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Background and Objectives: Systemic inflammation and nutritional impairment may influence outcomes after permanent pacemaker implantation, but the prognostic value of composite indices in degenerative complete atrioventricular block remains unclear. We evaluated the associations of routinely available inflammatory and nutritional indices with long-term all-cause mortality in this population. Materials and Methods: This retrospective, single-center study included 272 patients who underwent permanent pacemaker implantation for isolated complete atrioventricular block attributed to degenerative conduction system disease between August 2020 and July 2024. Baseline laboratory values were used to calculate the prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and pan-immune-inflammation value. The primary endpoint was all-cause mortality during follow-up. Discriminatory performance was assessed using receiver operating characteristic (ROC) analysis, and independent associations were evaluated using multivariable Cox regression. Results: During a mean follow-up of 27.8 ± 16.6 months, 69 patients (25.4%) died. Compared with survivors, non-survivors were older and had lower hemoglobin, lymphocyte count, albumin, estimated glomerular filtration rate, GNRI, LMR, and PNI values, whereas C-reactive protein, NLR, and SIRI values were higher. PNI had the numerically highest AUC for mortality prediction (AUC: 0.720, 95% CI: 0.648–0.793; p < 0.001), corresponding to moderate discriminatory performance, whereas GNRI showed fair discrimination (AUC: 0.677, 95% CI: 0.589–0.766; p < 0.001). In multivariable Cox regression, PNI remained independently associated with mortality (HR: 0.945, 95% CI: 0.909–0.982; p = 0.004). Conclusions: Among the evaluated inflammatory and nutritional indices, PNI demonstrated the numerically highest discriminatory performance and remained independently associated with long-term all-cause mortality. PNI may therefore serve as a readily available adjunct to clinical risk stratification in patients undergoing permanent pacemaker implantation for degenerative complete atrioventricular block; however, external validation is required.

Background: Arrhythmia recurrence after cryoballoon ablation remains a clinically relevant problem in atrial fibrillation (AF). However, factors associated with documented recurrence in low-risk patients without major comorbidities are not well defined. This study aimed to evaluate factors associated with documented arrhythmia recurrence after cryoballoon ablation in a highly selected low-risk AF population. Methods: This retrospective, single-center study included 153 eligible patients selected from an institutional cryoablation database after application of predefined exclusion criteria. Only patients with a CHA₂DS₂-VA (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischemic attack/thromboembolism, vascular disease, and age 65–74 years) score ≤ 1 and without major comorbidities, including diabetes mellitus, hypertension, coronary artery disease, chronic kidney disease, cerebrovascular disease, and heart failure, were included. Recurrence was defined as electrocardiographically documented AF or atrial tachyarrhythmia after the 3-month blanking period over 1 year of follow-up; Holter-detected episodes were required to last ≥30 s. The primary multivariable model included sex, age, AF type, and absolute left atrial diameter; a sensitivity model replaced absolute left atrial diameter with left atrial diameter indexed to body surface area (BSA). Results: The study population included 70 women (45.8%) and 83 men (54.2%). Paroxysmal AF was present in 125 patients (81.7%), whereas 28 patients (18.3%) had persistent AF. Documented arrhythmia recurrence occurred in 40 patients (26.1%). Female sex was more frequent in the recurrence group than in the no-recurrence group (62.5% vs. 39.8%, p = 0.013). The complete-case primary multivariable model included 126 patients with 36 recurrence events. Female sex was associated with documented arrhythmia recurrence (odds ratio [OR] 2.69, 95% confidence interval [CI] 1.14–6.37; p = 0.024). The estimate for left atrial diameter was directionally positive but statistically uncertain (OR 1.086 per mm, 95% CI 0.989–1.192; p = 0.085). In the BSA-indexed sensitivity model (n = 123), the female-sex estimate was attenuated and statistically uncertain (OR 2.16, 95% CI 0.90–5.18; p = 0.084), while left atrial diameter/BSA was also statistically uncertain (OR 1.145 per mm/m², 95% CI 0.977–1.343; p = 0.095). Conclusions: In this selected low-risk cohort undergoing second-generation cryoballoon ablation, female sex was associated with clinically detected, electrocardiographically documented arrhythmia recurrence in the primary model under an intermittent rhythm-surveillance strategy based on scheduled 12-lead electrocardiograms (ECGs) and symptom-driven evaluations. However, the estimate was attenuated and statistically uncertain after indexing left atrial diameter to BSA. Given the retrospective, single-center design, non-systematic rhythm monitoring, and sensitivity of the sex estimate to body-size adjustment, these findings should be interpreted as hypothesis-generating.

Background: Arrhythmia recurrence after cryoballoon ablation remains a clinically relevant problem in atrial fibrillation (AF). However, factors associated with documented recurrence in low-risk patients without major comorbidities are not well defined. This study aimed to evaluate factors associated with documented arrhythmia recurrence after cryoballoon ablation in a highly selected low-risk AF population. Methods: This retrospective study included 153 eligible patients selected from an institutional cryoablation database after application of predefined exclusion criteria. Only patients with a CHA₂DS₂-VA score ≤1 and without major comorbidities, including diabetes mellitus, hypertension, coronary artery disease, chronic kidney disease, cerebrovascular disease, and heart failure, were included. Recurrence was defined as electrocardiographically documented AF or atrial tachyarrhythmia lasting ≥30 seconds after the 3-month blanking period during 1-year follow-up. Results: The study population included 70 women (45.8%) and 83 men (54.2%). Paroxysmal AF was present in 125 patients (81.7%), whereas 28 patients (18.3%) had persistent AF. Documented arrhythmia recurrence occurred in 40 patients (26.1%). Female sex was more frequent in the recurrence group than in the no-recurrence group (62.5% vs. 39.8%, p = 0.013). In the primary multivariable logistic regression model including sex, age, AF type, and left atrial diameter, female sex was associated with documented arrhythmia recurrence (OR 2.69, 95% CI 1.14–6.37; p = 0.024). Left atrial diameter showed a borderline association, and persistent AF showed numerically higher odds of recurrence; however, these variables did not reach conventional statistical significance in the primary model. Conclusion: In this selected low-risk cohort undergoing second-generation cryoballoon ablation, female sex was associated with documented arrhythmia recurrence during 1-year follow-up. This finding should be interpreted as hypothesis-generating and requires confirmation in larger prospective studies using standardized rhythm monitoring.

Background and Objectives: Inflammatory and nutritional impairment may contribute to adverse outcomes after permanent pacemaker implantation, but their prognostic value in degenerative complete atrioventricular block remains unclear. We evaluated the association between routinely available inflammatory and nutritional indices and long-term all-cause mortality in this population. Materials and Methods: This retrospective single-center study included 272 patients who underwent permanent pacemaker implantation for isolated complete atrioventricular block attributed to degenerative conduction system disease between August 2020 and July 2024. Baseline laboratory values were used to calculate the prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and pan-immune-inflammation value. The primary endpoint was all-cause mortality during follow-up. Discriminatory performance was assessed by ROC analysis, and independent predictors were evaluated using multivariable Cox regression. Results: During a mean follow-up of 27.8 ± 16.6 months, 69 patients (25.4%) died. Non-survivors were older and had lower hemoglobin, lymphocyte count, albumin, estimated glomerular filtration rate, GNRI, LMR, and PNI, whereas C-reactive protein, NLR, and SIRI were higher. PNI showed the highest discriminative ability for mortality prediction (AUC 0.720, 95% CI 0.648-0.793; p< 0.001), exceeding albumin, lymphocyte count, GNRI, and other inflammatory indices. In multivariable Cox regression, PNI remained independently associated with mortality (HR 0.945, 95% CI 0.909-0.983; p=0.004). Single-chamber pacemaker implantation was also associated with all-cause mortality (HR 2.137, 95% CI 1.202-3.802; p=0.010), although this should be interpreted in the context of baseline vulnerability and device-selection patterns. Conclusions: PNI may provide useful prognostic information for mortality risk stratification in patients undergoing permanent pacemaker implantation for degenerative complete atrioventricular block.

Introduction: Coronary artery ectasia (CAE) refers to a 1.5 fold increase in coronary artery diameter compared to the normal segment. Although the underlying pathophysiological mechanism is not fully elucidated, coronary atherosclerosis is thought to play a role in more than half of the cases. Triglyceride glucose (TyG) index is an indicator of insulin resistance. In the present study, aimed to evaluated TyG index values in CAE cases and find if a predictive value of TyG index existed. Patients and Methods: Sixty-one patients with CAE (study group) and 64 patients with normal coronary arteries (control group) were included in the study. TyG index was calculated as ln (fasting triglyceride × fasting glucose/2). Results: There were no differences between the two groups with respect to age, sex, diabetes mellitus prevalence, and biochemical parameters including, white blood cell, platelet, lymphocyte, monocyte counts, hemoglobin, hematocrit, urea, glucose, total cholesterol, high density lipoprotein-cholesterol, triglyceride levels and TyG index value. Twenty-five patients (41.0%) had one-vessel involvement, 24 (39.3%) patients had twovessel involvement and 12 (19.7%) patients had three-vessel involvement. Right coronary artery was the most commonly affected vessel (11, 44%), followed by left anterior descending artery (8, 35%), left main coronary artery (4, 16%) and circumflex artery (1, 4%). TyG index was statistically significantly higher in patients who had two/three vessel involvement (8.80 ± 0.48 vs 9.14 ± 0.62, p= 0.027). TyG index had statistically significant correlation with the number of ectatic vessels (r= 0.275, p= 0.032). ROC curve analysis showed that TyG index was useful for the prediction of ectasia severity (AUC= 0.653, 95% CI= 0.515-0.792, p= 0.043). TyG index value of 9.16 had 41.7% sensitivity and 84% specificity for prediction of CAE severity. Conclusion: TyG index, which is easily calculated from biochemical parameters, might be used for the assessment of CAE severity.

In this study, we aimed to compare the management and clinical outcomes of patients with acute coronary syndrome (ACS) before and during pandemic. A total of 239 patients with ACS were enrolled into the study. Patients who were admitted during pandemic were compared with pre-pandemic patients according to their demographic, biochemical, angiographic features, revascularisation strategies and clinical outcomes. During the pandemic period, we observed an increase in total number of patient with ST elevation myocardial infarction patients compared to the pre-pandemic period. Initial high sensitive troponin and CK-MB levels were statistically higher in the pandemic group patients (1953 pg/ml versus 259 pg/ml for troponin I and 14 ng/ml versus 6 ng/ml for CK-MB p < 0.0001, p = 0.02, respectively). Type 4a myocardial infarction due to stent thrombosis was more frequent in pandemic group relative to the pre-pandemic group (10 versus 0, p = 0.003). Post-procedural TIMI flow grade was lower in the pandemic group and distal embolisation and TIMI thrombus score were significantly higher in the pandemic group compared to the pre-pandemic group (p = 0.001, p = 0.02, and p = 0.002, respectively). The number of patients who underwent bypass surgery was much lower compared to pre-pandemic period (27 versus 8, p < 0.0001). There was no statistically significant difference in hospital mortality and short-term all-cause mortality among groups (p > 0.05). Although clinical, laboratory, and angiographic features were worse in ACS patients during pandemic, the mortality rate of ACS was similar in both pre-pandemic and pandemic era. It is important to keep coronary intensive care units and catheter labs open and fully-functioning during the pandemic.