physical activity performed at a minimum of moderate intensity. For the outcomes of interest, mean differences (MD) and 95% confidence interval (CI) were calculated using a random-effects model. Results A total of 716 participants were included across 14 studies, comprising both randomized controlled trials and observational studies. Of these, 11 studies reported anthropometric indices, 8 reported metabolic profiles, and 5 evaluated sleep parameters. No significant associations were observed between exercise timing and the health outcomes assessed. Specifically, there were no notable differences in body weight (MD:-0.12 kg [95% CI -0.99 to 0.76, I²= 99%]) or body mass index (MD: -0.07 kg/m² [95% CI -0.58 to 0.44, I² = 99%]) between morning and evening exercise sessions. Sleep latency was also unaffected by exercise timing (MD: -2.24 minutes [95% CI-10.22 to 5.74, I² = 99%]). Additionally, metabolic biomarkers, including low-density lipoprotein (MD: 0.11 mmol/L [95% CI -0.37 to 0.58, I²= 100%]), and high-density lipoprotein (MD: 0.09 mmol/L [95% CI -0.05 to 0.22, I² = 99%]), showed no significant differences based on exercise timing. Conclusion This meta-analysis found no significant association between the timing of exercise and health outcomes, including anthropometric measurements, metabolic markers, and sleep parameters. While the findings are hypothesis-generating, they suggest that the timing of exercise may not substantially influence patient health outcomes and should be considered flexibly in clinical recommendations.

Background: Pulmonary vein isolation (PVI) is the mainstay treatment for rhythm control in patients with persistent atrial fibrillation (PsAF). However, due to the complex mechanisms of PsAF, the efficacy of PVI alone remains modest. Spatiotemporal electrogram dispersion (STED) ablation is a promising strategy to enhance outcomes. This study aims to evaluate the efficacy of STED ablation plus PVI versus PVI alone in PsAF ablation. Methods: A systematic search was conducted to identify studies published up to November 2024 comparing PVI plus STED ablation (PVI‐STED group) versus PVI alone (PVI group) in patients with PsAF. The primary outcomes were AF recurrence and sinus rhythm (SR) conversion. Results: Eleven studies (three randomized controlled trials, three prospective cohorts, five retrospective cohorts) involving 1607 patients (mean age of 63.9 ± 9.3 years) were included. The PVI‐STED group was significantly associated with a lower risk of AF recurrence (OR: 0.40, 95% CI: 0.27–0.59, I ² = 25%) and a higher likelihood of SR conversion (OR: 7.04, 95% CI: 1.62–30.62, I ² = 79%). No significant differences were observed in procedural time (MD: 27.61 min, 95% CI: −29.12 to 84.33, I ² = 97%), ablation time (MD: 4.4 min, 95% CI: −11.3 to 20.0, I ² = 98%), or fluoroscopy time (0.25 min, 95% CI: −3.4 to 3.9, I ² = 95%). The overall rate of AEs in the PVI‐STED group was 1% (95% CI: 1%–3%, I ² = 0%). Conclusion: The PVI‐STED approach demonstrated both efficacy and safety in treating PsAF, as evidenced by reduced AF recurrence and improved SR conversion rates.

Background Pulsed field ablation (PFA) and high-power short-duration radiofrequency ablation (HPSD) are emerging techniques for treating atrial fibrillation (AF), offering promising results compared to cryoballoon ablation (CBA). This network meta-analysis aims to evaluates the efficacy and safety of PFA, HPSD, and CBA. Method PubMed, Scopus and Cochrane Central Register of Controlled Trials were systematically searched for relevant studies until October 2024. The primary outcome is freedom from atrial arrhythmia. A random-effects model was used for data synthesis, and P-scores were employed for outcome ranking. Point estimation (odd ratios) was calculated for comparisons. Results Eighteen studies were included in our network meta-analysis, involving 7,071 atrial fibrillation patients. Among them, 2,023 (29%), 3,725 (53%), and 1,323 (18%) patients underwent PFA, CBA, and HPSD, respectively. PFA demonstrated a higher freedom from atrial arrhythmia, with an odds ratio (OR) of 3.63 (95% CI: 2.95–4.46) compared to CBA and 1.89 (95% CI: 1.47–2.43) compared to HPSD. However, PFA was associated with a higher risk of complications (OR = 6.54, 95% CI: 2.13–20.00) compared to CBA, while HPSD showed an insignificant association with a lower risk of complications compared to CBA (OR = 0.61, 95% CI: 0.15–2.42). PFA had the shortest procedural time (P-score: 100%), while HPSD had the longest (P-score: 0%). In contrast, HPSD had the shortest fluoroscopic time, with P-scores of 100%, 46%, and 3% for HPSD, PFA, and CBA, respectively. Conclusion PFA demonstrated higher efficacy but also a higher risk of complications compared to HPSD and CBA. HPSD showed greater efficacy with comparable safety to CBA. Graphical abstract

Unveiling Rarity: Giant Septal Coronary Vein Dissection, an Unforeseen Twist in Complications of Left Bundle Branch Area Pacing